Telepharmacy Results in Better Care!

... when a local pharmacist is not available, of course.

Pharmacy Practice News published an article in its July 2010 issue called Does Telepharmacy Result in Better Care? (free login required, or use bugmenot). As evidence that it does, they offered up an article by Judy L. Rose, PharmD, U.S. Public Health Service captain and clinical pharmacy director for Alaska Native Medical Center. She reports that pharmacists consult with clinical patients via video teleconferencing equipment, and:

Approximately 40% of our telepharmacy interventions lead to clinical improvements in several medication management areas, including drug order clarification, dose/interval changes, drug duplication, drug therapy recommendations, start/stop medication or change in drugs. Additionally, 38.7% of the interventions led to safety improvements, including better monitoring for drug allergies, drug interactions, contraindications and improved weight-based dosing. (No pre-telepharmacy measurements were available for benchmarking, so our percentages reported reflect the absolute number of interventions divided by the number of prescriptions.)
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Our results are clear: Telepharmacy can help remote hospitals deliver high-quality pharmaceutical care, despite staffing and resource challenges.

Here's an article published in Pharmacy Today from way back in 2005 about their program's success in improving care and reducing costs while providing comprehensive pharmacy services called Telepharmacy delivers comprehensive services in rural Alaska (PDF).

Additionally, Judy put out a study in 2007, Improved and Expanded Pharmacy Care in Rural Alaska Through Telepharmacy and Alternative Methods Demonstration Project (Original PDF) and this informative presentation for the 2008 USPHS Scientific & Training Symposium in San Diego, California (PDF):


What's blocking outpatient telepharmacies from serving the medically underserved in Ohio?

Ironically enough, it seems it is the Ohio State Board of Pharmacy.

Back on the subject of the original article mentioned in this blog post, Does Telepharmacy Result in Better Care?, Pharmacy Practice News also offers a second opinion, this one from Tim Benedict, Assistant executive director of the Ohio State Board of Pharmacy. Tim says, "Compared with Ohio, the states that allow telepharmacy are larger and more sparsely populated. The board feels telepharmacy isn’t relevant for our geography and populace."

I wonder if the populace which he acknowledges live 30 minute+ drives from pharmacies in Ohio would concur. He mentions a Pharmacist in Charge is required at every pharmacy as an obstacle, although plenty of other states still manage to have outpatient telepharmacy programs while satisfying the rule. Unless I'm reading his text incorrectly, he also implies that physicians can serve the medication needs of patients as well as pharmacists can and that pharmacy technicians are more likely to divert controlled substances than doctors. Does anyone know where to find numbers as to whether this is true?

Thankfully, he does mention:

The board has approved several off-site pharmacies to receive the new orders from the hospital and then enter into the hospital computer system to perform utilization review and either approve or reject the order. Furthermore, the board recently approved the use of a dispensing machine placed in an emergency room for use in after-hours situations. The physician creates the prescription in the hospital computer and then provides the prescription to the patient. The prescription contains a bar code. The patient takes the prescription to the machine and the machine reads the bar code and provides the drug to the patient. There is a telephone connected to the machine for patient counseling with a pharmacist. The pharmacist is located in another state.

Good news that they at least allow applications of clinical telepharmacy!

Medical Centers Extend Telepharmacy to Rural Alaskans

A telepharmacy provider, Alicia Roberts Medical Center in Klawock, won the "Outstanding Rural Health Organization Award" at the Alaska Rural Health Conference in Anchorage on April 28. According to "Stories In The News" out of Ketchikan (and later Capital City Weekly), they were able to greatly expand their medical services with funding through the U.S. Health Resources and Services Administration (HRSA). Meanwhile, the Maniilaq Health Center in Kotzebue provides telepharmacy services to surrounding villages in Northwest Alaska:

Clinic Administrator Donna Miller and SEARHC Community Health Care Services Medical Director Dr. David Vastola

According to their website, "The Pharmacy staff of four clinical pharmacists and two pharmacy technicians provides pharmaceutical products and clinical pharmacy services to outpatients, inpatients, village residents, and residents of the Kotzebue Senior Citizen's Cultural Center." You wouldn't know it by just reading their site, but this US Air Force article pronounced the fact, and Freddy Kaniki confirmed it to me via email.

VA hints at retail telepharmacies for rural Alaskans

In a press release issued by the senior US Senator from Alaska, Lisa Murkowski, Secretary of Veterans Affairs, Eric Shinseki, spoke at a hearing of the Senate Appropriations Veterans Affairs Subcommittee and responded to questions about the VA's future approach to delivering prescription health benefits to veterans in rural areas of the state:

Cross said the VA could help Alaska through “outreach clinics,” such as those slated for Juneau and Homer, and rural health initiatives, including telemedicine programs and prescription deliveries by mail so that veterans don’t have to visit a pharmacy.

“We have much to learn and much innovation to bring forward in regard to our veterans in Alaska and we look forward to working on that,” he said.

Considering that the VA has a good idea of what telepharmacy can offer, and the head of the VA is testifying that this is more or less what they have in mind to the Senators who are going to appropriate the money, it's a good bet it will happen.

Telepharmacy reaches out to the underserved

Not so long ago, medically underserved rural communities had only limited options, if any, when need arose for healthcare services and pharmaceutical support. That situation is finally changing, as necessity and technology converge in emerging applications of telepharmacy, the delivery of pharmaceutical care by means of telecommunications and information technologies to patients at a distance from large, usually urban tertiary healthcare centers.

Telepharmacy also provides nighttime pharmaceutical services to community hospitals. A few years ago, Sibley Memorial Hospital in Washington, DC, could not support a pharmacist to review medication orders for high-risk drugs (such as antibiotics, anticoagulants, antiplatelet agents, narrow therapeutic index drugs, and drugs with many potential interactions) during the night shift, so the hospital turned to telepharmacy. Once the service was implemented, nurses faxed new inpatient orders to clinical pharmacists and technicians, who reviewed these orders much as the hospital’s own pharmacy staff would have done during the day; the difference was that the nighttime pharmacy professionals were located at a remote site. Before administering medications, nurses waited for the pharmacists to review and confirm the orders. Pharmacy consultations and requests for drug information were also handled by telepharmacy during the night shift.

More recently, the Veterans Administration adopted telepharmacy practices in order to reduce costs and to remotely link patients as needed to centrally located pharmacies.

Another initiative, the North Dakota Telepharmacy Project, is a collaborative effort between the North Dakota Board of Pharmacy, the North Dakota Pharmacists Association, and the College of Pharmacy, Nursing, and Allied Sciences at North Dakota State University. In rural southeastern North Dakota, where initial testing of telepharmacy took place, seniors had been resorting to mail-order pharmacy. Now they have a community pharmacy, staffed by a pharmacy technician, and they use an internet connection to speak with a pharmacist located at a remote site. Under this model, a licensed pharmacist is located at a central pharmacy. Video conferencing enables the pharmacist to supervise a registered pharmacy technician at a remote pharmacy site. After preparing the prescription, the technician shows the pharmacist the original signed prescription, the computer-generated label, the stock bottle where the medication is stored, and the bottle the patient will take home. The drug is then dispensed and the patient has mandatory “face-to-face” counseling with the pharmacist by means of real-time audio and video.

To ensure the delivery of safe, high-quality pharmaceutical service and care, pharmacists provide drug utilization review, prescription verification/validation, and patient counseling. The latter 2 services are often omitted when a patient uses a mail-order or internet pharmacy. In 2001, North Dakota was the first state to pass administrative rules allowing retail pharmacies to operate remotely without requiring a pharmacist to be present. As of September 2008, North Dakota had 67 pharmacies, of which 44 were retail pharmacies and 23 were hospital pharmacies. Of these, at least 22 were central pharmacies and 36 were remote sites served by telepharmacy, according to Charles D. Peterson, PharmD, dean, professor, and principal investigator/director of the North Dakota Telepharmacy Project. The telepharmacy sites are full-service, with drug inventories that include over-the-counter drugs and other merchandise.

“Over 40,000 rural citizens have had pharmacy services restored, retained, or established through the North Dakota telepharmacy project,” said Dr. Peterson. “It has also added more than $12.5 million annually in economic development.” In addition, this project has created at least 40 to 50 new jobs.

In Anchorage, the Alaska Native Medical Center (ANMC) uses telepharmacy to improve prescription drug access and pharmacy services for rural patients whose villages are spread over 2,000 miles. The program employs an electronic medical record and prepackaged, bar-coded medication and prescription labels, as well as innovative software, videophones, and automated dispensing machines. The network began with 12 remote clinics and has since expanded. In 2006, the ANMC telepharmacy received an award for excellence in medication-use safety from the ASHP Research and Education Foundation.

As of September 2008, the states of Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont, and Wyoming, as well as Washington, DC, had changed their laws to permit establishment of remote pharmacies.

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