Recent Telepharmacy Study Round-Up

Jayashri Sankaranarayanan published a Viewpoint in Medscape today, about a study in the Journal of the American Pharmacists Association from August 2009 called "Exploring the formation of patient satisfaction in rural community telepharmacies" that attempted to assess patient satisfaction with outpatient telepharmacies in rural communities. The study concluded:

A previous application of this instrument in a traditional community pharmacy setting yielded two interrelated latent constructs ("friendly explanation" and "managing therapy"). Our analysis suggests that the formation of patient satisfaction in rural community telepharmacies is much simpler in that patients form a single construct exhibiting high mean and median values. Anecdotal evidence from the literature suggests that the formation of a single construct reflects patients' desire to retain a point of access to health care in their communities.

Jayashri's analysis of the study is a little more straightforward:

Low response rate (24%) may have biased the study findings because highly satisfied patients may have responded to the survey and dissatisfied patients may not have responded. Study results are limited to telepharmacies in the Midwest. Because some patients may want to keep a point of access to healthcare in their communities as opposed to driving outside of the community to receive it, they may have reported high satisfaction with telepharmacies.

This is one of the first studies to evaluate patient satisfaction with telepharmacy. If patient behaviors are consistent with patient values, telepharmacy may complement the rural community pharmacy and have the potential to remain profitable while improving quality of care.

Sounds like in any case, patients were able to get the drugs they needed, which might not have been possible locally, without a telepharmacy.

Upon realizing I missed this study back Fall 2009, I looked back through PubMed for more interesting stuff I might have missed and found a couple more.

Implementing after-hours pharmacy coverage for critical access hospitals in northeast Minnesota (Sept. 2008)

CONCLUSION: Using Internet-based health IT, pharmacists from a metropolitan (hub) hospital with round-the-clock pharmacist coverage participated in the care of patients at a number of small, rural hospitals and helped ensure that those patients received safe and effective medication therapy. The coverage provided by pharmacists at the hub hospital improved nursing satisfaction with the overall quality of pharmacy services provided by both the hub hospital and the local onsite pharmacists.

Implementation of home-based medication order entry at a community hospital (Nov. 2009)

CONCLUSION: A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.

New Study: Telepharmacist Monitoring ICU Patients Increased Sedation Guideline Compliance, Daily Sedation Interruptions, Interventions

A new study published in The Annals of Pharmacotherapy this month by a crew from UMass Memorial Medical Center and University of Massachusetts Medical School shows promising results for patients in intensive care. From Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically Ill Mechanically Ventilated Patients:

RESULTS: The addition of third shift tele-ICU pharmacist support was associated with a significant increase in the percentage of patients who received a daily sedative interruption (45% vs 54%; p < 0.0001). This occurred in the context of significant increases in the total number of ICU pharmacist interventions (36 vs 49.4 per 100 patient days, p < 0.0001), the number of therapeutic interventions (20.4 vs 26.1 per 100 patient days, p < 0.001), and the number of sedative-related interventions (0.9 vs 4.4 per 100 patient days, p < 0.0001).

CONCLUSIONS: Tele-ICU resources can be utilized to increase compliance with an established ICU sedation guideline and extend the benefits that daytime ICU clinical pharmacy services provide. Increased ICU pharmacist availability may have additional benefits not measured in this study.

This is the second study published this month that points to telepharmacy as an effective method for improving patient outcomes. Thanks Allison Forni, Nancy Skehan, Christian Hartman, Dinesh Yogaratnam, Milka Njoroge, Christopher Schifferdecker, and Craig Lilly!

5% of Healthcare Professionals in Malaysia use Telepharmacy

A group of pharmacists at the Universiti Sains Malaysia School of Pharmaceutical Sciences have published a study in this month's issue of the Journal of Clinical and Diagnostic Research entitled "Evaluation Of Knowledge And Perception of Malaysian Health Professionals About Telemedicine" (PDF):

The study doesn't state specifically how each respondent answered the questions, but it's a good bet that this reflects telepharmacy use in hospital pharmacy settings, because 1) 80% of respondents were from hospitals (private and government-run), and 2) "Nurses or medical doctors in clinic settings were excluded since telemedicine is yet to become a common practice in these settings," though telemedicine is defined as Teleradiology, Telesurgery, Telenursing as well as Telepharmacy. While 5% usage is low, this is the first I've heard of telepharmacy in use in Malaysia, whereas 42% of my fellow medical professionals in Malaysia have heard of it before, and as a developing country the only direction telepharmacy practice is headed there is up.

New Study: Telepharmacy an Effective Method of Providing Pharmaceutical Reviews

The Journal of Telemedicine and Telecare has released a new study out of Australia evaluating the effectiveness of remote pharmacist reviews of dispensed medications in rural hospitals without on-site pharmacists. Pharmaceutical review using telemedicine - a before and after feasibility study:

Only 42 of the 116 public hospitals in Queensland employ qualified pharmacists to staff their pharmacies. We undertook a feasibility study to determine if pharmaceutical reviews, undertaken face-to-face by a visiting pharmacist, could be replicated using telemedicine. The study was conducted in two phases, with the same pharmacist coordinating the project from the main hospital to two rural hospitals, which relied on supply nurses for all their pharmaceutical services. All inpatients admitted between October 2006 and May 2007 were included in the study. In Phase I the pharmacist made weekly visits to both facilities, to perform face-to-face pharmaceutical reviews of the current inpatients. In Phase 2, all pharmaceutical reviews were performed remotely by the pharmacist by telephone or videoconference. In Phase 1, 186 pharmaceutical activities were performed (mean 3.9 per patient). Of these, 78 pharmacist-initiated changes were recommended and 47 (60%) were implemented. In Phase 2, a total of 296 activities were performed (mean 3.1 per patient) and of the 140 recommendations made by the remote pharmacist, 74 (53%) were accepted. Of the accepted recommendations, there were 11 major interventions (those with a potential to prevent harm to the patient) in Phase 1 and 32 in Phase 2. There were no significant differences in the pharmaceutical activity rates in the two phases. Telepharmacy therefore may be an effective method of providing pharmaceutical reviews for patients in rural inpatient facilities, without an on-site pharmacist.

Thanks Louise Poulson, Lisa Nissen, and Ian Coombes!