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.
David Wahlberg of the Wicsconsin State Journal wrote a great article yesterday about the problem of vanishing pharmacies in Wisconsin, and the rise of outpatient telepharmacy programs. He explains why pharmacies are closing (mostly high costs, and mentions that pharmacists are expensive) and how telepharmacies and Dispensing Machines like InstyMeds' are taking the place of full-blown pharmacies:
InstyMeds machines
In some small towns where pharmacies have vanished, InstyMeds machines prevent patients from having to make trips to other cities.
...
About 200 InstyMeds machines are being used in 25 states, according to Minnesota-based InstyMeds. That includes 45 in Wisconsin, 34 of which are in rural clinics and hospitals.
While the machines fill a gap, an important connection is lost.
“It cuts pharmacists out of the loop, and we lose personal contact with patients,” said Mike Peterson, pharmacy director at Upland Hills.
Video connections
Pharmacists are in the loop but miles away at remote dispensing sites, which use video connections to preserve pharmacy services in some rural communities. They’re also called telepharmacy sites.
Wisconsin approved the sites two years ago, and rules on how to run them took effect this month. Sixteen states allow them, said Ann Rathke, telepharmacy coordinator in North Dakota, which in 2001 became the first state to approve the sites.
So far, four telepharmacies are operating in Wisconsin: at Marshfield Clinic centers in Mercer and Lake Hallie, near Chippewa Falls; and in Gillett and Mountain, small towns northwest of Green Bay where the clinics are owned by Community Memorial Hospital in Oconto Falls.
Pharmacy technicians work at the sites. As the tech prepares medications, a pharmacist consults from another location through a video screen. When the tech hands over the drugs to the patient, the pharmacist appears on another video screen to give instructions and answer questions.
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But with pharmacy techs making roughly $30,000 a year, compared with about $110,000 for pharmacists, the sites allow service in rural locations that don’t have enough business to justify having a pharmacist on site. “It’s a compromise,” Wunrow said.
Definitely check out the WSJ article. There are pictures, a flash graphic and a video included as well:
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.
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.
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.
Telepharmacy – Marana Health Center, Inc., 13644 North Sandario Road, Marana, AZ 85653 - $200,000, HHS-HRSA: Funding will be used to establish a telepharmacy in the MHC Primary Care Health Center at the TMC Campus to provide low-cost pharmaceuticals to uninsured and underinsured patients utilizing the 340B drug program. This service would be available to patients at six MHC satellite clinics in east and central Tucson, encompassing over 145,000 people. This is an important use of taxpayer funds because the only pharmacy services currently available in this area are commercial pharmacies, none which provide low-cost prescription drugs. Click here for a letter of support from Arizona State Representative David Bradley.
Looks like an ambulatory care telepharmacy operation is in the works in urban Arizona!
Earlier this month, the BC College of Pharmacists proposed some amendments to the Bylaws of the Pharmacy Operations and Drug Scheduling Act (PODSA, which is Current law in the Canadian province of British Columbia). Among the changes (in yellow) are adjustments from "Pharmacist" to "Full Pharmacist," rules for managers of "Central pharmacy sites" and quite a few responsibility shifts. Here are the current bylaws for comparison.
The North Dakota Pharmacists Association (NDPhA) is hosting several talks at their 125th Annual Convention in April. One is an update on the North Dakota Telepharmacy Project from Shelley Johnsen and Ann Rathke, the director of the Hospital Telepharmacy Project, and Telepharmacy Coordinator at NDSU, respectively. According to the convention schedule, it's from 2 to 3 PM on Friday, April 23, 2010. Students get in free and the lectures are worth CE credits.
First up, the FCC gave out $145 million in grant money to rural health consortiums in support of upgrading their networks for things like telehealth and just general day-to-day operations. All in all, the grants affect more than 2000 rural hospitals around the US. The press release, Rural Telemedicine Program Funds 16 More Broadband Telehealth Networks, states at least one health network will use the cash explicitly for a telepharmacy system between 12 hospitals:
Pennsylvania Mountains Healthcare Alliance ($4.49 M) – A new broadband network of approximately 12 hospitals in rural western Pennsylvania will provide a variety of telehealth services, specialty care, and telepharmacy in 18 counties.The network will provide a minimum of 10 Mbps service and connect with Internet2.The project previously merged with the Juniata Valley Network project, a network in the rural region of the Appalachian Mountains that will connect approximately 79 health care facilities to enable telemedicine and school wellness programs, and will connect to Internet2 at speeds ranging from 7 to 100 Mbps.
Additionally, this "Flex Update" from the University of North Dakota's Center for Rural Health has a section called Impacts of the 2009-2010 SHIP Grant Awards where they detail how Small Rural Hospital Improvement Program grants from the federal Office of Rural Health Policy were spent at Critical Access Hospitals around the state. North Dakota CAHs received a total of $271,250, of which, 69% were purchases for computers, software, servers and the like. Last years grants allowed CAHs to implement Electronic Medical Records. Some of this money will undoubtedly go to telepharmacy projects.
PharmaTrust's MedCentre remote consultation and dispensing machine is likely headed to the UK, they've announced in a press release:
British Minister for Trade, Investment and Small Business, Lord Davies, said: “I am delighted that PharmaTrust has chosen the UK for a major expansion of its business. Its new prescription drug dispensing technology will revolutionize the way medicines are dispensed across the country and beyond.”
PharmaTrust sees the UK as "a key gateway to the European market." The CEO and co-founder, Don Waugh was invited to attend the Global Investment Conference hosted by British Prime Minister Gordon Brown. In the press release, he draws some parallels between PharmaTrust's machine and the first ATMs, introduced in London. Click here for more information about the PharmaTrust MedCentre.
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!
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.
