Telepharmacy

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Pharmacy personnel deliver medical prescriptions electronically; remote delivery of prescription drugs is a feature of telepharmacy. Winn Army Community Hospital Pharmacy Stays Online During Power Outage.jpg
Pharmacy personnel deliver medical prescriptions electronically; remote delivery of prescription drugs is a feature of telepharmacy.

Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.

Contents

The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely. [1]

Benefits and drawbacks

A primary appeal of telepharmacy is its potential to expand access to pharmacy care in smaller rural communities, some of which cannot support a full-time pharmacist or cannot easily recruit a pharmacist to reside in their region. Telepharmacy can potentially give patients in remote locations access to professional pharmacy care that could not be received locally, which can lower costs and improve patient safety through better patient counseling, drug administration monitoring, [2] and compliance monitoring. Sharing of pharmacists between sites can also decrease costs in existing facilities, which might no longer need to employ a full-time pharmacist.

The potential costs of telepharmacy are broadly the same as those associated with all forms of telemedicine: potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, [3] and an increased risk that protected health information may be compromised through electronic information storage and transmission. [4] [5]

Implementation

The implementation of telepharmacy varies by region and jurisdiction. Factors including geography, laws and regulations, and economics influence its implementation.

Australia

A form of telepharmacy has been in use by Australia's Royal Flying Doctor Service since 1942. Medical chests containing medications and equipment are placed in remote communities where they can be administered to patients during a telehealth consultation. Some 3,500 chests were distributed around Australia as of 2006. In one year, Queensland recorded 21,470 telehealth consultations, of which 13.7% resulted in administration of a medication from a medical chest. The medication types administered most often are antibiotics, analgesics and gastrointestinal medications. This system improves access to both emergency and routine medical care in remote parts of Australia and reduces the need for patients to travel to seek medical care. [6]

Another application of telepharmacy in Queensland has been the provision of pharmaceutical reviews in rural hospitals that lack on-staff pharmacists. [7] Although broader use of telepharmacy could help alleviate a shortage of pharmacists, Australia has lagged the United States in its implementation of telepharmacy, partly because doctors, nurses, and other health care workers provide pharmacy services in rural and remote areas where there are no pharmacists. [8]

United States

Implementation of telepharmacy in the United States began in the 2000s. A combination of factors, including changes in Medicare reimbursement for medications [9] and the recession of 20078, led to a decline in the number of independent pharmacies in rural areas. [10] In response to the need for alternative means of delivering pharmacy in services in rural communities lacking a full-time pharmacist, several midwestern and northwestern states with extensive rural areas have led much of the development of policy and implementation methods for telepharmacy.

In 2001, North Dakota became the first U.S. state to pass regulations allowing retail pharmacies to operate without requiring a pharmacist to be physically present. The next year, state agencies and grants established the North Dakota Telepharmacy Project, which now supports more than fifty remote retail and hospital pharmacy sites throughout North Dakota. [11] In this program, a licensed pharmacist at a central site communicates with remote site pharmacy technicians and patients through videoconferencing. A 2004 study of the program found that telepharmacy delivered the same quality of pharmacy services as traditional facilities, [12] and a study of the operation of one North Dakota telepharmacy business from 2002 through 2004 found that, while medication inventory turnover was lower than the industry average, the remote sites were able to be operated profitably. [13] The success and expansion of this program were an inspiration and model for programs and laws in other states. [14]

The Community Health Association of Spokane, a network of community health centers in Spokane, Washington, started a telepharmacy program in 2001. The program delivers remote medication dispensing and health counseling to patients at six urban and rural clinics; remote site personnel are connected to pharmacists at the base site by videoconferencing. A survey found that most patients at the remote sites strongly agreed or agreed that they would have had difficulty affording their medications without this program. [15]

The Alaska Native Medical Center, a hospital in Anchorage, Alaska, providing telehealth services to Alaska Native populations, established a telepharmacy program in 2003 to improve its pharmaceutical services in rural native settlements. The American Society of Health-System Pharmacists gave the program its 2006 Award for Excellence in Medication-Use Safety, concluding that the use of telepharmacy had improved access to pharmaceutical care and enabled pharmacists to monitor medication safety and encourage medication adherence, as well as making pharmacy care more cost-effective. [16]

The U.S. Navy Bureau of Medicine operates a large-scale telepharmacy program for the use of service personnel. After piloting the program in 2006 at Naval Hospital Pensacola in Florida and Naval Hospital Bremerton in Washington, in 2010 the Navy expanded it to more sites throughout the world. This program represents the largest implementation of telepharmacy to date. [17]

California passed a Telehealth Advancement Act in 2011 to update the state's legal definitions of telehealth, simplify approval processes for telehealth services, and broaden the range of medical services that may be provided via telehealth. The law establishes legal parity between the direct and remote delivery of pharmacy care. [18] Iowa's first telepharmacy opened in September 2012 after receiving a three-year waiver from the Iowa Board of Pharmacy that allows the facility to operate without a pharmacist on-site. [19]

A 2010 study of the various American states' rural health offices found that telepharmacy in rural medical facilities varied in prevalence across the United States but was still not widespread, and that many states had not yet clearly defined regulations for telepharmacy in hospitals. [20] Adoption and implementation of telepharmacy methods has been slow compared to the spread of the basic technologies involved (internet access, audio/video compression algorithms, microphones and video cameras), despite periodic predictions of a forthcoming boom in the industry. Aside from more intangible factors (such as physicians' and pharmacists' personal uneasiness with the lack of physical interaction with patients), the major obstacles to telepharmacy implementation appear to have been the lack of clear legal regulations for telepharmacy, and the lack of network and software systems to manage (and secure) all of the data used in a professional pharmacy. [21] As of 2010, many of the telepharmacy facilities in active operation were operating as pilot programs or under temporary waivers issued by state regulators because many states still had no clear legal framework for the regulation of remote pharmaceutical sites without pharmacists. Even in states that had regulated retail telepharmacy practices, regulations were often not in place to permit the implementation of telepharmacy in hospital settings. [20] [22] For some pharmacy facilities that might otherwise consider telepharmacy, the cost and complexity of the infrastructure needed to manage patient data across multiple sites can be prohibitive. In addition to the computer hardware required for patient data storage, distribution and teleconferencing, telepharmacy programs must deploy network security tools and procedures adequate to protect patient medical information in compliance with HIPAA and other patient privacy regulations. In 2010 the North Dakota Telepharmacy Project estimated that the computer hardware needed for a typical retail installation costs US$17,300 per site, with an additional cost of US$5,000 to buy a mobile cart for a hospital installation. [23]

Canada

Adoption of telepharmacy in Canada began as a response to a nationwide shortage of pharmacists. Canada's first telepharmacy service was started by a hospital in Cranbrook, British Columbia, in June 2003 in order to assist a hospital in a nearby town that was unable to hire a pharmacist. To meet the need for service, a hospital pharmacist in Cranbrook began using telepharmacy technology to oversee pharmacy technicians at the other hospital. A similar service was subsequently extended to other small hospitals in the province; it is also used to provide coverage when a hospital's sole pharmacist is absent due to illness or vacation. [24] Remote dispensing machines for medication began operation in Ontario, Canada, in 2007. After a patient inserts a prescription into the dispensing machine, the prescription is scanned and the patient is connected by telephone videoconference to a pharmacist at a remote site. The pharmacist reviews the prescription, discusses the patient's medication history, and authorizes the machine to dispense medication to the patient. The machines proved successful, with one assessment revealing that 96% of patients using them had their prescription filled in under five minutes. [25] As of 2009, a hospital in Ontario, Canada, was using telepharmacy services in addition to retaining a pharmacist at the hospital; the telepharmacist reviews medication orders, while the on-site pharmacist works with patients and oversees medication safety in the facility. Thus telepharmacy support allows the on-site pharmacist to focus on the more sensitive and nuanced tasks for which physical presence is most helpful. [26]

Other countries

After their success in Canada, remote medication dispensing machines were scheduled to be tested at several hospital locations in the United Kingdom beginning in 2010. [25] In 2013, Maxor National Pharmacy Services, a U.S. company, reported that its remote dispensing machines for medication were being used in Bahrain, Belgium, Cuba, England, Germany, Guam, Italy, Japan, Spain and Venezuela. [27]

In 2010, Mannings drugstores became the first in Hong Kong to use videoconferencing to allow patients at outlets without full-time pharmacists to consult with pharmacists at other sites. [28]

See also

Related Research Articles

Pharmacist healthcare professional who practices in pharmacy

Pharmacists, also known as chemists or druggists, are health professionals who practice in pharmacy, the field of chemical sciences and health sciences focusing on safe and effective medication use. Pharmacists undergo university or graduate-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialized knowledge to patients, physicians, and other health care providers.

Pharmacy academic discipline studying preparation and dispensation of medicinal

Pharmacy is the science and technique of preparing, dispensing, and reviewing drugs and providing additional clinical services. It is a health profession that links health sciences with pharmaceutical sciences and aims to ensure the safe, effective, and affordable use of drugs. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, the pharmacy is classified as a community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies are considered clinical pharmacy.

Prescription drug licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained

A prescription drug is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia, as well as certain foreign visitors covered by a Reciprocal Health Care Agreement. The PBS seeks to ensure that Australian residents have affordable and reliable access to a wide range of necessary medicines. The PBS has faced increased scrutiny as its cost has increased. The scheme assumes responsibility for the cost of drugs to patients in the community setting rather than while in hospital which is the responsibility of each state and territory. Together with Medicare the PBS is a key component of health care in Australia.

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap.

An independent pharmacy is a retail pharmacy that is not directly affiliated with any chain of pharmacies and is not owned by a publicly traded company. Independent pharmacies are pharmacist-owned, privately held businesses in varying practice settings. They include single-store operations, pharmacist-owned multiple store locations, franchise, compounding, long-term care (LTC), specialty, and supermarket pharmacy operation. Independent pharmacy owners generally have more flexibility to build personalized customer relationships and they strive to differentiate their services from big-chain corporations.

NORTH Network

NORTH Network was a telehealth organization serving communities in Northern and Central Ontario. NORTH's head office was located in Toronto and its clinical headquarters in Timmins. NORTH was a program of Sunnybrook Health Sciences Centre, and received funding from the provincial government's Ministry of Health and Long Term Care.

Avera Health is a regional health system based in Sioux Falls, S.D., comprising more than 300 locations in 100 communities throughout South Dakota, Minnesota, Iowa, Nebraska and North Dakota. Avera serves a geographical footprint of more than 72,000 square miles and 86 counties, and a population of nearly 1 million.

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing. Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted as long as they are in compliance with HIPAA standards.

Rural health interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards older adults and people with disabilities.

Electronic prescribing is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, pharmacist, nurse practitioner, or physician assistant to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

Remote dispensing

Remote dispensing is used in health care environments to describe the use of automated systems to dispense prescription medications without an on-site pharmacist. This practice is most common in long-term care facilities and correctional institutions that do not find it practical to operate a full-service in-house pharmacy.

An automated dispensing cabinet (ADC) is a computerized drug storage device or cabinet for hospitals and many other healthcare settings. ADCs allow medications to be stored and dispensed near the point of care while controlling and tracking drug distribution. They also are called unit-based cabinets (UBCs), automated dispensing devices (ADDs), automated distribution cabinets or automated dispensing machines (ADMs).

Telehomecare definition of telehomecare

Telehomecare (THC) is a subfield within telehealth. It involves the delivery of healthcare services to patients at home through the use of telecommunications technologies, which enable the interaction of voice, video, and health-related data. The management of care is done from an external site by a healthcare professional.

Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

In the United StatesVeterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals. This differs slightly from the title of "veterinary pharmacy specialist," who might additionally work in consulting, research, and education for veterinary pharmacy. Regular pharmacists in a variety of settings come into play in the preparation and dispensing of animal medications as well. As veterinarians treat a wide variety of animals with a wide variety of products, pharmacists can help manage these treatments through their compounding and drug knowledge. Compounding is often necessary for animal patients, as they require different dosages and medication forms from humans. Through compounding, pharmacists can adjust a medication for an animal so it is more appealing in taste or appearance. While there is currently no required veterinary pharmacy curriculum in place by the Accreditation Council for Pharmacy Education, the American Veterinary Medical Association understands that some veterinary education might be beneficial to pharmacists as community pharmacies continue to supply animal medications.

The pharmacy management system, also known as the pharmacy information system, is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.

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