Research in Social and Administrative Pharmacy j (2015) j–j
Letter to the Editor
Telepharmacy: Time to pick up the line Aung Zaw Win, M.D., M.A., M.P.H.* Notre Dame de Namur University, 1500 Ralston Avenue, Belmont, CA 94002, USA
The National Association of Boards of Pharmacy (NABP) has defined the practice of telepharmacy as “the provision of pharmacist care by registered pharmacies and pharmacists through the use of telecommunications to patients located at a distance.”1 Rural communities in America cannot support a full-time pharmacist or cannot easily recruit a pharmacist to reside in their region.2 Telepharmacy expands access to quality health care to communities nationwide, primarily in rural, medically-underserved areas.3 Telepharmacy has the potential to improve the quality of pharmaceutical care and to decrease medication errors and adverse drug events.1 Additional advantages of telepharmacy include cost-effectiveness, improved access to care, higher productivity, after hours availability and reduced travel time.1 Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.2 Two large health systems–the Veterans Affairs (VA) and the U.S. Navy – that employ telepharmacy can be used as case studies. The Veterans Health Administration (VHA) is America’s largest integrated health care system. Telepharmacy is among the 44 telehealth subspecialties offered by the VA. The telepharmacy services offered by the VA include videoconference consultations on medication therapy management (MTM), and other e-consult services to answer medication-related questions.4 The VA telepharmacy provides services for medical conditions such as heart failure, diabetes mellitus, hypertension, hyperlipidemia, thyroid abnormalities, chronic obstructive pulmonary disease, and asthma.5 Moreover, telepharmacy services have expanded outside primary care to include other
specialties such as mental health, heart failure, hepatitis C, women’s health and anticoagulation therapy management.4 The pharmacist-led telepharmacy clinic provides individual and group consultations. Telepharmacy Hep C education groups provide an excellent mechanism to promote peer support.6 Educational material that is typically provided to the patients as written handouts can be reviewed as audio-visual movie clips. The telepharmacy service works together with their delivery service to ship medications to rural veterans. Telepharmacy saves travel time and expense, which are major barriers for rural, elderly, and disabled veterans. The U.S. Navy has the largest telepharmacy in place to help ease a shortage of pharmacists throughout the service.7 The system was first tested in 2008 at a nuclear submarine base in Seattle, Washington, and is now used by more than a hundred US Navy medical facilities throughout the world.8 The U.S. Navy’s telepharmacy system allows service members to remotely interact with a pharmacist. A single pharmacist can supervise medication dispensing at multiple satellite pharmacies.7 The Navy has bar-coded medication administration, automatic dispensing cabinets, pill-counting software and other mobile and remote technologies to automate pharmacy processes, and to save money.9 The bar coding system allows for increased accuracy, efficiency and patient safety. The Navy’s telepharmacy system can also verify drug/drug interactions and drug allergies.7 With audio and video links, the supervising pharmacist can view original handwritten prescriptions, and stored images of the prescribed drug to make sure the patient gets the right medication.7
* Corresponding author. Tel.: þ1 415 672 6209; fax: þ1 650 756 2778. E-mail address: [email protected]. 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.06.002
2
Letter to the Editor / Research in Social and Administrative Pharmacy j (2015) 1–2
Medication errors contribute to 250,000 nonfatal injuries and 7000 deaths each year. In the U.S., the annual cost of preventable adverse drug advents has been estimated at 2 billion dollars.10 Most hospitals reported that medication error rates have improved since telepharmacy implementation.1 Remote review of medication orders by pharmacists when the hospital pharmacy was closed decreased the number of potential adverse drug events reported.11 Additionally, there are more than 125 million Americans living with chronic medical conditions.12 There are also more than 8.1 million undiagnosed diabetics in the United States.13 Diabetesda debilitating chronic illness with an annual cost to the economy of $174 billiondhas a medication compliance rate of less than 50%.12 Noncompliance reduces the effectiveness of medication regimens and can lead to acute episodes and complications. A recent study showed that every $1 spent on improving compliance returned $7.10 for diabetes drugs, $5.10 for cholesterol drugs, and $4 for blood pressure medication.12 Pharmacists can monitor and encourage medication compliance with the aid of teleconferencing or videoconferencing. With the advent of smartphones, tablet PCs and PDAs operating on 3G or 4G networks, the future of telepharmacy looks more than feasible.14 In the U.S., approximately 74.4% of households have internet access, 58% of American adults have a smartphone and 42% of American adults own a tablet.15,16 Patients need only an internet connection and a laptop, desktop computer, iPad, smartphone or tablet at home to engage with the pharmacists. The Internet has quickly become a star performer, but utilization by health care lags behind that of other industries.1 Likewise, telepharmacy in America is still not widely utilized compared to other telemedicine subspecialties. All in all, telepharmacy can offer 24-h pharmacy coverage. Telepharmacy can deliver the same quality of pharmacy services as traditional facilities and patients were satisfied with their communication with pharmacists through videoconferencing.17,18 Moreover, telepharmacy can change the practice of pharmacy.19 The American Society of Health-System Pharmacists (ASHP) supports telepharmacy.20 Telepharmacy holds great promise for the profession and can enhance patient access to pharmacy services.
References 1. Casey MM, Sorensen TD, Elias W, Knudson A, Gregg W. Current practices and state regulations regarding telepharmacy in rural hospitals. Am J Health Syst Pharm 2010;67:1085–1092. 2. Angaran DM. Telemedicine and telepharmacy: current status and future implications. Am J Health Syst Pharm 1999;56:1405–1426. 3. Kolpack D. Telepharmacy project expands across country. USA Today; Edited 9/12/2008, http://usatoday30. usatoday.com/news/health/2008-09-12-virtual-phar macy_N.htm. Accessed 23.03.15. 4. http://www.usmedicine.com/2014-issues/vha-seeksto-expand-telepharmacys-reach-in-2014/. 5. http://www.telehealth.va.gov/newsletter/2012/102912Newsletter_Vol11Iss03.pdf. 6. You A, Kawamoto J, Smith JP. A pharmacistmanaged telemedicine clinic for hepatitis C care: a descriptive analysis. J Telemed Telecare 2014;20: 99–101. 7. Traynor K. Navy takes telepharmacy worldwide. Am J Health Syst Pharm 2007;67:1134–1136. 8. http://www.pharmaceutical-journal.com/news-andanalysis/features/remote-pharmacy-its-closer-thanyou-think/20065564.article. 9. http://www.fiercehealthit.com/story/navy-implement ing-worlds-largest-telepharmacy-system/2010-04-19. 10. Cole SL, Grubbs JH, Din C, Nesbitt TS. Rural inpatient telepharmacy consultation demonstration for after-hours medication review. Telemed J E Health 2012;18:530–537. 11. Schneider PJ. Evaluating the impact of telepharmacy. Am J Health Syst Pharm 2013;70:2130–2135. 12. Herrick DM. Convenient Care and Telemedicine. National Center for Policy Analysis; 2007. 13. http://www.cdc.gov/diabetes/pubs/statsreport14/na tional-diabetes-report-web.pdf. 14. http://www.usmedicine.com/agencies/department-ofdefense-dod/navy/telepharmacy-brings-navy-phar macists-to-remote-sites/. 15. http://www.census.gov/content/dam/Census/library/ publications/2014/acs/acs-28.pdf. 16. http://www.pewinternet.org/fact-sheets/mobile-tech nology-fact-sheet/. 17. Peterson CD, Anderson HC. The North Dakota Telepharmacy Project: restoring and retaining pharmacy services in rural communities. J Pharm Technol 2004;20(4):28–39. 18. Clifton GD, Byer H, Heaton K, Haberman DJ, Gill H. Provision of pharmacy services to underserved populations via remote dispensing and twoway videoconferencing. Am J Health Syst Pharm 2003;60:2577–2582. 19. Focus group on telepharmacy. Am J Health Syst Pharm 2001;58:167–169. 20. http://www.ashp.org/.
Letter to the Editor
Telepharmacy: Time to pick up the line Aung Zaw Win, M.D., M.A., M.P.H.* Notre Dame de Namur University, 1500 Ralston Avenue, Belmont, CA 94002, USA
The National Association of Boards of Pharmacy (NABP) has defined the practice of telepharmacy as “the provision of pharmacist care by registered pharmacies and pharmacists through the use of telecommunications to patients located at a distance.”1 Rural communities in America cannot support a full-time pharmacist or cannot easily recruit a pharmacist to reside in their region.2 Telepharmacy expands access to quality health care to communities nationwide, primarily in rural, medically-underserved areas.3 Telepharmacy has the potential to improve the quality of pharmaceutical care and to decrease medication errors and adverse drug events.1 Additional advantages of telepharmacy include cost-effectiveness, improved access to care, higher productivity, after hours availability and reduced travel time.1 Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.2 Two large health systems–the Veterans Affairs (VA) and the U.S. Navy – that employ telepharmacy can be used as case studies. The Veterans Health Administration (VHA) is America’s largest integrated health care system. Telepharmacy is among the 44 telehealth subspecialties offered by the VA. The telepharmacy services offered by the VA include videoconference consultations on medication therapy management (MTM), and other e-consult services to answer medication-related questions.4 The VA telepharmacy provides services for medical conditions such as heart failure, diabetes mellitus, hypertension, hyperlipidemia, thyroid abnormalities, chronic obstructive pulmonary disease, and asthma.5 Moreover, telepharmacy services have expanded outside primary care to include other
specialties such as mental health, heart failure, hepatitis C, women’s health and anticoagulation therapy management.4 The pharmacist-led telepharmacy clinic provides individual and group consultations. Telepharmacy Hep C education groups provide an excellent mechanism to promote peer support.6 Educational material that is typically provided to the patients as written handouts can be reviewed as audio-visual movie clips. The telepharmacy service works together with their delivery service to ship medications to rural veterans. Telepharmacy saves travel time and expense, which are major barriers for rural, elderly, and disabled veterans. The U.S. Navy has the largest telepharmacy in place to help ease a shortage of pharmacists throughout the service.7 The system was first tested in 2008 at a nuclear submarine base in Seattle, Washington, and is now used by more than a hundred US Navy medical facilities throughout the world.8 The U.S. Navy’s telepharmacy system allows service members to remotely interact with a pharmacist. A single pharmacist can supervise medication dispensing at multiple satellite pharmacies.7 The Navy has bar-coded medication administration, automatic dispensing cabinets, pill-counting software and other mobile and remote technologies to automate pharmacy processes, and to save money.9 The bar coding system allows for increased accuracy, efficiency and patient safety. The Navy’s telepharmacy system can also verify drug/drug interactions and drug allergies.7 With audio and video links, the supervising pharmacist can view original handwritten prescriptions, and stored images of the prescribed drug to make sure the patient gets the right medication.7
* Corresponding author. Tel.: þ1 415 672 6209; fax: þ1 650 756 2778. E-mail address: [email protected]. 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.06.002
2
Letter to the Editor / Research in Social and Administrative Pharmacy j (2015) 1–2
Medication errors contribute to 250,000 nonfatal injuries and 7000 deaths each year. In the U.S., the annual cost of preventable adverse drug advents has been estimated at 2 billion dollars.10 Most hospitals reported that medication error rates have improved since telepharmacy implementation.1 Remote review of medication orders by pharmacists when the hospital pharmacy was closed decreased the number of potential adverse drug events reported.11 Additionally, there are more than 125 million Americans living with chronic medical conditions.12 There are also more than 8.1 million undiagnosed diabetics in the United States.13 Diabetesda debilitating chronic illness with an annual cost to the economy of $174 billiondhas a medication compliance rate of less than 50%.12 Noncompliance reduces the effectiveness of medication regimens and can lead to acute episodes and complications. A recent study showed that every $1 spent on improving compliance returned $7.10 for diabetes drugs, $5.10 for cholesterol drugs, and $4 for blood pressure medication.12 Pharmacists can monitor and encourage medication compliance with the aid of teleconferencing or videoconferencing. With the advent of smartphones, tablet PCs and PDAs operating on 3G or 4G networks, the future of telepharmacy looks more than feasible.14 In the U.S., approximately 74.4% of households have internet access, 58% of American adults have a smartphone and 42% of American adults own a tablet.15,16 Patients need only an internet connection and a laptop, desktop computer, iPad, smartphone or tablet at home to engage with the pharmacists. The Internet has quickly become a star performer, but utilization by health care lags behind that of other industries.1 Likewise, telepharmacy in America is still not widely utilized compared to other telemedicine subspecialties. All in all, telepharmacy can offer 24-h pharmacy coverage. Telepharmacy can deliver the same quality of pharmacy services as traditional facilities and patients were satisfied with their communication with pharmacists through videoconferencing.17,18 Moreover, telepharmacy can change the practice of pharmacy.19 The American Society of Health-System Pharmacists (ASHP) supports telepharmacy.20 Telepharmacy holds great promise for the profession and can enhance patient access to pharmacy services.
References 1. Casey MM, Sorensen TD, Elias W, Knudson A, Gregg W. Current practices and state regulations regarding telepharmacy in rural hospitals. Am J Health Syst Pharm 2010;67:1085–1092. 2. Angaran DM. Telemedicine and telepharmacy: current status and future implications. Am J Health Syst Pharm 1999;56:1405–1426. 3. Kolpack D. Telepharmacy project expands across country. USA Today; Edited 9/12/2008, http://usatoday30. usatoday.com/news/health/2008-09-12-virtual-phar macy_N.htm. Accessed 23.03.15. 4. http://www.usmedicine.com/2014-issues/vha-seeksto-expand-telepharmacys-reach-in-2014/. 5. http://www.telehealth.va.gov/newsletter/2012/102912Newsletter_Vol11Iss03.pdf. 6. You A, Kawamoto J, Smith JP. A pharmacistmanaged telemedicine clinic for hepatitis C care: a descriptive analysis. J Telemed Telecare 2014;20: 99–101. 7. Traynor K. Navy takes telepharmacy worldwide. Am J Health Syst Pharm 2007;67:1134–1136. 8. http://www.pharmaceutical-journal.com/news-andanalysis/features/remote-pharmacy-its-closer-thanyou-think/20065564.article. 9. http://www.fiercehealthit.com/story/navy-implement ing-worlds-largest-telepharmacy-system/2010-04-19. 10. Cole SL, Grubbs JH, Din C, Nesbitt TS. Rural inpatient telepharmacy consultation demonstration for after-hours medication review. Telemed J E Health 2012;18:530–537. 11. Schneider PJ. Evaluating the impact of telepharmacy. Am J Health Syst Pharm 2013;70:2130–2135. 12. Herrick DM. Convenient Care and Telemedicine. National Center for Policy Analysis; 2007. 13. http://www.cdc.gov/diabetes/pubs/statsreport14/na tional-diabetes-report-web.pdf. 14. http://www.usmedicine.com/agencies/department-ofdefense-dod/navy/telepharmacy-brings-navy-phar macists-to-remote-sites/. 15. http://www.census.gov/content/dam/Census/library/ publications/2014/acs/acs-28.pdf. 16. http://www.pewinternet.org/fact-sheets/mobile-tech nology-fact-sheet/. 17. Peterson CD, Anderson HC. The North Dakota Telepharmacy Project: restoring and retaining pharmacy services in rural communities. J Pharm Technol 2004;20(4):28–39. 18. Clifton GD, Byer H, Heaton K, Haberman DJ, Gill H. Provision of pharmacy services to underserved populations via remote dispensing and twoway videoconferencing. Am J Health Syst Pharm 2003;60:2577–2582. 19. Focus group on telepharmacy. Am J Health Syst Pharm 2001;58:167–169. 20. http://www.ashp.org/.
