Expanding Access Takes Telepharmacy to the Next Level

During the COVID-19 pandemic many hospitals and health care services teams turned to telepharmacy to reduce delays in providing medications to patients while social distancing practices were in place.Hospitals quickly found that telepharmacy benefitted pharmacy services by providing patients with more efficient access to medical care and reducing costs. Thus, hospitals were able to focus more on patient care and less on logistics, which led to higher turnaround times and increased patient satisfaction.

Benjamin Kornitzer, MD, chief medical and quality officer of agilon health, noted that telepharmacy and meeting patients where they are can lead to higher-quality health care.

“During the pandemic we saw how challenging it was for a face-to-face encounter, and telepharmacy was a tremendous opportunity to continue offering these vital services to our patients, greatly increasing access to medications and medication adherence,” he said.

Expanding Hours, Locations

Randy Gerwitz, RPh, is pharmacy executive director at Vizient, a health care services company based in Irving, Texas. He notes that telepharmacy has expanded access to pharmacy services for patients, which is why hospital pharmacy teams benefit from implementing telepharmacy models into their workflows.

“There is a well-established history of operational benefits from these technologies remotely supporting common tasks such as prescriber order verification and the monitoring and verification of IV [intravenous] room production activities,” he said.

More recent efforts have focused on direct-to-patient and clinical services, including patient education, monitoring, and adherence support, as well as antimicrobial and opioid stewardship programs.

“These types of enhanced clinical offerings improve patient safety and allow [pharmacists] to reach patients that they may not have otherwise been able to care for,” Gerwitz said.

Ann Phan, PharmD, BCGP, manager of clinical programs for L.A. Care Health Plan in Los Angeles, California, said that telepharmacy in the inpatient setting allows a hospital’s pharmacy services to extend coverage, both temporarily and geographically.

“In this sense, rural and small-volume hospitals with limited resources could especially benefit from telepharmacy,” she said. “The benefits of telepharmacy can lead to expansion of service hours if [a location is] not already providing around-the-clock coverage, more available clinical pharmacy services, and improved safety and overall patient care.”

According to Seun Bammeke, managing director of PharmaServe in Winnipeg, Manitoba, telepharmacy can increase patients’ medication adherence. Additionally, these services allow an external licensed pharmacist to review and double-check the prescription to ensure it is correct, which can ease the workload of busy hospital pharmacists. He added that telepharmacy needs to be taught about from a return on investment (ROI) perspective as well, with plenty of savings available.

“Hospital pharmacies would require [fewer] pharmacists and technicians as a lot of the duties will be outsourced to the telepharmacy,” Bammeke said. “Plus, by using a JIT (Just In Time) system, the hospital can maintain less stock of medications [that] are not used on a daily basis, knowing they will arrive the next day. This prevents medications from expiring [or] being stolen, and [means] less work in process inventory, which frees up their finances to be used on things that are more needed.”

Pros and Cons

Eric Maroyka, PharmD, senior director of the Center on Pharmacy Practice Advancement at the American Society of Health System Pharmacists (ASHP), said telepharmacy has grown exponentially over the past year.

“We see it as an opportunity to improve patient outcomes, expand access to health care—whether it’s an acute or ambulatory care setting—and find that it’s also a way to enhance patient safety. It could in many ways achieve more effective delivery of care as well,” he said.

According to Maroyka, hospital pharmacy teams can benefit from implementing telepharmacy models into their workflows for medication selection order review. Dispensing the IV admixture verification can be done remotely. For instance, if you have a technician in a clean room, there could be a pharmacist who is working remotely to help with that verification process.

Then there are patient monitoring and counseling benefits. Maroyka explained that health systems that employ clinical pharmacy specialist can have them reach out to smaller facilities to provide patient counseling or consultations and real-time monitoring through telehealth services.

“It’s a solution for order review
and verification in tertiary medical centers when staffing—particularly in specialty areas [such as] oncology or pediatrics––is limited and provides a mechanism for health systems to provide enterprise-level pharmacy services throughout the system, even when those pharmacies may not operate 24-7,” he said.

It also provides a tool for virtual monitoring, assessment, detection, and decision-making for adverse drug reaction prevention and management. One major advantage, Phan noted, is the positive ROI produced by telepharmacy in decreasing pharmacy operating costs and repurposing pharmacists to other clinical services to improve patient outcomes, such as discharge medication counseling or antimicrobial stewardship.

Another advantage is increased accessibility. For instance, Gerwitz explained that telepharmacy allows the pharmacist to provide services in locations that are inefficient, impractical, or unfeasible.

“This is particularly true for services provided to at-risk populations and in rural or remote areas where distance and population density would make it impossible to pro- vide care in a way that is convenient for the patient and financially sustainable for the health care organization,” he said.

A disadvantage is patients’ dependence on technology and broad- band access.

As many learned and experienced during the pandemic, technologies and the internet ser- vices that support them are not always perfect. Gerwitz said glitchy connections, lag, and band- width challenges can at times cause frustration.

During the pandemic, the industry saw more widespread adoption of regulations that allow and even encourage the use of telemedicine and telepharmacy, but challenges still exist.

“The lack of a standardized regulatory environment and limitations on what pharmacy technicians can do under remote supervision in many states will continue to act as an obstacle to optimization of these technologies,” Gerwitz said.

Innovative Technology

There are plenty of new technologies available to help with a smoother transition and workflow.

Video conferencing has become a standard tool for telepharmacy to provide discharge medication counseling and medication therapy management.

Thankfully, systems have dramatically improved in recent years. Further maturation of technology and expanded access to broadband will continue to push the boundaries for telepharmacy, particularly in rural areas that struggle with access to health care.

“Certainly, video conferencing has existed for some time, but not always in a secure and compliant environment that was appropriate for the health care environment.,”Gerwitz said. “[Video communication] is especially beneficial when supporting patients on highly specialized therapies such as those seen in posttransplant care and oncology but can be very helpful as well in the setting of postdischarge medication reconciliation and home care.”

A graduate of the University of Miami, Keith Loria is a D.C.-based, award-winning journalist who has been writing for major publications for close to 20 years.