Telepharmacy reaches out to the underserved

Not so long ago, medically underserved rural communities had only limited options, if any, when need arose for healthcare services and pharmaceutical support. That situation is finally changing, as necessity and technology converge in emerging applications of telepharmacy, the delivery of pharmaceutical care by means of telecommunications and information technologies to patients at a distance from large, usually urban tertiary healthcare centers.

Telepharmacy also provides nighttime pharmaceutical services to community hospitals. A few years ago, Sibley Memorial Hospital in Washington, DC, could not support a pharmacist to review medication orders for high-risk drugs (such as antibiotics, anticoagulants, antiplatelet agents, narrow therapeutic index drugs, and drugs with many potential interactions) during the night shift, so the hospital turned to telepharmacy. Once the service was implemented, nurses faxed new inpatient orders to clinical pharmacists and technicians, who reviewed these orders much as the hospital’s own pharmacy staff would have done during the day; the difference was that the nighttime pharmacy professionals were located at a remote site. Before administering medications, nurses waited for the pharmacists to review and confirm the orders. Pharmacy consultations and requests for drug information were also handled by telepharmacy during the night shift.

More recently, the Veterans Administration adopted telepharmacy practices in order to reduce costs and to remotely link patients as needed to centrally located pharmacies.

Another initiative, the North Dakota Telepharmacy Project, is a collaborative effort between the North Dakota Board of Pharmacy, the North Dakota Pharmacists Association, and the College of Pharmacy, Nursing, and Allied Sciences at North Dakota State University. In rural southeastern North Dakota, where initial testing of telepharmacy took place, seniors had been resorting to mail-order pharmacy. Now they have a community pharmacy, staffed by a pharmacy technician, and they use an internet connection to speak with a pharmacist located at a remote site. Under this model, a licensed pharmacist is located at a central pharmacy. Video conferencing enables the pharmacist to supervise a registered pharmacy technician at a remote pharmacy site. After preparing the prescription, the technician shows the pharmacist the original signed prescription, the computer-generated label, the stock bottle where the medication is stored, and the bottle the patient will take home. The drug is then dispensed and the patient has mandatory “face-to-face” counseling with the pharmacist by means of real-time audio and video.

To ensure the delivery of safe, high-quality pharmaceutical service and care, pharmacists provide drug utilization review, prescription verification/validation, and patient counseling. The latter 2 services are often omitted when a patient uses a mail-order or internet pharmacy. In 2001, North Dakota was the first state to pass administrative rules allowing retail pharmacies to operate remotely without requiring a pharmacist to be present. As of September 2008, North Dakota had 67 pharmacies, of which 44 were retail pharmacies and 23 were hospital pharmacies. Of these, at least 22 were central pharmacies and 36 were remote sites served by telepharmacy, according to Charles D. Peterson, PharmD, dean, professor, and principal investigator/director of the North Dakota Telepharmacy Project. The telepharmacy sites are full-service, with drug inventories that include over-the-counter drugs and other merchandise.

“Over 40,000 rural citizens have had pharmacy services restored, retained, or established through the North Dakota telepharmacy project,” said Dr. Peterson. “It has also added more than $12.5 million annually in economic development.” In addition, this project has created at least 40 to 50 new jobs.

In Anchorage, the Alaska Native Medical Center (ANMC) uses telepharmacy to improve prescription drug access and pharmacy services for rural patients whose villages are spread over 2,000 miles. The program employs an electronic medical record and prepackaged, bar-coded medication and prescription labels, as well as innovative software, videophones, and automated dispensing machines. The network began with 12 remote clinics and has since expanded. In 2006, the ANMC telepharmacy received an award for excellence in medication-use safety from the ASHP Research and Education Foundation.

As of September 2008, the states of Alaska, Idaho, Illinois, Montana, South Dakota, Texas, Utah, Vermont, and Wyoming, as well as Washington, DC, had changed their laws to permit establishment of remote pharmacies.