In 2018, an article in Perspectives in Health Information Management, the research journal of the American Health Information Management Association, stated the following: "Telepharmacy may have significant potential to transform the delivery of pharmaceutical services."
Two years have passed, and we believe that telepharmacy is already beginning to have such a substantial impact. We expected this would be the case but thought it may take a little longer. Then the COVID-19 pandemic came along and rapidly accelerated the adoption and embracing of telehealth disciplines, including telepharmacy.
Accelerated may be putting it lightly. The U.S. Department of Health and Human Services recently noted that an internal Centers for Medicare & Medicaid Services analysis found that before the public health emergency, an average of 14,000 beneficiaries received a telehealth service in a week. During the period from mid-March through early-July 2020, more than 10 million beneficiaries received a telehealth service. While we lack data on how many of these services could be classified as telepharmacy, many undoubtedly included telepharmacy services.
As a prior blog discussed, common types of telepharmacy services include medication therapy management; medication selection, order review, and dispensing; patient counseling and monitoring; drug review/monitoring; verification of oral and sterile compounding; and patient assessment.
Why is telepharmacy rapidly growing in popularity? It delivers substantial and tangible benefits that, most importantly, improve patient care. Here are four of the top telepharmacy benefits.
1. Expanded access to pharmacy services
Telepharmacy dates back to the early 2000s when the North Dakota State Board of Pharmacy saw that the state's rural communities had lost more than two dozen of their community pharmacies and more communities were at risk of losing their pharmacies. The board established pilot rules for telepharmacy, which led to a successful pilot program and then permanent rules permitting telepharmacy to be practiced on a broader scale.
Understanding the roots of telepharmacy helps you appreciate one of the most significant benefits of the discipline: expanding access to the essential pharmacy services listed above and others for areas and people lacking access. While this often applies to rural and remote locations, it can also apply to individuals who are physically unable or should not travel to a pharmacy or meet in person with a pharmacist. The latter is particularly timely. People with certain underlying medical conditions that place them at increased risk for severe illness from COVID-19 are advised to limit interactions with other people as much as possible. Telepharmacy is allowing many people in this situation to receive pharmacy services without increasing their risk of exposure by meeting with a pharmacist.
2. Increased medication adherence
The Agency for Healthcare Research and Quality has published a chart identifying common barriers to medication adherence. The approach it takes is to explain what patients may say as reasons they struggle with medication adherence and then share suggestions to address these reasons. While there is some sound advice provided in the chart, it fails to mention telepharmacy even though it can effectively help patients overcome many of the barriers listed.
For "My medicine makes me feel sick," patients who know they can receive assistance via telepharmacy rather than needing to make a trip to a pharmacy may be more motivated to seek assistance faster. That same logic can be applied to three other quotes: 1) "I can't afford my medicine. I only take half a pill a day to save money;" 2) "I can't understand these instructions;" and 3) "There are so many pills. I can't keep them straight! It's too complicated." Knowing that help, potentially in the form of pharmacist counseling (which is highlighted in the chart), is just a phone call or video conference away (rather than a car ride or trip on mass transit) may be the difference between a patient's regimen undergoing changes that help improve adherence versus maintaining a regimen that's not conducive to adherence.
We've already explained how telepharmacy helps patients with "I can't get to the pharmacy": Telepharmacy eliminates the need for an in-person discussion about a patient's regimen. And considering most pharmacies now deliver medications, there is no need for patients to go to the pharmacy to pick up their prescriptions, which further addresses that challenge.
Two other benefits associated with telepharmacy can also help improve adherence: increased patient satisfaction and cost savings. When patients can access and receive positive support and timely information from pharmacists, which can be delivered effectively via telepharmacy, adherence is likely to improve. As a study on pharmacist monitoring on patient satisfaction with and adherence to antidepressant medication therapy published in Journal of the American Pharmacists Association notes, "Pharmacists can play a critical role in monitoring medication concerns at the beginning of use, allowing for problem solving, reinforcement, and greater patient satisfaction with and adherence to medication therapy."
With cost considered one of the most significant drivers of medication non-adherence, the savings achieved by reducing or eliminating travel to a pharmacy can help patients better cover expenses, including those associated with their medications.
3. Extending pharmacy support
While many of telepharmacy's benefits apply to patients, healthcare providers benefit as well. One way is through the ability of organizations to leverage telepharmacy to extend pharmacy coverage and support.
For example, some hospitals do not offer 24-hour pharmacy services. A 2012 national survey of hospitals conducted by the National Association of Boards of Pharmacy found that roughly one-third of hospital pharmacies lack such coverage. As an Integrated Pharmacy Research and Practice article notes, "Telepharmacy acts as a potential alternative to around-the-clock on-site pharmacist medication review for remote hospitals. …The emerging electronic health information systems and related technologies, such as fax, and electronic health records make information more readily available to pharmacist for review before a dose is available for administration to a patient. These technologies are advancing telepharmacy services and enabling pharmacist to contribute efficiently in improving medication use."
Other hospitals provide 24-hour coverage but with reduced staffing during slower hours (e.g., overnight). Then there are those hospitals that maintain consistent 24-hour coverage but do so with a lean staff. Telepharmacy can provide off-hours support to hospitals that take the former approach and can provide surge support or fill in when short staffing occurs for hospitals that take the latter approach. As the American Society of Health-System Pharmacists' notes, "Telepharmacy also provides a solution for order review and verification in tertiary medical centers when staffing, particularly in specialty areas such as oncology and pediatrics, is limited (e.g., due to attrition or staff turnover), creating a mechanism for health systems to provide enterprise-level pharmacy services throughout the system even when not all pharmacies operate 24 hours per day."
4. High level of quality pharmacy services
For our final benefit, we'll argue against what we consider to be a myth about telepharmacy: reduction in quality and safety compared to traditional community pharmacies. Not only does telepharmacy provide the benefits described above and many others, but a multi-year study found that at pharmacies relying on telepharmacy services, pharmacists were more likely to find medication dispensing errors during a final medication check than at standard community pharmacies.
This study was performed a number of years back. Since then, technology has greatly improved. This includes technology to help pharmacists identify errors and better support patients (e.g., medication counseling, adherence management, medication reconciliation, drug therapy monitoring) as well as technology used to communicate with patients. Telepharmacists can leverage a wide range of audio and video solutions to interact with patients and clinicians, most of which do not require special equipment or a significant investment.
Therefore, there is reason to believe that the quality of telepharmacy services has also improved and will continue down this path as telehealth becomes even more commonplace. We believe it's safe to say that the level of quality services delivered via telepharmacy generally compares favorably or at least equally to in-person services.
Obstacle to Success: Lack of Provider Status for Pharmacists
This blog has only scratched the surface of the many ways telepharmacy can and is helping improve healthcare. And yet there remains a significant barrier to maximizing these advantages and their reach: lack of provider status for pharmacists. We're on the record stating that we believe granting provider status for pharmacists is a much-needed change and one that would have far-reaching benefits, including "unleashing the power" of telepharmacy.
If you are interested in learning about why granting pharmacists with provider status is in the best interest of patient care, please read two of our recent blogs on the subject: the first on how pharmacists as providers would add value during this health crisis and the second on how it would add value following the pandemic.