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Remote pharmacy: it’s closer than you think

Technology is enabling pharmacists to work remotely, and might herald a new way of working. 

5 July Cover Image

We’re all familiar with the prefix ‘tele-’ in household words such as television or telephone, but recent years have seen it applied to healthcare, with the rise of telecare, teleheath and telemedicine. By making it easier for people to access medical professionals remotely, these innovations all help to reduce the pressure on health and social care.

The UK government is already supporting initiatives to assess the benefits of telehealth and telecare, including the 3millionlives project announced by England’s department of health in 2012, which aims to offer these services to 3 million people by 2016.

But what about telepharmacy? Some progress has been made in the UK, with a number of hospital trusts implementing telepharmacy as a way of improving the efficiency of their dispensaries. Videoconferencing equipment is used to enable prescriptions to be clinically checked at different departments by a pharmacist working in a single dispensary. This releases other pharmacists to deliver patient-facing clinical services.

In community pharmacy, a system to facilitate remote supervision of the sale and dispensing of medicines was developed and successfully piloted by Bristol-based company Pharmacy Plus back in 2004. But the company never implemented the system because it was unclear whether it would satisfy legal requirements around supervision and personal control and a review of this legislation was planned (see ‘Legal aspects of telepharmacy’).

In the United States, however, telepharmacy has been used for more than a decade.

Dispensing at a distance

Mike Coughlin, chief executive officer of ScriptPro, a specialist in pharmacy automation based in Kansas City, Missouri, says his company went into telepharmacy when the US Department of Veterans Affairs wanted to provide pharmacy services at its outpatient clinics where the workload did not justify having a pharmacy on site.

But the biggest user of telepharmacy is the US Navy’s global health system, Coughlin says. 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 in the United States and around the world. The Navy has only 26 pharmacists, says Coughlin, which meant that before telepharmacy, technicians dispensed prescriptions and pharmacist input was limited to “after the fact reviews”, by which time it was too late to intervene.

Now, technicians or robots prepare prescriptions at a remote site and record images of the process. When a prescription is complete, a pharmacist in a call centre or a support pharmacy is contacted, who checks the images and can communicate by video link to raise queries or give instructions. The pharmacist then authenticates the prescription by entering data, including from the process itself, which are retained in a permanent record, Coughlin explains. Counselling is via a real-time video link and the patient’s electronic signature is attained.

Outside the Navy, telepharmacy is aiding the preparation of sterile products, used in intravenous chemotherapy, for example. The University of Kansas Hospital has a ScriptPro system in which pharmacists use cameras to inspect the process at various points. Telepharmacy also allows pharmacists to verify activities taking place in clean rooms from the outside, eliminating the need to scrub up to enter the isolated area. There is therefore less need for pharmacists to handle empty syringes and vials, Coughlin says.

Remote counselling

One of the main advantages of telepharmacy, however, is that it can connect people in remote communities to pharmacists. Thrifty White is a chain of 91 pharmacies in the Midwest of the United States, often in rural areas, of which seven are telepharmacies — three in North Dakota (the first started in 2003) and four in Minnesota.

“In North Dakota, the towns can be 50 to 100 miles apart and are mainly populated by elderly residents,” says Aaron Jennissen, Thrifty White’s vice-president of pharmacy operations. “By having a telepharmacy, the patients are able to have access to a healthcare professional, as well as pharmacy services, without having to travel a long distance.”

Thrifty White’s telepharmacies are staffed by certified pharmacy technicians who are connected by webcam to a pharmacist in another location. The remote pharmacist can also use the webcam to provide ‘medication therapy management’ to patients who visit telepharmacies, esentially advising them about their medicine’s purpose, dose, administration time and side effects. The telepharmacists can also provide this service to people’s workplaces, and Thrifty White is considering extending it to patients in their own homes over the internet.

“Patients can receive their medicines by mail order and schedule a time to speak to the pharmacist. They only need an internet connection and a computer or tablet,” says Coughlin.

Telepharmacy could be used by UK pharmacists to provide pharmaceutical care or to conduct medicines use reviews (MURs), which give patients the opportunity to discuss their medicines with the pharmacist. Thrifty White already operates a patient care centre (PCC) that provides a similar service, called ‘comprehensive medication reviews’, to patients in its stores. The patient visits the pharmacy and speaks to the PCC pharmacist by webcam, leaving the local pharmacist free to deal with prescriptions and patients. The PCC pharmacists also review patient records to advise the local pharmacist about patients who may need advice or a review when they pick up their prescription. “We have found that we are able to reach a higher number of patients this way,” Jennissen explains. The costs are met by the patient’s insurance company.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065564

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