Quality healthcare service usually coincides with access to good hospitals and doctors. However, an important element that is often overlooked in this regard is the availability of high quality pharmacy services. The WHO’s ‘Essential Medicines and Pharmaceutical Policies’ department aims to ensure that ‘people everywhere have access to the essential medicines they need; that the medicines are safe, effective and of assured quality; and that they are prescribed and used rationally’. Transforming this vision into reality requires trained and highly-skilled pharmacists across the globe, which may prove challenging, especially when considering a case such as the US, whose rural communities are facing increasingly high numbers of pharmacy closures. The main factor that has played a significant role in these closures has been the nationwide pharmacist shortage which has raised the salaries of the available pharmacists to a level that is unsustainable for rural communities. As per a recent survey conducted by the California Hospital Association, out of a total 14 allied health positions, pharmacist vacancies were found to have the maximum adverse effect on the overall functioning and efficiency of a hospital.
By using telecommunication and information technology to widen the coverage of pharmacy services to underserved areas, telepharmacy manages to bridge the gaps in the pharmaceutical care to rural communities. In this process, prescriptions issued at the rural hospital are taken by the patient to the pharmacy technician located at the local telepharmacy. The pharmacy technician prepares the prescription for drug dispensing and sends it either by scan or fax to the pharmacist located at the urban pharmacy centre, which is the base pharmacy. The pharmacist at the base pharmacy then accesses the patient’s Electronic Medical Record to check the dosage, drug interactions or possible medication errors that may apply to the patient in question. Once the prescription has been verified, the pharmacist is allowed to authorise its electronic dispensation using an ADD (Automatic Dispensing Device). Video-conferencing may be used in cases where the patient requires a personal interaction with the pharmacist.
Telepharmacy has also proven to help increase cost efficiency: according to a study carried out by Pipeline Healthcare (a California-based provider of telepharmacy services), remote pharmacy consultation services cost 65% less than traditional pharmacy staffing business models.
The following video, available on Medication Review’s YouTube channel, goes over the basics of how the telepharmacy process works in small and mid-sized hospitals across the US:
Due to telepharmacy being a relatively new type of technology, it has had mixed responses across different countries.North Dakota was the first state in the US to establish a successful telepharmacy system. By the end of 2010, North Dakota had 72 established telepharmacy sites, being one of the 20 US states that had implemented this model.
Apart from the rural community hospitals, the US Navy is in the midst of deploying telepharmacy systems at 98 of its worldwide locations. The successful implementation of this strategy in the US has encouraged other countries explore the benefits of this system. The 16th Congress of the European Association of Hospital Pharmacists that took place in Vienna in 2011 provided a lecture focusing on remote pharmacy practice.
The benefits of telepharmacy have also been explored in the UK, when PharmaTrust, a Canadian medical device company, successfully tested the use of remote dispensing machines across 5 hospitals.
Developing countries have also begun to show a trend towards the implementation of this strategy. Ujjeewan Healthcare in India has been exploring options in this field to enable patients to order their medicines either online or by phone. Their services also include ‘Don’t Miss a Dose’, a free telephone medication reminder service. Such reminder services are feasible locally due to the penetration of mobile telephones, which is much higher than the broadband penetration rate.
Unlike doctors and nurses, the role of the pharmacist as a healthcare provider does not show uniformity worldwide, being subject to variations in health and socioeconomic status. Although a pharmacist is expected to counsel a patient on drug consumption at the time of its dispensation, this role is not put into practice in many countries, thereby affecting the quality of healthcare. Whilst in developed countries pharmacies can only be run by a registered pharmacists, many emerging markets such as India do not enforce equally strict regulations.
Putting in place solid and well defined policies that ban the misuse of therapeutic goods has been shown to reduce the widespread OTC (over the counter) sale of drugs such as antibiotics and anti-inflammatories, an issue that is still present in countries such as India and Brazil, where governmental control is loose in this respect.
Telepharmacy has also proven beneficial in restoring and retaining pharmacy services in rural communities with minimal requirements, such as a computer, camera, and a telephone or microphone along with a high-speed internet connection. With the advent of smartphones, tablet PCs and PDAs operating on 3G networks, the future of telepharmacy looks more than feasible. Digitalising the sale of drugs using telepharmacy services can hence serve as an important tool that aids in monitoring the pharmacist’s role and reducing possible medication errors.
