Telehealth Models for Increasing Access to Pharmacy Services
Rural communities are using telehealth to increase access to pharmacy services. Referred to as telepharmacy, this model helps rural communities overcome common challenges to practicing pharmacy, including financial difficulties related to low volumes of patients and a limited ability to recruit qualified pharmacists. Telepharmacy models can help rural communities retain, restore, or gain access to timely pharmaceutical services.
Telepharmacies can be implemented in retail, outpatient, mobile, or hospital settings. A typical telepharmacy involves a fully licensed pharmacist at a remote site who provides consultations and supervision to a pharmacy technician or nursing staff at a rural site. The pharmacist verifies prescriptions, assesses the appropriateness of the dose, and asks for clarifications before approving the order. The technician and pharmacist communicate through telephone, videoconference, electronic health records, or another form of secured electronic connection.
Many programs also use telehealth to record images of the prescription, medication, label, or prepared bottle for additional review by the pharmacist.
Another key component of telepharmacy is patient counseling and education. Many telepharmacy programs require pharmacists to conduct a live-video consultation with the patient prior to releasing a prescription. In some telepharmacy models, especially those located in hospitals, the rural site is equipped with an automated dispensing unit that contains prepackaged doses of medications.
Examples of Rural Telepharmacy Models
- The North Dakota Telepharmacy Project provides pharmacy services to rural and frontier communities across the state. A pharmacy technician prepares prescriptions and obtains approval from a pharmacist through videoconference to dispense the medication. In order to receive the prescription, the patient must first receive patient counseling from the pharmacist through videoconferencing. Telepharmacies have served 80,000 rural residents of North Dakota and contributed to economic development in rural communities.
- The Idaho State University College of Pharmacy has a telepharmacy project that serves rural towns in eastern and northern Idaho. The program engages pharmacy students and pharmacists to counsel patients on their medications. Patients in rural pharmacies can meet with pharmacy students and pharmacists through a live-video feed or over the phone.
- The Nebraska Medical Center Telepharmacy Service connects rural hospitals to remote pharmacists. Rural hospital staff fax medication orders to the pharmacists, who review the patient's electronic medical record to verify the prescription and review the patient's medical history before approving hospital staff to dispense the prescription.
- The TelePrEP program is using telepharmacy to expand access to Pre-Exposure Prophylaxis (PrEP) medication to rural Iowans who are at risk of contracting HIV. Patients use an mHealth application on their smartphone or other televideo technology to meet with a pharmacist from the University of Iowa Health Care system. The pharmacist counsels the patient and prescribes a PrEP regimen. Pharmacists hold periodic follow-up calls with patients through telehealth in order to ensure that patients are managing their medication appropriately.
There are 23 states that explicitly allow the use of telepharmacy and 11 additional states with laws or regulations that permit waivers or pilot programs to implement telepharmacies. Telepharmacies are commonly restricted to certain geographic locations and types of facilities. For example, telepharmacies in Louisiana must be located at least 20 miles away from another pharmacy. States may also strictly regulate staffing and supervisory models for telepharmacies. Rural programs should review pharmacy regulations in their state to assess any requirements that would prevent the use of telepharmacy, including physical supervision of pharmacy technicians.
Telepharmacy models may require substantial investments in health information technology infrastructure. For example, some telepharmacy programs require pharmacists to access electronic health records in order to verify prescriptions and review pertinent medical information. Telepharmacy may also involve digital cameras for capturing images of prescriptions and real-time videoconferencing technology for patient counseling. Rural programs may need to seek grant funding to implement telehealth technologies to conduct telepharmacy. For example, the North Dakota Telepharmacy Project used funding from the Office for the Advancement of Telehealth to purchase telepharmacy equipment for pharmacy sites in rural North Dakota.
The North Dakota Telepharmacy Project offers several resources for rural communities interested in implementing a telepharmacy project, including a consumer satisfaction survey to assess pharmacy services among community members. NDTP also provides a comprehensive technical assistance document with step-by-step guidelines and implementation considerations for rural programs. Other resources include sample policies and procedures for establishing telepharmacy contracts and agreements.
Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Funding & Sustainability.
Program Clearinghouse Examples
Resources to Learn More
How Retail Telepharmacy Works
Reviews four key steps involved in retail telepharmacy: transmitting prescription information to pharmacist, capturing high-quality images of the drug and prepared prescription, verifying the prescription, and providing counseling to patients.
Implementation of Telepharmacy in
Rural Hospitals: Potential for Improving Medication Safety
Describes telepharmacy initiatives at a broad range of rural hospitals in 2008. Discusses the implications of telepharmacy on medication safety for rural patients.
Author(s): Casey, M., Elias, W., Knudson, A., & Gregg, W.
Organization(s): Upper Midwest Rural Health Research Center
Rules and Statutes: A 50-State Survey
Identifies rules and statutes for all 50 states that regulate the use of telepharmacy in the U.S. Discusses the implications of telepharmacy for increasing access to care in rural communities.
Author(s): Tzanetakos, G., Ullrich, F., & Mueller, K.
Organization(s): RUPRI Center for Rural Health Policy Analysis