TELEPHARMACY
Name: Monideepa Dey
M.Pharm (1st Semester)
Department: Pharmaceutics
Roll No.:10
Netes Institute of
Pharmaceutical
CONTENTS
Introduction to Telepharmacy
How Telepharmacy Works?
Types of Telepharmacy
Types of Telepharmacy Models
Telepharmacy in support to clinical services
Telepharmacy in remote education and handling of “Special
pharmacies”
Telepharmacy in prescription and reconciliation of drug therapies
Advantages and Disadvantages
Conclusion
TELEPHARMACY
• Pharmacist along with the dispense of medication, can also advice on drug
assumption regimen and also provide pharmacovigilance services.
• Telepharmacy adopted to provide pharmaceutical services to underserved
areas and to address the problem of pharmacist shortage.
• The National Association of Boards of Pharmacy defines “Telepharmacy” as
“The provision of pharmaceutical care through the use of
telecommunications and information technologies to patients at a distance”.
• Typical services of Telepharmacy include medication order evaluation,
dispensing and compounding, drug information services, patient counselling,
and therapeutic drug monitoring.
• Telepharmacy employed the art of technology that enables a qualified
pharmacist in a central location to supervise a pharmacy assistant or a
pharmacy technician at a remote location during pharmaceutical dispensing
via audio and video computer interfaces.
HOW TELEPHARMACY WORKS?
An isolated area where hospital, pharmacy or clinic is present. They are
connected to a commonly utilized service model in larger urban area center
which has greater access to pharmacist staff. The connection is being made
possible through videophone systems, novel software, and automated
dispensing machine
Rural area is usually staffed by either pharmacy technicians or nurses,
depending on whether the site is a pharmacy or a clinic.
Telepharmacy helps to communicate the prescriptions (either through fax)
collected from patients the one who is staffed report to the central site, it is
reached to the qualified pharmacist.
Central pharmacist reviews the prescription and release the appropriate
items at the ruralareas (prepackaged medication from the automated
dispensing machines) and then label.
The pharmacy technician or nurse at the rural area scans the bar code so
that the prescription matches with its label, attaches the label, and supplies
it to the patient.
At process end the central pharmacist provides a two-way video consultation
for the patient to ensure that they understand the intended medication use
and administration.
Automated dispensing machines, as difficult to afford so an alternative
technique is developed where a technician under the videoconference
supervision of a central pharmacist at a distant location prepares medication
for dispensing, repackaging, and relabeling.
TYPES OF TELEPHARMACY
Inpatient
(Remote IV
Order-Entry admixture
Review)
Remote Dispensing
Remote
(Retail/ Outpatient/
Counseling
Discharge)
Inpatient (remote order-entry review)
Inpatient telepharmacy is when a pharmacist at a remote location provides
remote order entry services for a hospital's inpatient pharmacy. The remote
pharmacist reviews medical orders before the hospital personnel administer the
drug to the patient.
Uses-Inpatient telepharmacy benefits the hospitals and health systems by
allowing them to evaluate and verify prescription orders in real time. Remote
order-entry review in a health system functions as an extension of the in-house
pharmacy. Inpatient telepharmacy allows remote pharmacist to provide 24/7
coverage or fill-in during peak hours, supplementing and strengthening the
inpatient pharmacy.
Remote dispensing(Retail/
outpatient/discharge)
A remote-dispensing site, also known as a retail community telepharmacy, is a
registered pharmacy staffed by one or two qualified pharmacy technicians
(depending on volume). A pharmacist supervises the technician, reviews
prescriptions, and perform his or her responsibility from remote location using
technology.
Uses-Telepharmacy, which is commonly employed in retail community pharmacies
and outpatient/discharge pharmacy settings, provides patients with convenient
access to a pharmacist and prescription medication regardless of their geographic
location. Remote dispensing enables healthcare organisations to establish retail
telepharmacies in places where a traditional pharmacy would be impractical by
spreading the expense of a pharmacist over numerous stores. Furthermore,
telepharmacy reduces readmission rates by improving patient adherence,
improves financial performance, and provides a better patient experience
IV admixture
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
defines IV admixture as, “the preparation of pharmaceutical product which
requires the measured addition of a medication to a 50 mL or greater bag or
bottle of intravenous fluid.”
Uses-Hospital pharmacies can save time and money by integrating telepharmacy
in the IV-admixture process. A pharmacist can save time by reviewing the IV
admixture remotely, rather than having to suit up and enter the cleanroom to do
so. This is freeing up chemists' time which allows them to concentrate on clinical
activities and other revenue-generating responsibilities. Implementation of
image-based telepharmacy workflow in a cleanroom allows you to document
each stage of the procedure and reduces errors.
Remote counseling
Remote-patient counseling equates to pharmacists providing patient counseling
via a live-and-interactive video session, or by some means through
telecommunications.
Uses-Remote-patient counselling enables chemists to consult with patients and
deliver a variety of pharmacy-care services using secure, live video chats.
Remote counselling not only benefits retail independents, community, clinic, and
hospital-based pharmacies, but it also allows for speciality counselling
(diabetics/HIV/AIDS), discharge counselling, and numerous clinical contacts with
pharmacists.
Types of Telepharmacy Models
Traditional full-service pharmacy- This telepharmacy model
encompasses services such as filling prescriptions, medication reviews, and
patient counseling. These telepharmacy sites have complete drug
inventories that include prescription and over the counter medications
along with other health and beauty aids and other general merchandise.
Remote consultation sites-Prescriptions are prepared at the central
pharmacy and are delivered to the rural sites. Audio and video computer
interfaces are used to deliver patient education and counseling.
Hospital telepharmacy- Hospital pharmacist in urban medical center
reviews and verifies the prescriptions that are issued in rural areas and
through technology medium it is sent from rural hospitals. Automated
dispensing machine (ADM) is used to electronically release the
prepackaged medication. A nurse or pharmacy assistant at rural end
double- checks the label and medication prior dispensing them to patients.
The pharmacist from central (urban) location monitors the verification
process and involves in consultation between the patients, nurses, or
physicians when required via videoconference link.
Automated Dispensing Machine-Pharmacist at a central location upon
receiving drug order (electronically or by fax) confirms the patient profile,
conducts proper drug utilization review, and finally instructs the
Automated Dispensing Machine to release the medication. Through the
involvement of audio and video computer links, patient counseling is being
conducted.
Telepharmacy in support to clinical
services
Medication Adherence
The Pharmacological Intervention in Late Life (PILL) program is a service
developed for in rural area of United States to help them to follow prescriptions
adherence after hospital discharge. PILL is being designed
to make easier patient medication management through assisting the patients
with pharmacist telephone calls. (United States)
Clinical Pharmacist Shortage
Clinical pharmacists are healthcare practitioners trained to ensure medication-
related assistance to
hospital personnel and patients. The access to this service in rural and/or remote
areas is a challenge for
health systems. The hospital assigned a remote pharmacist intervention to
support underserved hospitals with proper pharmacist assistance for safe
treatments to hospital inpatients due to this telepharmacy plays a important role.
Pharmaceutical Counselling Activity
Home drug delivery (HDD) is a recent method of delivering medications to
patients' homes or workplaces. This saves time and money for individuals
undergoing prolonged pharmacological treatment and frequent visits to a
pharmacy or a hospital to obtain their medications. HDD is particularly useful in
rural or geographically dispersed places. This included remote chemist advice for
patients who ordered medications online or got them at home. Community
chemists provided counselling primarily through phone or video calls. To ensure
sufficient therapy is achieved. (Spain and Denmark)
Telepharmacy in remote education and
handling of “Special pharmacies”
Medical Staff Training and Patient Education
Telepharmacy training has been established in the hospitals from hospital to
hospital via
videoconferencing (USA, Egypt). Telepharmacy approaches were also used
applied to educate patients suffering from diseases to improve medications
use and adherence to treatment.
Remote Surveillance of Anti-Neoplastic Medication Preparation
Telepharmacy was used to supervise the preparation of anti-neoplastic
medications. With this
approach a remote pharmacist controlled the activity of technicians via a
camera system during
anti-neoplastic treatments preparation. Cameras were placed outside the
working area to avoid contamination of preparations. This intiative is an
approach towards preparation of oncological treatment (France, Canada).
Control of Medicine Chests in Seagoing Vessels
Merchant (cargo) ships do not carry on board qualified health personnel. Medical duties
(including
ship pharmacy maintenance) belong to the responsibility of the ship’s captain or of
another officer he
has assigned. Supervision and maintenance of the ship pharmacy (named ship’s medicine
chest) is
difficult due to the limited pharmacological/pharmaceutical skills of ship officers. The
PARSI software,
developed by the International Radio Medical Centre (Centro Internazionale Radio-Medico,
C.I.R.M.)
in Rome, makes easier to check and control the proper care of the ship pharmacy by a
pharmacist
ashore. The software includes two sections: medicines and medical devices. The software
registers
medicines and medical devices withdrawn and sends a warning if replacement is needed. A
feature
of PARSI is that it does not require an internet connection to work it is an advantage as
due to presence of unstable network.
Telepharmacy in prescription and
reconciliation of drug therapies
In 2010, the Catholic Health Initiatives (CHI) in partnership with the North
Dakota Telepharmacy Project (NDTP) started a project designed to create a
Central Order Entry (COE) site in Fargo. The purpose of this service was to
check prescriptions in medically underserved rural communities. In this project
the fuction of the pharmacist is that reviewing prescriptions, oversees
medication preparations, performed remote order entry. Activity was followed if
necessary by teleconsultations with nurses, physicians, pharmacy technicians
and patients.
In California (USA), from an analysis assessed that review of medication orders
in remote areas of
three small community hospitals lacking a 24-h pharmacy service. The service
provided a review
of medication orders before dispensing drugs from an automated cabinet and to
prevent eventual
medication-related problems. The nurses in charge of treatment administration
could contact a
A community hospital in Washington (D.C.,USA), has realized that providing to
patients partially handwritten and not enough verified discharge medication list
cannot guarantee safe pharmacotherapy. Therefore they have requested the
introduction of a telepharmacy service for medication reconciliation. These
introduction led to support onsite clinical pharmacists to ensure availability at
any time.
The unavailability of a 24-h pharmacy service means that patients do not have
the opportunity of receiving a continuous prescription check service if need
arises. In this aspect, telepharmacy can provide 24 hour availability of service.
In study of North Dakota, a study has demonstrated that videoconferencing
supervision by a pharmacist is effective for avoiding mistakes by technician
staff in remote areas.nHence, telepharmacy could represent a relevant
approach to deliver and ensure a proper pharmacy
service in remote sites
A Telepharmacy Robotic Supply Service (TPRSS) was implemented in a rural
area in North-east
Scotland, to supervise drug dispense by using a videoconferencing system. In
this there is direct interaction between the patient and the remote pharmacist
ADVANTAGES
• Enhanced Clinical Role of Pharmacist
• Improved Patient Adherence
• Patient Satisfaction
• Effective Patient Counseling
• Minimal Shortage of Pharmacist
DISADVANTAGES
• Security
• Plenty of Time, Effort and Money
• Inability to use Technology
• Practical challenges
CONCLUSION
The adoption of telepharmacy can represent a solution to
the problem of pharmacist shortage and can contribute to
a proper pharmaceutical assistance in rural areas. The
adoption of telepharmacy represent a challenge involving
different aspects; in the cooperation between public and
private sectors as well as scientific institutions and
academia which is of paramount importance to obtain
relevant results and an effective improvement in
healthcare.
REFERENCES
• Baldoni, S.; Amenta, F.; Ricci, G. Telepharmacy Services: Present Status and Future Perspectives: A
Review. Medicina 2019, 55 (7), 327. https://doi.org/10.3390/medicina55070327.
• https://blog.telepharm.com
• Poudel, A.; Nissen, L. Telepharmacy: A Pharmacist’s Perspective on the Clinical Benefits and
Challenges. Integrated Pharmacy Research and Practice 2016, Volume 5 (5), 75–82.
https://doi.org/10.2147/iprp.s101685.
• Le, T.; Toscani, M.; Colaizzi, J. Telepharmacy: A New Paradigm for Our Profession. Journal of
Pharmacy Practice 2018, 33 (2), 176–182. https://doi.org/10.1177/0897190018791060.
