BETHESDA, MD 18 March 2013—Pharmacists in different care settings are finding ways to make telepharmacy work in ways that improve patient care and make health care spending more efficient.
A telepharmacy program based in Connecticut saved nearly $300,000 in projected health care service costs for 96 elderly Cambodian Americans in Connecticut and California who received medication therapy management (MTM) services from the program, said Thomas E. Buckley, assistant clinical professor at the University of Connecticut School of Pharmacy.
The program sent local community health workers, who had a trusting relationship with the Cambodian Americans and spoke their language, into the patients' homes. Each health worker used a laptop to set up a secure, remote audiovisual link to a pharmacist and served as an interpreter so that the patient and pharmacist could communicate effectively.
The telepharmacy services were provided to 53 patients in Connecticut and 43 in California. Buckley said he and four other pharmacists performed the MTM services, which typically required multiple remote encounters over a six- to nine-month period. The pharmacists identified a total of 604 medication-related problems and resolved 93% of them.
Funding for the program was provided by the Connecticut Pharmacists Foundation, Khmer Health Advocates, Friends of Mount Carmel, and the pharmacy school.
Cambodian survivors of the Khmer Rouge regime began emigrating to the United States in the late 1970s and formed communities in New England, California, and elsewhere. Buckley said Cambodian Americans often have poor health and limited access to health care services, and they may initially distrust the health care system.
The telepharmacy program, he said, was really about "bringing in technology to an isolated population to give them the best service they can possibly get."
And, he noted, the patients easily grasped the technology and were comfortable with it. Many, he said, had used webcams and Internet services for years to communicate with family members still in Cambodia.
"Sometimes we have a stereotype of, 'I can't use technology services for a particular patient population.' You have to break through those biases," he said.
Amy Busker, a geriatric pharmacist with Edina, Minnesota-based Fairview Partners, was initially worried that her elderly clients would be uncomfortable receiving MTM services remotely.
"But they basically think it's really neat," she said.
Busker provides remote MTM services to community-living seniors, with an initial focus on patients with diabetes or heart failure. She said the project took off in 2011 and was an outgrowth of an earlier pilot program involving residents of Fairview Partners' assisted living facilities.
At the assisted living facility, she said, a kiosk was set up to provide remote access to interpreter and nursing services, as well as Busker's MTM services.
For the newer project with patients in the community, Busker uses a laptop with a webcam to communicate with her patients and help solve their medication-related problems. She works with the patients' case manager to coordinate care.
Busker said the remote technology has allowed her to establish strong personal relationships with her patients without them having to leave their homes. And since the patients don't need to travel to a clinic to see her, they can more easily keep their appointments.
"I don't have patients not showing up because they did not want to go out. That was always a barrier in the clinic, especially with older patients, especially in the middle of winter in Minnesota," she said.
Busker maintains a spreadsheet to collect data on the interventions she performs. Her initial estimate after 72 encounters with 38 patients is that her efforts saved about $720 per encounter through the avoidance of hospitalization and emergency-room visits, laboratory tests, and office visits and by the reduction in drug expenditures.
That data convinced Fairview Partners to expand the program to additional patients, she said, adding that she expected to begin recruiting new clients soon.
"There are a lot of patients out there who maybe have not been able to have access to the MTM, and they'll be able to get that," she said. "It's another way for us to reach more people."
Busker said she is able to bill for services she provides to patients covered by Minnesota Senior Health Options, the state's medical assistance program for low-income Medicare beneficiaries.
Helen Kasimatis, clinical pharmacy program manager for Veterans Integrated Service Network (VISN) 12 in Westchester, Illinois, expects telepharmacy to be a "huge" enterprise within the Department of Veterans Affairs (VA) in the next few years.
VISN 12 started a clinical video telehealth (CVT) program in 2011 to serve veterans in the Great Lakes region, which is home to seven VA medical centers and 33 outpatient clinics. Through 2012, the CVT model placed clinical pharmacists at four medical centers, where they spent part of their day providing real-time remote care to veterans at VA's outpatient clinics.
Kasimatis said VISN 12 clinical pharmacists logged more than 1000 CVT encounters from 2011 through late last year. She expects that number to grow soon, since VISN 12 recently obtained funding for a full-time CVT pharmacist to serve patients at clinics affiliated with three medical centers.
"The services that we provide are similar to what we would provide in our face-to-face visits in ambulatory care," Kasimatis said. "In general, we follow disease states such as diabetes, hypertension, hyperlipidemia, asthma, smoking cessation, thyroid abnormalities."
More specialized CVT services are sometimes performed by pharmacists, including psychotherapy and heart failure management, she said. And one site in VISN 12 plans to offer infectious diseases pharmacy services through CVT, with a focus on hepatitis C therapy.
Kasimatis said offering CVT clinical pharmacy services through VA's outpatient clinics provides veterans with care that would otherwise only be available to them at VA medical centers.
"No matter what their distance is from the main VA hospital, we just felt that each patient should be able to get these types of services," Kasimatis said.
She plans to collect cost-savings data for the remote services after the full-time CVT pharmacist is established at VISN 12.
Kasimatis encouraged pharmacists to think creatively about remote services and other new ways to help patients and expand the role of the profession.
"When I started this, people were saying it's just going to be impossible to coordinate," she said. "And it really isn't; as long as you work together and try to figure out the best way to accomplish it, you can accomplish the goal in the end."