Sunday, November 24, 2024
Virtual Heart Care
Telehealth 

Telepharmacy: A Systematic Review of Field Application, Benefits, Limitations, and Applicability During the COVID-19 Pandemic

Editor


Introduction

The application of information and communication technology can open new prospects in providing telemedicine services to help reduce the burden of the health sector. Telemedicine deals with many spheres of health care, consisting of telepharmacy. Telepharmacy is well known for the delivery of pharmaceutical-related services by registered pharmacists and pharmacies using telecommunications technology to patients at a distance.1 Some telepharmacy services include clinical pharmacy services, patient consultation and monitoring, drug selection counseling, prescription check, dispensing, and intravenous drug preparation.1,2

Telepharmacy has been seen as a potential alternative method in drug-related problem assessment for hospitals, pharmacy care for patients in underserved areas due to economic or geographic problems, and discomposure to risks related to patient data privacy and integrity.3 We conducted a systematic review of the reported usages, benefits, and limitations of telepharmacy models to further clarify the pros and cons of a telepharmacy model.

Materials and Methods

SEARCH METHODS

The review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement (Supplementary data).4 We did not register our review on PROSPERO.

We searched with the keyword “telepharmacy” on four databases: PubMed, Virtual Health Library (VHL), Global Health Library (GHL), and Google Scholar. All references of selected studies were used for manual search. The study selection procedure is represented in the PRISMA flow diagram (Fig. 1).

Fig. 1.

Fig. 1. The PRISMA flow diagram of study selection. PRISMA, preferred reporting items for systematic reviews and meta-analyses.

SELECTION CRITERIA

We included all original studies and clinical reports published through April 2021 and selected all articles with reported data on the application, benefits, and limitations of telepharmacy models in health care practice.

We excluded irrelevant articles, which are studies in the field of telepharmacy, but the results do not evaluate the effects on the study subjects’ health. Other unreliable sources were also excluded, including book chapters, abstract-only articles, conference reports, reviews, dissertations, posters, discussions, and letters.

RESEARCH SELECTION

We included articles through a two-stage process: first screening the title and abstract, and then scanning the full text. The screened articles were chosen based on inclusion and exclusion criteria; any duplicated articles were excluded. Two independent reviewers independently screened all titles and abstracts. Two senior reviewers independently evaluated the full texts of all included articles. Disagreement was solved by discussion. All relevant articles were used in qualitative data extraction. Data synthesis was conducted following textual descriptions and summarized in a Table 1.

Table 1. Advantages and Disadvantages of Telepharmacy
AUTHOR (YEAR) COUNTRY TYPES OF STUDY SPECIFIC PURPOSES SAMPLE SIZE STRENGTH WEAKNESS
Order review and dispensing
 Scott et al. (2012), USA14 Cross-sectional pilot study To examine differences in dispensing errors within community telepharmacy practices 24 rural community telepharmacies Quality-related events rates were consistent with national estimates in traditional community pharmacies Remote sites were more likely to include incorrect directions in the medication entry process
 Sankaranarayanan et al. (2014), USA9 Retrospective cross-sectional study To evaluate a telepharmacy service model 450,000 prescription orders The frequency of interventions significantly increased each year Not identified
 Peláez et al. (2020), Spain39 Cross-sectional study To report a telepharmacy model during the COVID-19 epidemic 1,186 patients Telepharmacy provided multiple benefits to patients during home quarantine Not identified
Patient satisfaction
 Wakefield et al. (2010), USA5 Case studies To describe the implementation of a telepharmacy service to provide round-the clock medication order review 9,163 approved orders, 2,226 new orders, 1,294 modified orders, 972 discontinued orders, and 179 voided orders The telepharmacy model in a multihospital health system increased access to pharmacy services, allowing for round-the-clock medication order review by pharmacists Not identified
 Pathak et al. (2020), USA12 Cross-sectional study used retrospective data To evaluate the relationship between telepharmacy services in rural areas and the quality of medication use 2,832 patients
4,402 observations		 The quality of medication use at telepharmacies was no worse than at pharmacies Not identified
 Clifton et al. (2003), USA6 Reports To describe a telepharmacy program 93 patients at remote sites Telepharmacy was well received by most of the patients and improved their access to medications and pharmacy services Not identified
106 patients at the base site
 Ibrahim et al. (2020), UAE10 Cross-sectional, observational, comparative study To examine medication dispensing errors across community pharmacies with and without telepharmacy services 19,974 patients at a telepharmacy group Telepharmacy helped COVID-19 patients’ access to pharmaceutical care and on medication dispensing safety Not identified
9,151 patients at community pharmacy group
 Mohamed Ibrahim et al. (2021), UAE11 Prospective observational study To evaluate the predictors for effective telepharmacy services and dispensing errors in community pharmacies 79,253 recommendations related to COVID-19 Provide COVID-19-related recommendations to patients Telepharmacy were more likely to include wrong patient errors
12,471 prescriptions Dispensing errors in pharmacies with telepharmacy were significantly lower than the control group
 Friesner et al. (2011), USA13 Pilot, cross-sectional, comparison study To evaluate the differences in medication dispensing errors between telepharmacy and standard community pharmacy 47,078 prescriptions via telepharmacy Medication dispensing errors rates of both groups were consistent with nationally reported levels The error rates of telepharmacies were slightly higher than comparison pharmacies
123,346 prescriptions in a standard pharmacy
 Khan et al. (2008), USA15 No mentioned To assess the financial operation of a Single Business Unit, consisting of one central retail pharmacy and two remote retail telepharmacies Income statements and balance sheets for three consecutive years The rate of growth showed that it was getting close to median sales The inventory turnover ratio remained consistently below the industry average
The net operating income percent was below the industry average
 Margolis and Ypinazar (2008), Australia8 No mentioned To describe the telepharmacy program 21,470 consultations Enabling early access to medications for both emergencies and definitive care Not identified
Minimizing the need for mail order pharmacy or patient travel
 Asseri et al. (2020), Kingdom of Saudi Arabia38 No mentioned To report a telepharmacy model during the COVID-19 epidemic 14,618 outpatient department requests Telepharmacy significantly had an impact on the technical efficiency and health care system’s effectiveness on resource utilization in this newly adopted institutional pandemic response model Not identified
10,030 inpatient orders
41,242 counseling sessions
 Lam and Rose (2009), USA7 No mentioned To describes the operation and service outcomes of a telepharmacy service Five network clinics without in-house pharmacies Telepharmacy could improve patient access to pharmaceutical care beyond remote medication dispensing to include point-of-care refill authorization and medication assistance referrals Not identified
Patient counselling and monitoring
 Ho et al. (2015), Denmark19 No mentioned To analyze the type of enquiries made by customers receiving chat-based counseling 476 enquiries Patient satisfaction The diverse enquiries require professional chat operators with broad experience
 León et al. (2011), Spain21 Open-label, two-arm, prospective randomized study To evaluate home health care by telemedicine for HIV patients, comparing with standard care 83 patients (42 via telemedicine, 41 via standard care) Clinical parameters, evaluation of quality of life, and psychological questionnaires changed significantly between two types of care Not identified
Patient satisfaction
 Stockton and Deas (2019), USA26 Retrospective chart review To review clinical outcomes of patients receiving the telepharmacy service versus the standard of care 67 patients Telepharmacy service produced changes in clinical outcomes that numerically exceeded those experienced by patients receiving specialty care, in the diabetes clinic, and within primary care Not identified
 Brown et al. (2017), USA25 Pilot study To assess the feasibility of incorporating telepharmacy services within a community pharmacy to deliver asthma education services 20 patients Telepharmacy was an effective means to engage patients to gain and maintain asthma control Not identified
 Taylor et al. (2018), USA16 Pilot, retrospective record review To evaluate a virtual, interprofessional chronic care management 69 patients Telepharmacy program constituted an added service for patients while simultaneously filling a gap in on-site pharmacist counseling services Not identified
 Young et al. (2012), USA49 Randomized controlled trial To assess the feasibility, acceptability, and preliminary impact of a telepharmacy in asthma patient 83 patients Telepharmacy intervention was feasible and showed indicators of effectiveness Not identified
Helping patients manage asthma
 Johnstone (2017), Australia24 No mentioned Effectiveness of telepharmacy on managing patients with chronic diseases 82 patients Telepharmacy services improved access and allowed for the provision of cost-effective health care management Not identified
 Bynum et al. (2001), USA17 Randomized controlled trial To determine the effectiveness of telepharmacy in asthma patients 15 patients using telepharmacy Interactive compressed video was an effective medium for teaching and improving the metered-dose inhaler technique Not identified
21 patients in control group
 Hudd and Tataronis (2011), USA20 Retrospective electronic review To measure the effect of a satellite telepharmacy on adherence of medication 26 patients Telepharmacy resulted in a high level of satisfaction with accessibility, service, and patient counseling Not identified
 McGinnis et al. (2019), USA27 Cross-sectional study To describe the components of this innovative telepharmacy program 124 patients The completion of medication histories via telepharmacy by a pharmacy technician was a novel approach that incorporates virtual services with limited resources Not identified
 Gordon et al. (2012), Canada18 No mentioned To establish and evaluate a telepharmacy program 47 patients Patient satisfaction Each chemotherapeutic preparation took longer to manufacture and compound using telepharmacy.
109 treatment visits Oversee the compounding of intravenous chemotherapy and provide a clinical review of physician orders
Clinical interventions
 Kosmisky et al. (2019), USA36 Not mentioned To provide a description of the implementation and evolution of ICU telepharmacy More than 110,000 alerts Telepharmacy provided critical care pharmacy expertise during nontraditional hours with documented clinical and financial benefits Not identified
13,000 interventions
 Monane et al. (1998), USA31 Cohort study To evaluate a program designed to decrease the use of potentially inappropriate medications among the elderly 23,369 patients Telepharmacy improved prescribing patterns and quality of care and thus provides a population-based approach to advance geriatric clinical pharmacology Not identified
 Amkreutz et al. (2020), Germany35 Prospective observational study To implement and evaluate an additional telepharmaceutical expert consultation as a part of tele-ICU services 103 patients Telepharmacy provided the possibility to implement guidelines recommending pharmaceutical service in the ICU Not identified
 Poulson et al. (2010), Australia34 No mentioned Comparison of effectiveness between telepharmacy clinical intervention and hospital pharmacists 48 patients in Phase 1 No significant differences in the pharmaceutical activity rates between telepharmacy and direct intervention Not identified
97 patients in Phase 2
 Keeys et al. (2002), USA32 Report To describe the need for clinical pharmacy services at night and the telepharmacy approach 1,039 drug orders Telepharmacy provided medication order review, resolution of drug-related problems, and drug information and clinical pharmacy services Not identified
 Patterson et al. (2014), USA29 No mentioned To describe the use of clinical telepharmacy 3,040,635 patients Increasing the presence of clinical pharmacists in community clinics Not identified
 Cole et al. (2012), USA28 Retrospective chart review To discuss the implementation and results of a telepharmacy 70 patients Telepharmacy represented a potential alternative to round-the-clock on-site pharmacist medication review for rural hospitals Not identified
302 telepharmacy patients
 Stubbings et al. (2005), USA33 Report To describe a telepharmacy service in a health maintenance organization 40,000 patients Reducing costs and improving quality of care Not identified
 Rebello et al. (2017), USA50 Retrospective study To evaluate the efficacy of telepharmacy in rural areas 100 veterans Telepharmacy was effective in decreasing acute care utilization within 30 days after hospital discharge Not identified
 Killeen et al. (2020), Canada41 Case report To report on the effectiveness of telepharmacy during the COVID-19 pandemic 75-year-old man Clinical pharmacological interventions on hypertension prescriptions Patients experiencing low income or socioeconomic status or reduced digital literacy may have difficulty
 Garrelts et al. (2010), USA30 Case study To evaluate the impact of telepharmacy in a multihospital health system 619 clinical interventions Telepharmacy services expanded hours of service, improved the speed of processing of physician medication orders, and increased clinical pharmacy services and cost avoidance Not identified
881 clinical interventions via telepharmacy
 Scott et al. (2014), USA51 No mentioned To measure medication quality-related events at critical access hospitals of telepharmacy 17 hospitals The telepharmacy model was effective in identifying and resolving quality-related events Not identified
 Bindler (2020), USA23 Retrospective study To review the effectiveness of telepharmacy 218,000 prescriptions Telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions Not identified
Aseptic preparation
 Jean et al. (2020,) USA52 Double-arm, prospective study To evaluate the impact of remote sterile product pharmacist checks 2,609 compounded sterile products No difference in the accuracy and safety of sterile product pharmacist checks The median pharmacist review time in the local process was significantly lower
Workload sharing and cost savings
Emergency
 Russi et al. (2019), USA37 Case report To describe the telepharmacy intervention for volatile aromatic alcohol poisoning A patient commits suicide Via telepharmacy, pharmacists calculated the proper amount of antagonistic ethanol Not identified

DATA EXTRACTION

We extracted data on primary outcomes, including fields of use, benefits, and limitations of telepharmacy models. Secondary outcomes, including requirements for building an effective telepharmacy model and current regulations governing telepharmacy, were also discussed.

Results

A total of 413 articles were found. After the selection process, we used 39 articles for data extraction, all of which were written in English (Fig. 1).

Thirty-nine selected articles reported the application of telepharmacy in eight countries, including the United States, Canada, Spain, Germany, Denmark, the United Arab Emirates, the Kingdom of Saudi Arabia, and Australia. The application of telepharmacy included three main areas: (1) checking prescriptions and dispensing drugs, (2) clinical pharmacy, and (3) patient consulting and monitoring. In addition, telepharmacy was also applied for aseptic preparation and emergencies (tele-emergency) to a lesser extent (Fig. 2).

Fig. 2.

Fig. 2. Fields for application of telepharmacy.

Based on the telepharmacy application fields shown in Figure 2, data on the actual advantages and disadvantages of telepharmacy in each area were extracted. The results are shown in Table 1.

The pharmaceutical supply chain is a crucial application of telepharmacy, especially in remote or underserved regions. The models of remote drug distribution by telepharmacy have developed widely in a lot of countries, and several randomized pilot studies have shown that these models work. Telepharmacy helps improve patient medicines availability during hospital night shifts,5 patients in remote areas, and creates favorable conditions to support remote drug delivery by courier companies.6–9 The quality of drug dispensing and medication errors of telepharmacy might be a significant concern to ensure safety and effectiveness.

Many studies have compared the quality between telepharmacy and traditional pharmacies; however, the results were inconsistent. Some suggested amelioration, but others showed no significant differences in drug dispensing safety and efficacy between the two models.10–12 For example, in a cross-sectional pilot study by Friesner et al., the error rate in areas using telepharmacy was even higher than that of the control.13 A greater level of errors reached the patient at the central sites than at the remote sites.14 However, these error rates were still lower than the average nationally reported.13,14

Despite the near-average sales growth, telepharmacy models are expected to face the challenge of a lower-than-average inventory turnover ratio. When it comes to a reasonable number of customers, the host should focus on scaling up and expanding the telepharmacy model to be profitable.15

Consulting and managing patient treatment remotely with telepharmacy is a method to save travel costs16 and receive higher patient satisfaction.17–22 Telepharmacy helped enhance pharmacy service to ensure drug safety and effectiveness for patients and avoid preventable adverse reactions.23 The management of patients with chronic diseases is one of the most crucial concerns for telepharmacy,16,24 such as HIV infection,21 asthma,17,22,25 diabetes mellitus,26 and cancer.18 These models help patients monitor and improve personal clinical indicators, hence improving quality of life. Telepharmacy also allowed to effectively collect medication history to provide adequate medication reconciliation.27

Clinical pharmacists have an essential role in ensuring safe and effective drug use, providing drug warnings, and improving health care quality. The health system faces a barrier in providing this service in rural or distant places. Telepharmacy helps clinical pharmacists remotely intervene and support hospitals and replace onsite clinical pharmacy services.18,28,29 Various studies have shown that telepharmacy increases not only the number of clinical warning interventions,30,31 but also the number of warnings about potential side effects in prescriptions,23 especially at night,32 and improves the speed of doctors’ prescribing30 while optimizing cost-effectiveness.33

A study of efficacy comparison showed no significant differences in the pharmaceutical activity rates in the two models: weekly visits or remotely reviews by pharmacists.34 In the intensive care unit, telepharmacy is mandatory for providing expert consultations in pharmacovigilance and dose adjustment in special cases.35,36

In addition, telepharmacy has proven its value in telemedicine for rural locations with limited resources. A case of volatile alcohol (ethylene glycol/methanol) ingestion in a rural critical access hospital, who was cared for by tele-emergency pharmacy and medicine, was described. The patient was diagnosed, and the remote pharmacists calculated the ethanol concentration required to neutralize poison.37

Another application field for telepharmacy is the isolated inspection of sterile products. A study in the United States demonstrated the accuracy and safety of telepharmacy while checking sterile products, which showed no statistically significant differences in error levels with direct work procedures (p = 0.177). However, the mean time required for direct collecting workflow is significantly lower (p < 0.001); telepharmacy cost savings are estimated at $23,770.08/year.38

During the COVID-19 pandemic, when infection control requirements are necessary, telepharmacy models have been applied to drug distribution and counseling to foster remote clinical warnings and relieve several burdens in a straightforward manner. This model has shown effectiveness in helping patients access medicine early during home isolation39,40 and received a high level of patient satisfaction.40 Comparative studies using parallel drug dispensing by telepharmacy and other distribution methods have shown no difference in drug error rates between the two procedures,10,11 despite a higher number of patient information errors in the telepharmacy group, which suggested the need for a stricter operational process for telepharmacy.11

Telepharmacy helps intervene in medication-related problems warnings to patients41; it also addressed concerns and questions related to COVID-19 to provide necessary recommendations.11

QUALITY ASSESSMENT

The included studies were evaluated for study quality. We used Study Quality Assessment Tools (SQAT) of National Institute of Health42 to assess the quality of each research method separately, including (1) observation cohort/cross-sectional studies, (2) case-control studies, and (3) case report/case series.

Each item was rated as 1 for good practice or 0 for potential flaws. In addition, if the grading is ambiguous, we followed the guidance of SQAT to place “NA” (not applicable), “NR” (not reported), or “CD” (cannot determine). These categories represent potential flaws that we should be cautious of. The final score would be calculated as a percentage with an equal point for each item. The scoring threshold is those at least 75% to be assessed as “good” quality, those between 75% and 43% as “fair,” and below 43% as “poor” quality. Two reviewers independently extracted the assessment. Discrepancies were resolved by discussion and agreement.

Ten articles were designed as observation cohort and cross-sectional studies (Table 2), 12 articles were case-control studies (Table 3), and 6 were case report/case series (Table 4). Eleven articles were unable to be categorized to apply the SQAT. Those articles carried a high risk of bias. Thus, it should be interpreted with care.

Table 2. Quality Assessment for Cohort and Cross-Sectional Studies
References Criteria Overall
No Id Article 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 9 Sankaranarayanan et al. (2014), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA 1 Fair
2 16 Taylor et al. (2018), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA 1 Fair
3 20 Hudd and Tataronis (2011), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA NA Fair
4 23 Bindler (2020), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA NA Fair
5 26 Deas and Stockton (2019), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA 1 Fair
6 27 McGinnis et al. (2019), USA 1 1 1 1 NA 0 0 NA 1 NA 1 NA NA NA Poor
7 28 Cole et al. (2012), USA 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA NA Fair
8 31 Monane et al. (1998), USA 1 1 1 1 NA 1 1 NA 1 NA 1 NA NA 1 Fair
9 35 Amkreutz et al. (2020), Germany 1 1 1 1 NA 1 NA NA 1 NA 1 NA NA 1 Fair
10 40 Peláez et al. (2020), Spain 1 1 1 1 NA 0 0 NA 1 NA 1 NA NA 1 Fair

Table 3. Quality Assessment of Case-Control Studies
REFERENCES CRITERIA OVERALL
NO ID ARTICLE 1 2 3 4 5 6 7 8 9 10 11 12
1 6 Clifton et al. (2003), USA 1 1 0 1 1 1 1 NA NA 1 NA 1 Fair
2 10 Ibrahim et al. (2020), UAE 1 1 1 1 1 1 1 NA 1 1 NA 1 Good
3 11 Ibrahim et al. (2020), UAE 1 1 1 1 1 1 1 0 0 1 NA 1 Fair
4 12 Pathak et al. (2020), USA 1 1 0 1 1 1 1 NA 1 1 NA NA Fair
5 13 Friesner et al. (2011), USA 1 1 0 1 NA 1 1 0 0 1 NA 1 Fair
6 14 Scott et al. (2012), USA 1 1 1 1 1 1 1 0 0 1 NA NA Fair
7 15 Khan et al. (2008), USA 1 1 0 NA NA 1 1 NA 1 1 NA NA Fair
8 17 Bynum et al. (2001), USA 1 1 0 1 1 1 1 NA 1 1 NA 1 Fair
9 21 León et al. (2011), Spain 1 1 0 NA 1 1 1 NA 1 1 NA NA Fair
10 22 Young et al. (2012), USA 1 1 1 1 1 1   NA 1 1 NA 1 Good
11 38 Jean et al. (2020), USA 1 1 0 0 1 1 1 NA 1 NA NA NA Fair
12 42 Rebello et al. (2017), USA 1 1 0 0 1 1 1 NA 1 1 NA 1 Fair

Table 4. Quality Assessment for Case Report and Case Series Studies
REFERENCES CRITERIA OVERALL
NO ID ARTICLE 1 2 3 4 5 6 7 8 9
1 5 Wakefield et al. (2010), USA 1 1 1 NA NA 1 NA 1 1 Fair
2 25 Brown et al. (2017), USA 1 1 1 NA NA 1 1 1 1 Good
3 32 Keeys et al. (2002), USA 1 1 NA NA 1 1 NA 1 1 Fair
4 41 Killeen et al. (2020), Canada 1 1 1 1 1 NA NA 1 1 Good
5 30 Garrelts et al. (2010), USA 1 1 1 1 NA 1 NA 1 1 Good
6 37 Russi et al. (2019), USA 1 1 1 1 1 1 1 1 1 Good

Among 10 observation cohort/cross-sectional studies, the overall rating indicated that none of the studies was of “good” quality. Nine studies were of “fair,” and only one was of “poor” quality. However, none of these studies was excluded from our systematic review. In the case-control group, the overall quality was “fair” in terms of bias, except two studies that were evaluated as “good.” Four out of six case reports/case series had “good” quality, indicating a potentially low bias level.

Discussion

The use of communication and information technology in pharmacy practice has attracted attention in many countries worldwide. The United States has the most experience, with the first telepharmacy service in the early 2000s.17,22 Telepharmacy is a new approach to providing care from pharmacists in multidisciplinary health care that is becoming more and more popular.43 Our review shows that telepharmacy has been widely applied in drug dispensing, patient counseling and management, clinical pharmacy, aseptic product preparation, and emergency interventions. Telepharmacy serves as a new ecosystem to communicate with patients or provide online pharmacy support to other health care workers in remote medical facilities.29,37 The obtained results suggest the importance and enormous potential of the telepharmacy service in the future, which we will discuss next.

First, telepharmacy could be the solution to help reduce the shortage of pharmacists. Patients living in rural or separated areas may have difficulty accessing pharmacy services.44 The uneven distribution of the industry structure causes a shortage of pharmacist care services in rural or hard-to-access areas, especially clinical pharmacy services.45,46 A common term for these communities is pharmacy deserts.47,48 Telepharmacy helps ensure proper pharmaceutical support in underserved areas6–9 or facilitates remote pharmacist intervention to support hospitals in providing inpatient clinical pharmacy care.18,28,29 These technological advancements contribute to reducing inequalities in health care delivery.

Second, telepharmacy can help improve the quality of drug use. The quality of telepharmacy delivery was reported and compared with the control group through the quality-related events (QREs) index.10–14 Telepharmacy is generally considered to have no adverse effects on public health, patient safety, and quality of health care,10–12 and it is not inferior to pharmacies.13,14 The Hawthorne effect (i.e., the tendency of some people to work harder and perform better when they are experimental participants) may have become a potential factor influencing the results of the studies.

Long-term studies of the Hawthorne effect will have a less pronounced impact (which cannot be wholly reduced).49 Further, within 45 months of data collection, the study by Friesner et al. showed a decreasing trend in QRE, which suggested that error rates will decrease as pharmacists and their technicians get used to them. The regulations, protocols, and standards of practice are inherent in the telepharmacy model.13 In hospitals, telepharmacy has created an environment that facilitates pharmacists to remotely intervene on drug-related issues,30,31 expand the scope of 24-h hospital pharmacies,32 help speed up prescription processing,30 and reduce order processing time, freeing pharmacists for money-saving or quality-improvement initiatives.33

Remote pharmacist interventions in the telepharmacy service model coordinate patient-centered pharmaceutical care and facilitate the meaningful use of electronic health records.9

Third, several studies examining the effectiveness of telepharmacy services in the era of COVID-19 have shown that telepharmacy improves drug-dispensing practices, helping to increase a patient’s access to pharmaceutical care.10,11 In response to the health crisis caused by the COVID-19 pandemic, hospitals have adapted their outpatient counseling and dispensing services to telepharmacy to reduce the risk of infection.39,40 Telepharmacy offers a more comfortable environment for pharmacists to consult with patients without the risk of viral transmission.

Last but not least, education about telapharmacy is essential, not only for pharmacists but also for patients, to reinforce its use.6 Formal continuing education programs will keep pharmacists up to date with current telepharmacy practices. Today, people need greater access to medicines due to an increased proportion of the aging population and comorbidities,7,8 leading to a higher need for pharmacists to meet these new needs.33 However, not all patients have the exact needs. Further action is needed to determine which groups of patients need more intensive pharmaceutical care and, therefore, who can benefit most from telepathy, not just delivery. The goal is to continue to provide high-quality care.

LIMITATIONS

Our review had some limitations. Regardless of following the PRISMA statement, we did not register our review on PROSPERO. We have not yet made a comparison between the telepharmacy model in the studies and each other because of different backgrounds and the miscellaneous type of models when it comes to reality. Also, data on the limitations of telepharmacy were not fully understood. We suggest further clarification of these data in the future.

Conclusions

Telepharmacy has shown certain benefits in providing an alternative solution to the problem of lack of pharmacists and also contributing toward ensuring patient access to medicines in underserved areas. Despite the variation in models and some limitations requiring a higher capacity of the pharmacist in the application of technology and a higher concentration, telepharmacy is effective in providing clinical pharmacovigilance related to drugs and managing patients in treatment, thereby helping to increase the ability to use resources, as well as to save costs.

During the COVID-19 pandemic, some telepharmacy models have been shown to be effective in ensuring drug dispensing, in enhancing drugs’ safety and effectiveness, and in coping with the disease in general. These data suggest the potential of telepharmacy to replace or complement pharmaceutical-related activities and facilitate future innovation in the health care industry.

Authors’ Contributions

T.V.D. and V.L.T. were responsible for the idea and supervision. All authors did screening and extraction under the supervision of N.T.H. All authors extracted data, and N.T.H. contributed toward interpreting the results. T.V.D., V.L.T., and N.K.Q. took the lead in writing the article. All authors contributed to the article writing and approved the final version.

Disclosure Statement

No competing financial interests exist.

Funding Information

This study was funded by Ho Chi Minh City Department of Science and Technology (DOST HCMC to Truong Van Dat: under Decision 1362/QD-SKHCN and Grant 99/2020/HD-QPTKHCN).

Supplementary Material

Supplementary Data

REFERENCES

  • 1. Win AZ. Telepharmacy: Time to pick up the line. Res Social Adm Pharm 2017;13:882–883. Crossref, Medline, Google Scholar
  • 2. Le T, Toscani M, Colaizzi J. Telepharmacy: A new paradigm for our profession. J Pharm Pract 2020;33:176–182. Crossref, Medline, Google Scholar
  • 3. Sherman J. Telepharmacy-a promising alternative for rural communities. Pharm Times 2009;73:1–65. Google Scholar
  • 4. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. Crossref, Medline, Google Scholar
  • 5. Wakefield DS, Ward MM, Loes JL, O’Brien J, Sperry L. Implementation of a telepharmacy service to provide round-the-clock medication order review by pharmacists. Am J Health Syst Pharm 2010;67:2052–2057. Crossref, Medline, Google Scholar
  • 6. Clifton GD, Byer H, Heaton K, Haberman DJ, Gill H. Provision of pharmacy services to underserved populations via remote dispensing and two-way videoconferencing. Am J Health Syst Pharm 2003;60:2577–2582. Crossref, Medline, Google Scholar
  • 7. Lam AY, Rose D. Telepharmacy services in an urban community health clinic system. J Am Pharm Assoc (2003) 2009;49:652–659. Crossref, Medline, Google Scholar
  • 8. Margolis SA, Ypinazar VA. Tele-pharmacy in remote medical practice: The Royal Flying Doctor Service Medical Chest Program. Rural Remote Health 2008;8:937. Medline, Google Scholar
  • 9. Sankaranarayanan J, Murante LJ, Moffett LM. A retrospective evaluation of remote pharmacist interventions in a telepharmacy service model using a conceptual framework. Telemed J E Health 2014;20:893–901. Link, Google Scholar
  • 10. Ibrahim OM, Ibrahim RM , A ZAM, Al Mazrouei N. Role of telepharmacy in pharmacist counselling to coronavirus disease 2019 patients and medication dispensing errors. J Telemed Telecare 2020:1357633×20964347. Crossref, Google Scholar
  • 11. Mohamed Ibrahim O, Ibrahim RM, Abdel-Qader DH, Al Meslamani AZ, Al Mazrouei N. Evaluation of telepharmacy services in light of COVID-19. Telemed J E Health 2021;27:649–656. Link, Google Scholar
  • 12. Pathak S, Haynes M, Qato DM, Urick BY. Telepharmacy and quality of medication use in rural areas, 2013–2019. Prev Chronic Dis 2020;17:E101. Crossref, Medline, Google Scholar
  • 13. Friesner DL, Scott DM, Rathke AM, Peterson CD, Anderson HC. Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project. J Am Pharm Assoc (2003) 2011;51:580–590. Crossref, Medline, Google Scholar
  • 14. Scott DM, Friesner DL, Rathke AM, Peterson CD, Anderson HC. Differences in medication errors between central and remote site telepharmacies. J Am Pharm Assoc (2003) 2012;52:e97–e104. Crossref, Medline, Google Scholar
  • 15. Khan S, Snyder HW, Rathke AM, Scott DM, Peterson CD. Is there a successful business case for telepharmacy? Telemed J E Health 2008;14:235–244. Link, Google Scholar
  • 16. Taylor AM, Bingham J, Schussel K, Axon DR, Dickman DJ, Boesen K, et al. Integrating innovative telehealth solutions into an interprofessional team-delivered chronic care management pilot program. J Manag Care Spec Pharm 2018;24:813–818. Crossref, Medline, Google Scholar
  • 17. Bynum A, Hopkins D, Thomas A, Copeland N, Irwin C. The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas. Telemed J E Health 2001;7:207–217. Link, Google Scholar
  • 18. Gordon HL, Hoeber M, Schneider A. Telepharmacy in a rural Alberta Community Cancer Network. J Oncol Pharm Pract 2012;18:366–376. Crossref, Medline, Google Scholar
  • 19. Ho I, Nielsen L, Jacobsgaard H, Salmasi H, Pottegård A. Chat-based telepharmacy in Denmark: Design and early results. Int J Pharm Pract 2015;23:61–66. Crossref, Medline, Google Scholar
  • 20. Hudd TR, Tataronis GR. The impact of an urban telepharmacy on patient medication adherence in a federally qualified health center. J Pharm Technol 2011;27:117–122. Crossref, Google Scholar
  • 21. León A, Cáceres C, Fernández E, Chausa P, Martin M, Codina C, et al. A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: A randomized study. PLoS One 2011;6:e14515. Crossref, Medline, Google Scholar
  • 22. Young D. Telepharmacy project aids North Dakota’s rural communities. Am J Health Syst Pharm 2006;63:1776, 9–80. Crossref, Medline, Google Scholar
  • 23. Bindler RJ. The impact of telepharmacy services on the identification of medication discrepancies, high-alert medications, and cost avoidance at rural healthcare institutions. J Int Soc Telemed E Health 2020;8(e5):1–6. Google Scholar
  • 24. Johnstone L. Telepharmacy and chronic kidney disease—a Making Tracks investment strategy2017. Available at www.ruralhealth.org.au/14nrhc/sites/default/files/Johnstone%2C%20Laura_E10.pdf (last accessed April 2, 2022). Google Scholar
  • 25. Brown W, Scott D, Friesner D, Schmitz T. Impact of telepharmacy services as a way to increase access to asthma care. J Asthma 2017;54:961–967. Crossref, Medline, Google Scholar
  • 26. Stockton K, Deas C. Evaluation of outcomes of a pharmacist-run, outpatient insulin titration telepharmacy service. Innov Pharm 2019;10, DOI: 10.24926/iip.v10i2.1737. Crossref, Medline, Google Scholar
  • 27. McGinnis B, Padilla E, Garret P, Aziz S. Using pharmacy technicians and telepharmacy to obtain medication histories in the emergency department. J Am Pharm Assoc (2003) 2019;59:390–397. Crossref, Medline, Google Scholar
  • 28. Cole SL, Grubbs JH, Din C, Nesbitt TS. Rural inpatient telepharmacy consultation demonstration for after-hours medication review. Telemed J E Health 2012;18:530–537. Link, Google Scholar
  • 29. Patterson BJ, Kaboli PJ, Tubbs T, Alexander B, Lund BC. Rural access to clinical pharmacy services. J Am Pharm Assoc (2003) 2014;54:518–525. Crossref, Medline, Google Scholar
  • 30. Garrelts JC, Gagnon M, Eisenberg C, Moerer J, Carrithers J. Impact of telepharmacy in a multihospital health system. Am J Health Syst Pharm 2010;67:1456–1462. Crossref, Medline, Google Scholar
  • 31. Monane M, Matthias DM, Nagle BA, Kelly MA. Improving prescribing patterns for the elderly through an online drug utilization review intervention: A system linking the physician, pharmacist, and computer. JAMA 1998;280:1249–1252. Crossref, Medline, Google Scholar
  • 32. Keeys CA, Dandurand K, Harris J, Gbadamosi L, Vincent J, Jackson-Tyger B, et al. Providing nighttime pharmaceutical services through telepharmacy. Am J Health Syst Pharm 2002;59:716–721. Crossref, Medline, Google Scholar
  • 33. Stubbings T, Miller C, Humphries TL, Nelson KM, Helling DK. Telepharmacy in a health maintenance organization. Am J Health Syst Pharm 2005;62:406–410. Crossref, Medline, Google Scholar
  • 34. Poulson LK, Nissen L, Coombes I. Pharmaceutical review using telemedicine—a before and after feasibility study. J Telemed Telecare 2010;16:95–99. Crossref, Medline, Google Scholar
  • 35. Amkreutz J, Lenssen R, Marx G, Deisz R, Eisert A. Medication safety in a German telemedicine centre: Implementation of a telepharmaceutical expert consultation in addition to existing tele-intensive care unit services. J Telemed Telecare 2020;26:105–112. Crossref, Medline, Google Scholar
  • 36. Kosmisky DE, Everhart SS, Griffiths CL. Implementation, evolution and impact of ICU telepharmacy services across a health care system. Hosp Pharm 2019;54:232–240. Crossref, Medline, Google Scholar
  • 37. Russi CS, Mattson AE, Smars PA, Newman JS, Beuning AJ. Ethylene glycol and methanol ingestion cared for by tele-emergency pharmacy and tele-emergency medicine. J Telemed Telecare 2019;25:445–447. Crossref, Medline, Google Scholar
  • 38. Asseri AA, Manna MM, Yasin IM, Moustafa MM, Roubie FM, El-Anssasy SM, et al. Implementation and evaluation of telepharmacy during COVID-19 pandemic in an academic medical city in the Kingdom of Saudi Arabia: Paving the way for telepharmacy. World J Adv Res Rev 2020;7:218–226. Crossref, Google Scholar
  • 39. Peláez Bejarano A, Villar Santos P, Robustillo-Cortés MLA, Sánchez Gómez E, Santos Rubio MD. Implementation of a novel home delivery service during pandemic. Eur J Hosp Pharm 2021;28(Suppl. 2):e120–e123. Crossref, Medline, Google Scholar
  • 40. Killeen RM, Grindrod K, Ong SW. Innovations in practice: Telepharmacy’s time has arrived. Can Pharm J (Ott) 2020;153:252–255. Crossref, Medline, Google Scholar
  • 41. Access to primary and community health-care services for people 16 years and over with intellectual disabilities: A mapping and targeted systematic review [Internet]. National Institute of Health, 2020 [cited March 2022]. Available at https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools (last accessed April 2, 2022). Google Scholar
  • 42. Kane-Gill SL, Rincon F. Expansion of telemedicine services: Telepharmacy, telestroke, teledialysis, tele-emergency medicine. Crit Care Clin 2019;35:519–533. Crossref, Medline, Google Scholar
  • 43. Todd A, Copeland A, Husband A, Kasim A, Bambra C. Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation. BMJ Open 2015;5:e007328. Crossref, Medline, Google Scholar
  • 44. McFarland R. Telepharmacy for remote hospital inpatients in north-west Queensland. J Telemed Telecare 2017;23:861–865. Crossref, Medline, Google Scholar
  • 45. Rita Baeten, Slavina Spasova, Bart Vanhercke, Coster S. Inequalities in access to healthcare. A study of national policies 20182018. Available at https://op.europa.eu/en/publication-detail/-/publication/aff4d623-e7c2-11e8-b690-01aa75ed71a1/language-en (last accessed April 2, 2022). Google Scholar
  • 46. Howarth HD, Peterson GM, Jackson SL. Does rural and urban community pharmacy practice differ? A narrative systematic review. Int J Pharm Pract 2020;28:3–12. Crossref, Medline, Google Scholar
  • 47. Pednekar P, Peterson A. Mapping pharmacy deserts and determining accessibility to community pharmacy services for elderly enrolled in a State Pharmaceutical Assistance Program. PLoS One 2018;13:e0198173. Crossref, Medline, Google Scholar
  • 48. Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ 2015;351:h4672. Crossref, Medline, Google Scholar
  • 49. Young HN, Havican SN, Griesbach S, et al. Patient and phaRmacist telephonic encounters (PARTE) in an underserved rural patient population with asthma: Results of a pilot study. Telemed J E Health 2012;18:427–433. Link, Google Scholar
  • 50. Rebello KE, Gosian J, Salow M, Sweeney P, Rudolph JL, Driver JA. The rural PILL program: A postdischarge telepharmacy intervention for rural veterans. J Rural Health 2017;33:332–339. Crossref, Medline, Google Scholar
  • 51. Scott DM, Friesner DL, Rathke AM, Doherty-Johnsen S. Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project. Am J Health Syst Pharm 2014;71:58–67. Crossref, Medline, Google Scholar
  • 52. Jean SJ, Francart SJ, Eckel SF, et al. Evaluation of telepharmacy and the use of a gravimetric technology-assisted workflow system for remote sterile product pharmacist checks. Am J Health Syst Pharm 2020;77:560–567. Crossref, Medline, Google Scholar





Source link