The era of telehealth pharmacy practice

Abstract

The Association Report column in JAPhA reports on activities of APhA’s 3 academies and topics of interest to members of those groups.The APhA Academy of Pharmacy Practice and Management (APhA--APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the APhA–APPM Special Interest Groups (SIGs), the Academy provides members a mechanism to network and support the profession, by addressing emerging issues. To learn more about APhA–APPM and to access a listing of APhA—APPM SIGs, visit https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management.The mission of the APhA Academy of Research and Science (APhA--APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the 3 APhA--APRS Sections (Clinical Sciences; Basic Pharmaceutical Sciences; and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. To learn more about APhA--APRS, visit https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science.The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy.The Association Report column is written by Officers and members of the respective Academy and coordinated by APhA staff. Suggestions for future content may be sent to Margaret Tomecki, Director, Practice and Science Academies ( [email protected] ). The Association Report column in JAPhA reports on activities of APhA’s 3 academies and topics of interest to members of those groups. The APhA Academy of Pharmacy Practice and Management (APhA--APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the APhA–APPM Special Interest Groups (SIGs), the Academy provides members a mechanism to network and support the profession, by addressing emerging issues. To learn more about APhA–APPM and to access a listing of APhA—APPM SIGs, visit https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management. The mission of the APhA Academy of Research and Science (APhA--APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the 3 APhA--APRS Sections (Clinical Sciences; Basic Pharmaceutical Sciences; and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. To learn more about APhA--APRS, visit https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science. The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy. The Association Report column is written by Officers and members of the respective Academy and coordinated by APhA staff. Suggestions for future content may be sent to Margaret Tomecki, Director, Practice and Science Academies ( [email protected] ). Preparing to become future telehealth providers Telehealth practice has recently been at the center of discussion for many health care professions, as the utilization of telehealth services has expanded greatly because of the coronavirus disease 2019 pandemic. With many clinics and other outpatient facilities unable to accommodate in-person appointments, providers turned to telehealth as a means of providing care to patients. In addition, there was a federal expansion of telehealth service coverage, allowing more patients to access these virtual services. In the outpatient setting, telehealth services have been used for outpatient clinic visits, urgent care consultations, medication monitoring, and complete medication reviews, as well as medication counseling. In the inpatient setting, virtual platforms were implemented to connect providers on patient care teams, resulting in virtual patient rounding and collaborative care. Despite the abrupt necessity for telehealth services during the pandemic, telehealth services were already becoming increasingly popular. As the new “normal” of health care practice sets in, it is reasonable to conclude that telehealth will be a component of pharmacy practice indefinitely. That means it is essential for student pharmacists to gain exposure and confidence in providing telehealth services. The pandemic presented student pharmacists with diverse challenges, one of which was virtual learning. In-person learning transitioned to online for many pharmacy programs, including both lecture-based classes as well as patient care–focused laboratories and simulations. Although virtual learning did present unique difficulties, one enormous benefit was the volume of experience that the students gained working in teams and connecting with patients in a virtual environment. At the Washington State University College of Pharmacy and Pharmaceutical Sciences, online platforms simulating telehealth encounters were used in a variety of patient care interactions and assessments. Certifications and credentialing opportunities through classes were successfully delivered and earned virtually, including the American Pharmacists Association Medication Therapy Management certification, the Washington State Pharmacy Association (WSPA) Smoking Cessation certification, and the WSPA Clinical Community Pharmacist certification. Student pharmacists had multiple opportunities to practice building patient rapport and promote engaging patient interactions in the simulated telehealth visits. They learned techniques to optimize medication device counseling in a virtual environment, as well as promote the use of online resources and videos to enhance patient education during the encounter. In addition, students had the opportunity to work on a medical team to assess patients and provide patient care plans to a preceptor, practicing teamwork and interprofessional skills within a virtual environment. Knowing that students will engage in substantial in-person patient interactions during rotational experiences, it can be argued that virtual encounters should be viewed as an asset to pharmacy education. These experiences will result in increased confidence and competency in future pharmacist providers’ telehealth practice. Realizing that telehealth will be a continued experience for pharmacist providers, it is important to understand the general advantages and barriers of telehealth that exist. Studies over the past 10 years have highlighted multiple benefits of telehealth, two of the largest being increased patient access to care and improved patient outcomes.1Brearly T.W. Goodman C.S. Haynes C. McDermott K. Rowland J.A. Improvement of postinpatient psychiatric follow-up for veterans using telehealth.Am J Health Syst Pharm. 2020; 77: 288-294Crossref PubMed Scopus (5) Google Scholar, 2Littauer S.L. Dixon D.L. Mishra V.K. Sisson E.M. Salgado T.M. Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review.Pharm Pract. 2017; 15: 1134Crossref PubMed Scopus (29) Google Scholar, 3Litke J. Spoutz L. Ahlstrom D. Perdew C. Llamas W. Erickson K. Impact of the clinical pharmacy specialist in telehealth primary care.Am J Health Syst Pharm. 2018; 75: 982-986Crossref PubMed Scopus (22) Google Scholar, 4Mohammad I. Berlie H.D. Lipari M. et al.Ambulatory care practice in the COVID-19 Era: redesigning clinical services and experiential learning.J Am Coll Clin Pharm. 2020; https://doi.org/10.1002/jac5.1276Date accessed: November 2, 2021Crossref PubMed Scopus (12) Google Scholar, 5Murry L.T. Parker C.P. Finkelstein R.J. Arnold M. Kennelty K. Evaluation of a clinical pharmacist team-based telehealth intervention in a rural clinic setting: a pilot study of feasibility, organizational perceptions, and return on investment.Pilot Feasibility Studies. 2020; 6: 127Crossref PubMed Scopus (5) Google Scholar, 6Niznik J.D. He H. Kane-Gill S.L. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review.Res Soc Admin Pharm. 2018; 14: 707-717Crossref PubMed Scopus (74) Google Scholar, 7Singh L.G. Accursi M. Korch Black K. Implementation and outcomes of a pharmacist-managed clinical video telehealth anticoagulation clinic.Am J Health Syst Pharm. 2015; 72: 70-73Crossref PubMed Google Scholar With the advent of reimbursement expansion due to the pandemic, these advantages can now be applied to a diverse set of patients, not only those who reside in rural areas or areas with shortage of health care providers. This can lead to enhanced access to care and improved patient outcomes for both rural and urban residing patients and patients with other barriers to accessing care such as transportation or childcare difficulties. Despite these benefits to telehealth, there are a variety of barriers that patients and providers are still experiencing. First, many patients experience technology barriers including access to devices (i.e., smart phone, tablet, computer), access to required services to use technology (i.e., high speed Internet, phone service), understanding how to use the technology they have, and the knowledge to optimize their technology for their personal use (i.e., hearing loss, poor eyesight). In addition, some patient care visits are limited by current telehealth capabilities, specifically those that involve physical exams such as blood pressure measurements or on-site point-of-care international normalized ratio (INR) measurements.1Brearly T.W. Goodman C.S. Haynes C. McDermott K. Rowland J.A. Improvement of postinpatient psychiatric follow-up for veterans using telehealth.Am J Health Syst Pharm. 2020; 77: 288-294Crossref PubMed Scopus (5) Google Scholar, 8DeRemer C.E. Reiter J. Olson J.L. Transitioning ambulatory care pharmacy services to telemedicine while maintaining multidisciplinary collaborations.Am J Health Syst Pharm. 2021; 78: 371-375Crossref PubMed Scopus (2) Google Scholar, 9Kennelty K.A. Engblom N.J. Carter B.L. et al.Dissemination of a telehealth cardiovascular risk service: The CVRS live protocol.Contemp Clin Trials. 2021; 102: 106282Crossref PubMed Scopus (2) Google Scholar Another complicating factor includes the variety of regulations and laws surrounding telehealth practice limitation and reimbursement variability that differ state by state. For telehealth to be optimally successful and continue to provide benefits, these barriers will need to be continually addressed to improve telehealth practice. Student pharmacists can play an essential role in addressing these barriers and improving their future telehealth practice. First, students need to advocate for the advancement of the pharmacist profession, including promoting and supporting provider status both at the state and federal level. Provider status is essential to the advancement of the profession and is one of the largest contributors to reimbursement barriers and practice limitations. On a more patient-focused level, students can begin to evaluate the needs of patients who may be using telehealth practices. Understanding patients’ unique access to resources and adapting to patient-specific factors allow pharmacists to provide optimal individualized care. Students can also take the time to educate themselves on telehealth practices in the pharmacy profession. Talking with current practicing pharmacists and learning which telehealth services are best provided via video versus telephone or what virtual patient education tools are available are great ways to start building a strong foundation of telehealth practice. Finally, practice is key to improving and optimizing telehealth provider skills. If students have not had the opportunity to participate in simulated telehealth services in their curriculum, discussing the benefits of these experiences with school leaders could lead to implementation of these encounters in pharmacy programs. Looking for opportunities while on rotation, whether it be shadowing a telehealth visit or performing their own, will provide valuable experience in telehealth practice as well as virtual platforms. From the increased telehealth utilization trend before the pandemic now reinforced with the broad expansion of telehealth during the pandemic, virtual care will undoubtably be a part of future pharmacy practice. Taking advantage of opportunities as students to improve our telehealth practice skills will provide the confidence necessary to be exceptional telehealth providers. Olivia Hiskey, BS, Third-year Student Pharmacist, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA; E-mail: [email protected]