Innovative Models for Providing Clinical Pharmacy Services to Remote Locations Using Clinical Video Telehealth

Innovative Models for Providing Clinical Pharmacy Services to Remote Locations Using Clinical Video Telehealth
Briana Gray, Pharm.D., St. Cloud VA Medical Center 

Background: Almost half of U.S. veterans live in rural or highly rural areas and face significant travel time and costs to receive primary care services. These patients often have difficulties attending frequent appointments and building relationships with their providers, especially if they have complicated disease states. Veterans Affairs (VA) Medical Centers have implemented several forms of telehealth, as shown in Table 1, for veterans to reach Clinical Pharmacy Specialists (CPSs) more efficiently for primary care services.

Table 1: Telehealth Modalities Used in the VA Healthcare System

 

Methods: Two team-based models were implemented through a telehealth hub based at the Boise VA Medical Center in Idaho with a focus to reach the largest rural areas in the Northwest United States. In the first model, the patient and nursing staff are located at one site and the remainder of the team is at a location other than the patient site. The clinical team members may be located at the same site or may also have a virtual relationship across different sites. In the second model, the patient and the majority of the care team are located at one site while the CPS is at a separate site. The latter situation is best to serve patients without a CPS at their site or clinic while the former serves as a virtual primary care team.

Results: Since 2014, the Boise VA Medical Center pioneered clinical pharmacy telehealth services in diabetes, hypertension, hyperlipidemia, tobacco cessation, and other chronic disease states. The program started with one half-time CPS and grew to six full-time CPSs each serving a panel of up to approximately 3,600 patients. They collaborated with 16 rural VA clinics across Alaska, Washington, Oregon, Idaho, and Montana, saw more than 1,200 unique patients, and achieved an overall patient satisfaction score of 96%. The CPSs completed consults limited to chart review in an average of less than one day and, if patients required a video conference visit, they were seen in an average of 6.4 days.

Discussion: Benefits to serving patients via telehealth include decreased overall costs for the patient, “face-to-face” video visits that allow assessment of patient appearance and body language, and the means to count the visit similarly to an in-person visit. Barriers include patient preference for in-person visits, the convenience of telephone visits (no hardware needed and fewer logistics), patient's’’ ability to adapt to the technology, and increased documentation (a telehealth consult must be placed for a patient to receive services).

Overall, health systems can utilize telehealth to decrease healthcare costs and expand services for patients in rural areas. Each form of telehealth provides quality care tailored to the patient’s situation in a timely manner and the patients adapted well to the new routes of service. Further studies are needed to show if improved accessibility also leads to improved clinical outcomes as expected.

References:

  1. Perdew, C., Erickson, K., & Litke, J. (n.d.). Innovative models for providing clinical pharmacy services to remote locations using clinical video telehealth. American Journal of Health-System Pharmacy., 74(14), 1093-1098.