November 20, 2020

by Andrew Straw, Pharm.D.

Recently my wife was in need of a consultation with a physician on short notice. She entered her information into the online patient portal and requested a consultation. In less than five minutes from submitting her request, she was talking to a physician via video. She was very pleased with the access and convenience that this experience provided. Her experience with telehealth caused me to reflect on my own experience providing telehealth and its impact on both patients and the field of pharmacy.

Telehealth Explained

Telehealth is the use of various telecommunications technologies to provide or support clinical healthcare and education. Common technologies associated with telehealth include video conferencing and telephonic communication but also include remote monitoring through email and phone messaging. These technologies allow a healthcare professional to provide care via a secure connection through either a simple telephone call or a video call. Although telehealth has been put in the spotlight since the start of COVID-19, the technology or its use in healthcare is not new. Physicians have been using various forms of telehealth for over 40 years, and pharmacists frequently utilize telecommunications technologies to perform medication therapy management (MTM).

Unexpected Opportunity for Patient Access to Healthcare

Pharmacists now have more freedom and technological access to provide remote medication therapy management services, chronic care management visits, as well as remote monitoring services.
The use of telehealth in primary care was somewhat limited for many years, as many payors did not provide reimbursement of healthcare services that were not provided in person. As COVID-19 concerns mounted in early 2020, many payors made sweeping changes to their reimbursement rules opening the door for many healthcare professionals across the care spectrum to deliver their services via telephone and video technology. This has also opened up unique opportunities for pharmacists to provide telehealth services as well. Pharmacists now have more freedom and technological access to provide remote medication therapy management services, chronic care management visits, as well as remote monitoring services. At my clinical site, we’ve been able to perform chronic care management visits for diabetes and utilize video conferencing to show patients how to properly and safely administer injectable medication.

The Benefits of Telehealth

There are many advantages that telehealth provides to both providers and patients. Convenience and access to care are two major benefits. The convenience of taking a phone call or video call on a cell phone or computer in one’s own home can help patients feel comfortable and eliminate barriers to care access. For low-income patient populations or those that live in rural or remote areas, transportation to appointments can be problematic and result in missed or canceled visits. Additionally, concerns about COVID-19 exposure have also limited travel. Even without pandemic concerns, telehealth can be a key tool to help increase patient’s access to care.

Both improved care quality and reduction in healthcare costs have been demonstrated with telehealth. Studies have demonstrated the ability for telehealth programs to reduce ED visits and hospital admissions while effectively treating chronic disease states as well. Cost-savings have been shown across a variety of healthcare settings including both hospital and outpatient settings.

The Challenges of Telehealth

Telehealth does not come without its share of barriers. The largest barrier up until early 2020 was willingness for payors to reimburse for telehealth services. With this barrier greatly reduced, other issues have been illuminated. Provider offices must be equipped with technology and platforms that are HIPAA-compliant to facilitate more widespread use of virtual visits. Unstable internet connections can make communicating clearly with patients via video conferencing a challenge and open the door for reduced care continuity. Some patients may struggle with technology use or have the means of using these devices, limiting their access to care. The increased convenience of these visits can occasionally result in patients answering calls in places not conducive to their privacy or ability to engage in the visit. The personal touch from an in-person visit is also missing and can make it a bit harder to connect on a personal level with patients.

A Pharmacist’s Experience With Telehealth

My overall experience has been positive, and I can attest to the ability for telehealth to improve access to care and benefit both the patient and pharmacist.
As a pharmacist providing chronic care management through a collaborative practice agreement in a Federally Qualified Healthcare Center, I have had the opportunity to use telehealth frequently this year. My overall experience has been positive, and I can attest to the ability for telehealth to improve access to care and benefit both the patient and pharmacist. Our “no-show” rate to appointments decreased compared to our “in-person” percentage, and we were able to reach a segment of patients that previously had been difficult to reach. Patients enjoy the ability to join visits from their own home and are more willing to engage in follow-up visits. There have been some challenges as well. In some cases, patients have attended telehealth visits from grocery stores, their cars, and even the bathroom, so setting expectations for patients in these visits is important to ensure effective and appropriate conditions for care. Some services, such as dietary education with replica food models, had to be adapted to fit the virtual visit model. Training patients on new medication devices also required some adaptation, but can still be accomplished with video conferencing. Gathering patient data via point-of-care testing such as Hemoglobin A1C and INR still needs to be done and has been accomplished via a “curbside” type model.

Overall, pharmacists have a tremendous opportunity to engage their patients via telehealth models in a time that has changed the landscape of healthcare and the way in which it is delivered.

Dr. Andrew Straw is Assistant Professor of Pharmacy Practice at the Cedarville University School of Pharmacy. He also serves as a clinical pharmacist and Residency Program Director at Rocking Horse Community Health Center in Springfield, Ohio. His professional interests include ambulatory care pharmacy and chronic care management.

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