Rural and remote patients are able to access pharmacists for medication management and other clinical services using technology
Technology is transforming healthcare “in a way that would have been unimaginable only a few years ago,” says Sydney GP Dr Walid Jammal in his editorial ‘Ready or not here comes telehealth’, published in MJA InSight.
“Practically speaking, telehealth is anything that uses technology to treat a patient at a distance,” says Jammal.
The term encompasses anything from phone consultations with a patient to online prescription of medical certificates and remote video consultations involving a patient and a team of health care professionals in multiple locations, he explains.
“The literature is full of stated benefits of telehealth. Improving access to care is clearly one. Clinical effectiveness comparable to face-to-face care is another,” says Jammal.
Telehealth pharmacy services—or “telepharmacy”—is already being conducting across remote and rural Queensland, and all signs point to it being as effective as HMRs.
These programs are reaching out to isolated residents in an attempt to provide equitable access to clinical pharmacy services. One example is in the town of Atherton in far-north Queensland.
Atherton Hospital senior pharmacist Michelle Rothwell and rural and remote pharmacist Adam Hogan have helped set up a telehealth system that delivers services from a medium-sized rural hospital and seven different rural/remote healthcare facilities across the state, covering an area of approximately 160,000 kilometres.
Rural and remote pharmacist Adam Hogan, Mt Garnet Indigenous Health Worker Jedda Geesu with Mt Garnet nurse Deborah Kelly. (Source: Queensland Health)
With infrastructure for video conferencing already in place in all facilities, a clinical pharmacist outpatient clinic was set up at the hospital.
Nurses are utilised to identify patients from their communities through at risk from mediation misadventure, using referral criteria adapted from the Australian Pharmaceutical Formulary and Handbook.
An appointment letter and explanation brochure is emailed either direct to the patient or to the patient via the nurse, and the patient is advised to bring all their medicines with them to the consult.
The nurse then attends the consult with the patient, and the pharmacist conducts the medication review via telehealth.
An electronic medication list is compiled for the patient and any pharmacist recommendations are then communicated to the GP or Royal Flying Doctor Service.
“This new service allows our patients and clinicians direct access to a pharmacist and as a result patient medication reviews can be done quickly and easily,” says Rothwell.
“Previously pharmacy services to the seven rural and remote facilities consisted of supply and occasional phone information for nursing staff, now nurses are actively engaged with our pharmacist outpatient clinic and we are already seeing strong patient uptake.”
Telehealth can enhance the provision of pharmacy consultation to rural areas – improving patient access to a pharmacist and decreasing patient risk of medication misadventure, Rothwell and Hogan say.
HMRs similar to telehealth
Clinical consultant pharmacist Chris Braithwaite has also had positive experiences with telehealth.
“I was employed by Queensland Health Torres & Cape Hospital and Health Service to deliver medication reviews via telehealth to remote Cape York communities.
“In my work as a telehealth pharmacist, I focused on medication management, education and adherence. The structure was similar to an HMR, with findings and recommendations being reported to the treating doctor, triggering any changes deemed necessary.
“The most positive aspect is that high-risk patients with a significant chronic disease burden can have input from a pharmacist. This is unique for these patients as before telepharmacy, there was no opportunity for medication review,” says Braithwaite.
He says the experience proved that there were similar patient outcomes between HMRs and telepharmacy, and patients had no reluctance to engage in telehealth.
However there needs to be funding for the telehealth model to ensure its financial viability and sustainability, so remote communities can access direct patient clinical pharmacy services, Braithwaite adds.