Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review

Abstract

Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls) and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine.

Evaluation of a mobile health intervention to support asthma self-management and adherence in the pharmacy

“…This is important nowadays, because pharmacists are expected to combine their management role with more healthcare providing roles, and there is an ongoing shift towards integrated care settings [29]. Currently, not many mHealth interventions are designed in pharmacies [4, 6, 30], while positive effects of pharmacy delivered mHealth interventions are shown for disease management of several chronic diseases in adult patients [31, 32]. In the current study, even non-chronic medication users were mentioned as a target group for mHealth.…”

Impact of a pharmacist‐physician collaborative care model on time‐in‐therapeutic blood pressure range in patients with hypertension

“…Of course, this can be challenging to implement in routine clinical practice, but this can be achieved in models that provide care where patients live, work, and worship . Technology and telemedicine have also been proven to be useful alternatives to traditional face‐to‐face visits for up titration of antihypertensive therapy and may be necessary to implement a more intensive approach to managing patients with hypertension . It seems evident that a multimodal approach is necessary to ensure improvement in hypertension outcomes.…”

Ambulatory care practice in the COVID‐19 era: Redesigning clinical services and experiential learning

“…It will be important for pharmacists to sustain heightened levels of patient‐centered care in various modes of delivery, including telehealth. Furthermore, provision of telehealth by pharmacists can increase access to and quality of care, which is prudent as health care continues to transition from traditional payment models to value‐based care 49 . Advocacy for maintaining expanded scopes of pharmacy practice will be important in removing barriers that hinder the optimization of medication therapy through pharmacists' care.…”