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Telepharmacy: the Pharmacy of the 21St Century

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Telepharmacy: the Pharmacy of the 21St Century SMGr up Telepharmacy: The Pharmacy of the 21st Century Marlise Araújo dos Santos1,4*, Patrícia Bellicanta Lazzarotto1,4, Helena Willhelm de Oliveira2,4, Júlio César M de Lima3,4 and Thais Russomano4 1 2 Joan Vernikos Aerospace Pharmacy Laboratory, Brazil 3 eHealth Laboratory, Brazil 4 Aerospace Engineering Lab, Brazil *CorrespondingMicroG- PUCRS, Brazil author: Marlise Araújo dos Santos, Joan Vernikos Aerospace Pharmacy Laboratory, MicroG- PUCRS, Brazil, Tel: +55 51 998287743 and +55 51 33536369; Email:Published [email protected] Date: June 27, 2017 ABSTRACT Telehealth is a new area of health assistance, research, and education, in which information and telecommunication technologies (ICT) are used to give support services to communities where there is a lack of healthcare or access to particular specialties of medical assistance. One area of activity of telehealth is telepharmacy, which makes pharmaceutical assistance possible to remote and disadvantaged areas.This Chapter presents the establishment of the The Brazilian Telepharmacy experience is highlighted, which includes the laws and regulations first telepharmacy services in U.S. hospitals, its spread to local pharmacies and other countries. involving the rational use of medication and medicinal plants, and how the Brazilian Health Policy to medical doctors and dentists, nutritionists, pharmacists and physiotherapists can prescribe and System promotes and motivates this area. According to Brazilian laws, for example, in addition medicinal plants and phytotherapies to their patients. This Chapter also discusses the eHealth Telemedicine | www.smgebooks.com 1 Copyright dos Santos MA.This book chapter is open access distributed under the Creative Commons Attribution 4.0 International License, which allows users to download, copy and build upon published articles even for com- mercial purposes, as long as the author and publisher are properly credited. activities of the MicroG Centre, PUCRS. The MicroG telehealth assistance projectsbegan in its eHealth Laboratory, as a multidisciplinary initiative, involving joint projects with other labs of the MicroG, such as theAerospace Engineering and Joan Vernikos Aerospace Pharmacy laboratories. The latter has three different pharmacy assistance projects that includethe evaluation of drug medicinal plants and the interference of cultural aspects of different communities on their use. interactions, drug adverse effects, drug- medicinal plant interactions, and the identification of Therefore, the application of telecommunication and computer technologies, software and digital knowledge of different areas of pharmacy. In this way, telepharmacy has successfully enabled the tools has allowed and promoted a more cost-effective spread of the technical and scientific delivery of pharmaceutical care to patients in situations and regions where direct contact with a pharmacist is not possible, which in turn improves the quality of life of patients as a whole. INTRODUCTION TO TELEPHARMACY Telehealth is an emerging area of health assistance, research, and education that applies information and telecommunication technologies (ICT) to enable the delivery of remote health- related care, education and support services to communities where there is currently a shortage of access, such as a lack of specialist healthcare or access to particular areas of medical assistance. Telehealth has the potential to transform and improve health services, and is an important support tool for enabling the diagnosis and management of diseases. One of the areas of activity of telehealth programs is Telepharmacy, which makes remote pharmaceutical assistance possible. According to the National Association of Boards of Pharmacy and pharmacists through the use of telecommunications to patients located at a distance” [1]. It (NABP), the practice of telepharmacy is “the provision of pharmacist care by registered pharmacies comprises of actions, such as: [2] health assistance activities aimed at optimization of medication based on the promotion of continuous education and social programs providing pharmaceutical use through prescription, dispensing and consumption habits; and [3] educational initiatives information and assistance with the intention of reducing disparities and promoting equity [1]. Pharmaceutical care (PC) brings together a set of actions aimed at the improvement, protection and recovery of health, through the promotion of access to medicines and their safe and rational (WHO) service in the patient-drug relationship, and the process of healing or maintenance of health can be use [4]. According to the World Health Organization , it can be defined as an indispensable pharmaceutical care, leading to decreases in medication errors and adverse drug-related events, compromised without it [5]. Telepharmacy, therefore, has the potential to improve the quality of while as the same time increasing the cost-effectiveness of provision and improving access to care [1]. Telepharmacy then becomes an essential tool for the advancement of pharmaceutical care, a practice that prioritizes pharmacotherapeutic guidance and monitoring to help improve patient very expensive to recruit and support the activities of pharmacists [1]. quality of life, and is of particular benefit in remote and/or disadvantaged areas, where it is often Telemedicine | www.smgebooks.com 2 Copyright dos Santos MA.This book chapter is open access distributed under the Creative Commons Attribution 4.0 International License, which allows users to download, copy and build upon published articles even for com- mercial purposes, as long as the author and publisher are properly credited. via telephone, with subsequent evolution as modern technologies developed, such as multimedia The roots of telepharmacy first grew at a hospital level, through pharmaceutical care provision access tools designed to provide remote monitoring and therapy. The advent of telephone call centers also helped contribute to the wider use of telepharmacy, as they opened up the ability to as formulary compliance monitoring [2]. However, the use of telepharmacy soon spread outside provide medication counseling, and prior and refill authorization for prescription drugs, as well the confines of the hospital environment and into the community. Telepharmacy was first officially evaluated in the United States in 2001,when North Dakota became the first state to examine its use through a study involving 81 pharmacies (53 retail the establishment of a telepharmacy service resulted in a reduction in the rate of dispensing and 28 hospital-based), conducted at North Dakota State University. The findings suggested errors to half that of the national average, which stood at 2% [6]. A further study, also conducted medication dispensing errors between remote telepharmacy sites without an on-site pharmacist in North Dakota State and performed between 2005 and 2008, assessed the differences in and community pharmacy sites with a pharmacist in attendance. The results demonstrated a lower overall rate (1.0%) and a slight difference in medication dispensing error rates between the remote telepharmacy sites (1.3%) and the control sites (0.8%) [7]. An evaluation conducted in 2017 examined the sustainability of the business model of the North Dakota Telepharmacy Project, involving 38 community pharmacy organizations (14 central, 24 remote) and 27 community telepharmacy business model was noted as being more established than that of the organizations (11 central and 16 remote sites), with an overall response rate of 71%. The hospital telepharmacy. The majority of respondents reported their telepharmacy sites (especially the remote sites) as generating little positive financial returns for the organization. They also believed the closure of their remote sites would significantly harm the communities they served, suggesting that, although the telepharmacy model does not generate significant economic profit, it is sustainable and benefits service users [8]. Furthermore, the positive experiences of the implementation of telepharmacy in North Dakota motivated an increase in the number of telepharmacy services in other U.S. states, such as in Michigan and Ohio, following the closure of economic calamity saw a 12.1% reduction in total pharmacy numbers, mainly in rural areas, of many physical pharmacies due to the global financial crises from 2007 to 2009. This period with 490 communities losing their only local pharmacy, creating a gap in healthcare services and decreased medication adherence [9]. Telepharmacy projects and initiatives have been applied in diverse areas. For example, the use of telepharmacy has featured in the U.S. Navy since 2008 in an attempt to overcome a lack of of medications at multiple satellite pharmacies through the use of a bar-coded administration pharmacists throughout the organization. A single pharmacist remotely oversees the dispensing system, pill-counting software and other remote technologies that allow automation of the Telemedicine | www.smgebooks.com 3 pharmacy process. All this combined has createdCopyright a more dos Santos accurate,MA.This book chapter isefficient open access distributed and under thecost-effective Creative Commons Attribution 4.0 International License, which allows users to download, copy and build upon published articles even for com- mercial purposes, as long as the author and publisher are properly credited. system, speeding up the time of health care delivery [1]. Going beyond simple remote medication
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