Telepharmacy—Enabling Technology to Provide Quality Pharmacy Services in Rural and Remote Communities Michael B Kimber, Gregory M Peterson

PHARMACY PRACTICE Telepharmacy—Enabling Technology to Provide Quality Pharmacy Services in Rural and Remote Communities Michael B Kimber, Gregory M Peterson ABSTRACT • rural allowances and support; The provision of quality pharmacy services to rural and remote • improved Indigenous access to community communities is influenced by the National Strategy for the pharmacy services; Quality Use of Medicines. The implementation of this strategy • dose administration aids for people at risk; is challenged by the shortage of pharmacists in rural areas. • pilot programs to develop pharmacy’s role in the care Australia compares unfavourably with both the UK and US in of asthma and diabetes; and this regard. The Fourth Community Pharmacy Agreement • e-health initiatives. between the Commonwealth of Australia and the Pharmacy Other countries, stimulated by the World Health Guild commits the parties to 13 key objectives and makes Organization, are implementing national medicinal drug provision for funding initiatives for professional pharmacy policies to ensure that essential, affordable drugs of programs. Two of these programs are medication reviews and acceptable quality, safety and efficacy are available for e-health initiatives. Telepharmacy, as an enabling technology, their population. The Commonwealth of Australia represents a unique and innovative way to deliver quality established the Australian Pharmaceutical Advisory pharmacy services to rural areas. Telepharmacy operations are Council (APAC) and the Pharmaceutical Health and in place in other countries. In the US, two principal models are Rational Use of Medicines Committee (PHARM) in 1991 in Washington State and North Dakota, although other states in an effort to improve the use of medicines and further such as Texas, Nebraska and Alaska also have telepharmacy develop a national medicines policy. The activities of the models in place. Studies in Australia have had mixed results and government, based on advice from APAC and PHARM, have not been as successful. However, there are some promising together with representative groups from all interested models that have been employed in telemedicine, including for parties in health care, resulted in the establishment of the the delivery of physiotherapy and other allied health services. National Prescribing Service in 1998 and the National It is of key importance to involve pharmacists in telepharmacy Medicines Policy in 2000.3 services and a key initiative to be studied soon in Far North The National Medicines Policy is based on four Queensland will involve home medication reviews being central objectives within a framework of active and conducted via telepharmacy. respectful partnerships, taking into account elements of J Pharm Pract Res 2006; 36: 128-33. social and economic policy. 4 These objectives are described as timely access to medicines, which meet PHARMACY SERVICES AND QUALITY USE OF appropriate standards of quality, safety and efficacy, at a MEDICINES cost that individuals and the community can afford and Australia’s rural areas are characterised by small that embody QUM principles, while maintaining a communities and towns spread over vast distances. The responsible and viable medicines industry. people of these communities and those who travel The key focus of the National Strategy for Quality through them do not have ready access to quality Use of Medicines is to ensure that medicines are used pharmaceutical services that people living in urban areas judiciously, appropriately, safely and efficaciously. 5 take for granted. Quality pharmaceutical services have APAC, the coordinating body for the implementation of been described as: dispensing, supply and distribution the QUM strategy, comprises interested parties of medicines; provision of knowledge and information representing the major partners identified in the National about drugs, with the primary objective being the Medicines Policy. APAC’s strategic plan is detailed under promotion and assurance of quality use of medicines the four arms of the National Medicines Policy. 6 (QUM); and provision of pharmaceutical care, which The progression and cascading of the National involves pharmacists responding to patients’ drug-related Medicines Policy and strategies down to the provision needs to assist them achieve their desired health of quality pharmaceutical services is partly embedded in outcomes.1 the Fourth Community Pharmacy Agreement.7 The Fourth Community Pharmacy Agreement between the Commonwealth of Australia and the RURAL PHARMACY AND WORKFORCE Pharmacy Guild, commits the parties to achieving 13 key CHALLENGES objectives.2 Of interest are the funding initiatives for Rural communities have always had difficulty recruiting professional pharmacy programs (including a Better health professionals. These difficulties are now being Community Health program), which will provide: compounded by a nationwide pharmacist shortage. The • medication reviews; first of the recent workforce reports, Pharmacy Labour Force 1998, identified that the number of pharmacists Associate Professor Michael B Kimber, DipPharm, GradDipAdv Management, per 100000 population declined by 13.8% between 1990 MPS, FAIM, School of Pharmacy and Molecular Sciences, James Cook University, 8 Townsville, Queensland, Professor Gregory M Peterson, BPharm(Hons), PhD, and 1996. This compared unfavourably with the US MBA, FSHP, FACP, Unit for Medication Outcomes Research and Education, and the UK, where increases in the number of Tasmanian School of Pharmacy, Hobart, Tasmania pharmacists per 100000 population were recorded for Address for correspondence: Michael Kimber, School of Pharmacy and Molecular Sciences, James Cook University, Townsville Qld 4811, Australia the same period. Australia was also in the lower third of E-mail: [email protected] countries surveyed in the number of pharmacists per 128 Journal of Pharmacy Practice and Research Volume 36, No. 2, 2006 100000 population and this did not take into account product. The Pharmacy Guild claims that the Quality Care Australia’s vast geographical area. Pharmacy Program will result in all dispensing and supply A study by the Department of Employment and of scheduled products being services. The provision of Workplace Relations in December 2002, found that there medication management reviews by pharmacists is the were national shortages of community and hospital first example of this.14 It is envisaged that there will be pharmacists in all states and territories.9 There were many more such services provided which relate to the severe shortages of hospital pharmacists in New South management of specific chronic illnesses or ongoing Wales and acute shortages of community pharmacists conditions, such as diabetes and asthma, as identified in in Queensland’s regional areas. This indicated that the the Fourth Community Pharmacy Agreement. position had become more acute since the study by the It will be difficult to introduce these professional Department of Employment and Workplace Relations and activities into rural and remote Australia, given the Small Business in December 1999, which found that there shortage of pharmacists. Indeed, the shortage in these were national shortages of community and hospital areas has often resulted in the role of providing pharmacy pharmacists in all states except NSW. 10 services to rural and remote communities being shifted A study by Health Care Intelligence Pty Ltd (HCI) in to doctors, nurses, aboriginal and other healthcare 1999, reported that the market for hospital pharmacists workers.15 may be nearly balanced by 2010, but there may be a shortage of community pharmacists.11 The pharmacy TELEPHARMACY workforce study (2001), ‘A demand model for hospital The US Health Resources and Services Administration pharmacists’, by O’Leary et al. reported that three of the has defined telepharmacy as the use of electronic main drivers for the demand for hospital pharmacists information and communication technology to provide are: the National Medicines Policy, implementation of and support comprehensive pharmacy services when the APAC guidelines which follow on from the National distance separates the participants.16 Telepharmacy Medicines Policy; increased patient safety; and the represents a unique and innovative way to deliver introduction of Pharmaceutical Benefits Scheme pharmacy services to rural areas incorporating all the dispensing in public hospitals.12 These drivers were the safe practices offered by the traditional mode of delivery. reason for the HCI 1999 report coming to a set of different Potential benefits to the rural communities include workforce conclusions to the O’Leary report. restoring access to health care, pharmacy services and The O’Leary report estimated that approximately 310 pharmacists, and improving the chances of recruiting or qualified pharmacists were required immediately to fill retaining pharmacists in rural communities, as well as positions currently vacant in hospitals across Australia. providing new clinical training sites for pharmacy An additional 395 to 515 hospital pharmacists were students for teaching them how to deliver pharmacy required in the period 2001–2006, and an additional 715 services to rural communities in a unique way. 17 to 1330 hospital pharmacists will be required in the period 2006–2010. This equates to at least 860 additional Telepharmacy Models qualified pharmacists. There are a number of telepharmacy initiatives in full Parts of the O’Leary report were

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