A Patient's Perspective Telepharmacy
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4/29/19 1 Patient journey 2 Why it matters Telepharmacy: Agenda 3 Telepharmacy in rural areas A Patient’s Perspective 4 Telepharmacy in urban areas 5 Regulatory landscape Welcome to Springfield! The Game of LIFE Patient edition! ❖ Population: 1,800 ❖ Nearest retail pharmacy: 12 miles ❖ Local businesses: health clinic, grocery store, bank, convenience store Your patient journey Choose a path to start! You just got handed your prescription at your local clinic, would you rather: ? You start You visit your local What do you Option 1 Option 2 feeling ill clinic and the do next? doctor writes you a Fulfill the prescription at the Go to the nearest traditional prescription OR telepharmacy next door? pharmacy? 1 4/29/19 Choose a path to start! What is a You just got handed your prescription at telepharmacy? your local clinic, would you rather: ❖ Brick and mortar location Option 1 Option 2 ❖ OTC and front end products ❖ Private counseling Fulfill the prescription at the Go to the nearest traditional OR telepharmacy next door? pharmacy? ❖ Pharmacist is always available Telepharmacies look and feel Your prescriptions are filled and verified like a traditional pharmacy Technician fills prescription, 1 taking images of the process Prescription is remotely 2 verified by a pharmacist via HIPAA-compliant software Additional services Consult with your while you wait pharmacist ❖ OTC products ❖ Visit with your pharmacist via secure two-way audio-visual ❖ Immunizations when software pharmacist is on site ❖ Your pharmacist is presented ❖ Consult pharmacist with any with your patient notes during questions the call 2 4/29/19 GAME OVER! Leave with your Why telepharmacy medications in hand matters to patients and your questions answered Telepharmacy... The four types of telepharmacy Is defined as, "the provision of pharmaceutical care through the use of INPATIENT OUTPATIENT telecommunications and information technologies to patients at a distance," according to the National Association of Boards of Pharmacy. Remote order Retail entry review telepharmacy Benefits pharmacies, clinics, communities and the healthcare industry as a whole, but its biggest effect is seen on the most important stakeholders - patients. Remote IV admixture counseling Telepharmacy improves access and adherence Rural: 10+ miles 1 Current options of Urban: 1+ miles for patients in 2 95% patients medically One out of three patients fail reportedly filled their initial 3 to fill their initial prescriptions prescriptions when offered the underserved Mail delivery option by a pharmacist at the point of care areas 4 Physician dispensing Source: New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions; Harvard Business Review Vol 44 | Num 5 | Oct 2009. 3 4/29/19 Impact of telepharmacy 1 2 Convenient access to Compliments local clinic Rural access is declining medication and a or point of care to pharmacist improve fill rates and adherence 3 4 1,231 64+ million 1.7+ million Value of personal Boosts local economy relationships by keeping business Independent pharmacies People in the US Residents living in rural local closed between 2003-2018. living in rural areas pharmacy deserts 10+ miles from the nearest pharmacy Source: Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018; RUPRI Center for Rural Health Policy Analysis, Rural Policy Brief July 2018; Abiodun Salako, MPH; Fred Ullrich, BA; Keith J. Mueller, PhD Excuses why it’s not needed in rural areas 10 mile radius around Salt Lake City “People live in rural areas for a “Mail order will take care of rural 1 4 reason, they don’t mind driving 10 patients” miles each way” “Residents won’t like a “People won’t understand the 2 5 pharmacist on a screen” technology” “A pharmacist would move to the rural “The population in town won’t support 3 community” 6 a pharmacy” Rural use cases ● Open pharmacies in towns without access to a pharmacy ● Expand hours pharmacy is open Patients in rural ● Open new pharmacies in towns that can’t sustain a traditional pharmacy communities ● Keep existing pharmacies open that risk going out of business benefit from a local pharmacy 4 4/29/19 Sharon Telepharmacy patient “Sometimes they would call and say our meds were ready and we would get there and they weren’t ready. We had to go back the next day. Now I’m 3 minutes away!” Dave Telepharmacy patient “Just the fact that we have a pharmacy here in town has been a huge benefit. My wife is fighting cancer so to have the convenience to be able to get the drugs here locally is wonderful.” Christy City clerk, telepharmacy patient “We asked the community what we needed, and they said we need to Need for improved access in urban areas bring back the pharmacy. The pharmacy had closed down and we had to drive 20-30 minutes to the nearest pharmacy. My colleague heard about telepharmacies opening in Nevada and Zearing. We wanted a pharmacy in town they can rely on. The convenience of the telepharmacy is amazing; It’s a crucial part of the community.” 1,231 32% or 1 million 1+ miles Independent pharmacies People in Chicago’s 802 Distance to the nearest “I’m diabetic and need insulin every day. When the pharmacy closed I closed between 2003-2018. census tracts were in urban pharmacy in an urban started going to a pharmacy 20 minutes away, which was a disaster. pharmacy deserts pharmacy desert Now, I walk in and 10 minutes later I have my prescription.” Source: Qato, Daviglus, Wilder, Lee, Quato, Lambert. (2014). ‘Pharmacy deserts’ are prevalent in Chicago’s predominantly minority communities, raising medication access concerns. Health Affairs, 1958-1965. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2013.1397 5 4/29/19 Excuses why it’s not needed in urban areas Urban use cases “There’s a pharmacy on every “Patients don’t have issues traveling 1 4 ● Community Health Centers corner” half a mile” ● Federally Qualified Health Centers ● Hospitals “It’s unfair competition” “It’s not as good quality of care” ● Urgent Care Clinics 2 5 ● HIV Clinics ● Health Clinics “This would compete with my “Why not just hire a pharmacist” 3 pharmacies” 6 The growing impact of retail telepharmacy Lorraine Telepharmacy patient “I used to walk 6 blocks to get my medications 214 435,412+ 6,830,793+ and sometimes it wouldn’t be ready when I got Telepharmacy sample patients served prescriptions filled there, which means I had to come back later. I 40% urban, 60% rural call it the Magnificent Mile because it’s a very long walk. Now it’s more convenient. I can come right out from seeing the doctor and pick up my medicine and go straight home.” 655,135+ 982+ pharmacists consultations 1,142+ technicians Impact of telepharmacy in Illinois Telepharmacy regulations by state WA ME MT ND OR VT ● State with most operating MN NH ID SD NY WI MA RI telepharmacies WY S MI CT IA PA NJ NV NE IL OH MD UT IN DE CO WV CA VA ● 60 in operation today KS MO KY NC TN AZ OK AR NM SC MS AL GA Permitted, but practice may be ● 50% urban, 50% rural restricted and/or requires Board TX LA approval AK FL In progress HI Not permitted 6 4/29/19 Regulatory considerations Steps to implementing regulations # 1 Look for statutory authority 2 Board committee drafts rules Pharmacy technician Special rules around Limits on number of certification hours/ controls remote sites or Board notices rules to public experience technicians 3 4 Public comment period 5 Administrative rules review & approval Security requirements Mileage restrictions Technology requirements Implementation Frequently asked questions Contact your state pharmacy association Fill accuracy 1 Safety: staff & location 2 Contact your state board of pharmacy What next? 3 Diversion ? 4 Contact your legislator or public official Internet outages Pharmacist’s oath Friend reached traditional pharmacy "I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: ● I will consider the welfare of humanity and relief of suffering my primary concerns. ● I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients. ● I will respect and protect all personal and health information entrusted to me. ● I will accept the lifelong obligation to improve my professional knowledge and competence. ● I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. ● I will embrace and advocate changes that improve patient care. ● I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.” Source: https://www.pharmacist.com/oath-pharmacist 7 4/29/19 Description: Telepharmacy has been proven to be a safe and effective means to provide pharmacy services and allows pharmacists to maximize their expertise and provide better access to essential pharmacy services in both rural and urban communities. This presentation takes a look at the impacts of telepharmacy from the eyes of the patient and how this new practice model is changing the way they access their medications and other pharmacy services. Questions? Learning Objectives: 1. Analyze the current trends in the pharmacy industry and their effect on patient access. 2. Discuss the impact of telepharmacy on patients in rural and urban communities. 3. Describe the regulatory environment and what states are doing with rules surrounding telepharmacy. 8 .