TELEPHARMACY

This topic is part of Drug Delivery System of M. Pharm pharmaceutics 1st SEM .
Telepharmacy means how we can approach a pharmacist by internet without physical presence of a pharmacist and how we can take care by taking advice from them.

1. PRESENTED BY S. Sharat chandrika M .Pharm 1 st year( Sem Ⅰ) Pharmaceutics GRCP GUIDED BY Dr.Monika Nijhawan Associate Professor GRCP TELEPHARMACY 1

2. INTRODUCTION TELEMEDICINE: Term “tele ” from a Greek word “telos ”- “ at a distance” Term “medicine” from Latin word “Meden” –to heal”. According to WHO - delivery of healthcare services by healthcare professionals using information and communication technologies for diagnosis ,treatment , prevention of diseases & all the interest of advancing health of individuals. This practice is done by involving telephones ,videoconference & net. 2

3. TELEPHARMACY : “ The National Association Of Boards of pharmacy” defined telepharmacy as “provision of pharmaceutical care through use of telecommunications & information technologies to patients at distance. It delivers clinical pharmacy services &dispensing of prescription at remote location without physical presence of pharmacist. Pharmacist at central level assist pharmacist at remote site by audio &video. 3

4. PURPOSE OF TELEPHARMACY : Need for rural and remote communities, as this technology holds significant promise to improve access to pharmaceutical care . Clinical pharmacists are healthcare professionals trained to ensure medication related assistance to hospital personnel and patients. This type of access act as service in rural and remote areas & will overcome the shortage of healthcare providers . 4

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6. INVOLVEMENT OF PHARMACIST Pharmacist play important role in delivery of pharmacy services. The pharmacist ensure high quality of care like medication reviews and patient counseling. Adverse drug events and other medication errors result in several deaths each year. With growing population patient with chronic medical conditions all round the world involvement of pharmacist improve monitoring & encouraging medication compliance decrease risk of errors,ADR’s,&cost 6

7. TYPES OF TELEPHARMACY 1. Inpatient (remote order-entry review ): A pharmacist at a remote location performing remote order-entry services  for an inpatient pharmacy at a hospital. Reviews medication orders before the hospital staff administers the drugs to the patient.   With inpatient telepharmacy, remote pharmacists are able to provide 24/7 coverage. 7

8. 2.Remote dispensing (retail/outpatient/discharge):   A   retail community telepharmacy is a licensed pharmacy ,staffed  by a certified pharmacy technician   . A  pharmacist supervises the technician, reviews prescriptions and performs his or her duties from a remote location via technology .. This provide patients for convenient access to a pharmacist and prescription medication no matter geographic location .  8

9. 3 . IV admixture: The Joint Commission on Accreditation of Healthcare Organizations ( JCAHO ) defines IV admixture as, “the preparation of product or medication to a 50 mL or greater bottle of intravenous fluid .” P harmacist review the IV admixture remotely and save the time needed to suit up and enter the cleanroom to review the solution. Implementing an image-based telepharmacy workflow in a cleanroom allows you to document each step of the process and minimize mistakes.   9

10. 4 . Remote counseling: Remote-patient counseling equates to pharmacists providing patient counseling via a live-and-interactive video session .   A llows pharmacists to consult and provide a variety of pharmacy-care services to patients via live-video calls. P rovides opportunities for specialty counseling (diabetics/HIV/AIDS), and various clinical interactions with pharmacists.   10

11. Types Of T elepharmacy M odels 1.Traditional full service pharmacy 2.Remote consultation sites 3.Hospital telepharmacy 4.Automated dispensing machines(ADM’S) 11

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13. ADVANTAGES : Reduced operating costs Enhanced Clinical Role for Pharmacists Improved Patient Adherence Access to healthcare system Patient Satisfaction Minimal Shortage Of Pharmacists Effective Patient Counseling Economic Benefits 13

14. DISADVANTAGES Practical Challenges Pharmacy Regulation Laws Security Plenty Of Time, Effort and Money Inability To Use Technology 14

15. WORKING OF TELEPHARMACY T here are basically 4 main steps for successful running of telepharmacy as following: 1.A prescription arrives at the pharmacy 2.The prescription is filled 3.Pharmacist reviews the prescription 4.Live video patient counseling 15

16. [ START] Patient visit OPD for Doctor local checkup   Is patient referred to telemedicine system or not   Some special investigations may be suggested   An operator enter patients test records to the telemedicine data entry console &appoint date for online session   Offline data transfer from local center   stop Day one activity 16

17. Start   Patient queue based on appointment     Online conference of patient with doctor & pharmacist of nodal hospital & central level pharmacists along with specialist at remote area   Stop Day two activity 17

18. Evaluation of prescription: It starts when medication Orders from physician in rural areas sent to urban via scanning device. Nursing staff enter medication Order into patient electronic Medical record 18

19. verification: The urban hospital pharmacist reviews the order in medical record system against scanned copy. This process is used in both to check accuracy of order entry and appropriateness of order .In order to do this ,the pharmacist must have access to the patients complete medical record. 19

20. Identification of medicines: 20

21. RESTOCKING OF ADM’S The telepharmacy program also allows the urban pharmacist to oversee restocking of automated dispensing device using specially mounted video camera. The camera on rolling cart is positioned next to cabinet that needs to be restocked . By this way urban pharmacist actually see down into each drawer as it is being filled. 21

22. TELEPHARMACY DURING COVID-19 A corona virus identified as SARS-CoV-2, was discovered in December 2019 in Wuhan, China . the virus continued to spread and its infectious impact was seen across the world Initially, mitigation strategies such as social distancing and wearing a mask were implemented in efforts to reduce the spread Elective surgeries and noncritical medical services were postponed or limited . Anxiety and fear were widespread, especially among those who needed to seek healthcare for non-COVID-19 emergencies .Patients avoided seeking hospital care due to stay-at-home orders or fear of the rising contagion. 22

23. The use of telehealth was promoted during the COVID-19 pandemic to combat this situation Telepharmacy services include drug review and monitoring, dispensing, medication therapy management, patient counseling, outcomes assessment, and drug information . Remote healthcare services during the pandemic have demonstrated benefits for the healthcare system and improving public health . Access to telehealth services allowed for increased social distancing and reduced potential infectious exposures. 23

24. Various Telepharmacy Initiatives Implemented in different countries The most commonly observed telepharmacy initiatives were virtual consultations, home delivery of medicines, monitoring patients ,optimizing medication use and patient education as part of their telepharmacy initiatives. A network of 19 hospitals in China developed a “cloud-pharmacy care” to consult with pharmacists using texts and the internet. Another hospital in China introduced “zero-contact pharmaceutical care” using online medication consultation through an app called We Chat. 24

25. Use of mobile applications for home delivery of medicines in China and Colombia . In Spain , the hospital pharmacy services adapted to use information on communication technologies & the use of integrating geo-location for efficient delivery of medicines. Kingdom of Saudi Arabia- by adapting new e-tools such as a business Whats App and webpage portals . 25

26. In the Sri Lanka , use of teleprescriptions along with videoconferencing and audio consultations. In the United States , state pharmacy modified requirements for telemedicine, including telepharmacy, by allowing videoconferencing . A case study from one hospital in the U.S. reported the use of Microsoft Teams for patient education and counseling . A article reported the use of hotline numbers in New Zealand for phone consultations and prescription orders, the use of mail, fax, and e-mails for prescriptions . 26

27. eSanjeevani - National Telemedicine Service The scheme was started in November 2019. It is run by the Ministry of Health and Family Welfare. Also called the National Teleconsultation Service, it aims to provide healthcare services to patients in their homes.  It includes a structured and safe teleconsultation between a doctor and a patient through online mode (eSanjeevani OPD ).  eSanjeevani, Govt. of India’s free telemedicine service,  Has crossed  8 crore teleconsultations . 27

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30. Sharing information and decision-making process in the telepharmacy program Figure  represent a set of tasks that occurred during telepharmacy service establishment. Through this model, we can find out how clinical pharmacists can communicate with several centers through teleconsultation. The information in the proposed model refers to any types of patients clinical data. 30

31. TELEPHARMACY PRESENT STATUS AND FUTURE PERSPECTIVE Present status: If there was no pandemic, a section on telepharmacy role in healthcare today would have sounded a little But COVID-19 came along, and the value of telepharmacy — like other forms of telehealth — has become even more apparent, appreciated, and embraced. The federal government quickly championed telepharmacy as a way for pharmacists to minimize their risk of exposure to the novel corona virus and reduce the risk for patients during the COVID-19 pandemic 31

32. Future: As Healthcare IT News notes, a recent survey found that about three-quarters of patients who have received virtual care during the pandemic said they want to see it become a standard part of care. The following steps are going to emerge in future to fulfill the usage of telepharmacy and make advantageous to all the people over the country especially in rural area or remote areas . 32

33. Support to Clinical Services like- 1. Medication Adherence  2. Clinical Pharmacist Shortage  3. Pharmaceutical Counseling Activity  4. Remote Education and Handling of “Special Pharmacies ” 5. Medical Staff Training and Patient Education  6. Prescription and Reconciliation of Drug Therapies 33

34. REFERENCES 1. Arpana S. Karnvar ,et al . A Review on Telepharmacy services. International Journal of Pharmaceutical Research and Applications, 30-11-2020 ; Volume 5, Issue 2, pp: 619-623 . 2. Vaishnavi R. Belokar, Hitesh R. Sahejwani, Sachin J et al . Telepharmacy: way to digital .World Journal of Pharmaceutical and Life Sciences, 23-02-2022;Vol . 8, Issue 3, 227 – 233. . 34

35. 3.Gaurav Joshia , Keshav Jindala, et al. IJPPR, February 2020 Vol.:17, Issue:3. 4.Elizabeth j , kanchita Patel et al. Telepharmacy during covid-19 : A Scoping Review. m dpi , 11 -11-2021 ; Volume 9, Issue 4. 5. Niloofar Khoshnam‐Rad1 ,et al. Rapid implementation of telepharmacy service to improve patient‐centric care and multidisciplinary collaboration across hospitals in a covid era : A cross‐sectional qualitative study.wiley,2022;Volume 5, Issue 6. 35

36. 36 6.Matawalli et al. Health Care Using Telemedicine: A Case Study of Yobe State, Nigeria. IJCSN 2014: 3(5): 385-392 . 7. Muflih S. M, Al- Azzam , S , Abuhammad, S et al .Pharmacists ’ experience, competence and perception of telepharmacy technology in response to covid-19,   2021;   75. 8. Clifton, G.D , Byer, Heaton K et al .Provision of pharmacy services to underserved populations via remote dispensing and two-way videoconferencing. American Journal of Health-System Pharmacy, 2003; 60(24): 2577- 2582

37. 37 9.Gordon HL, Schneider A et al. Telepharmacy in a rural alberta community cancer network. Journal of Oncology Pharmacy Practice. 2012; Vol. 18 p. 366– 76. 10. Poudel A, Nissen L et al . Telepharmacy: a pharmacist’s perspective on the clinical benefits and challenges. Integr Pharm Res Pract. 2016 Oct ; volume 5:75– 82. 11. Baldoni S, Amenta F, Ricci G. Telepharmacy services: Present status and future perspectives: A review. Vol. 55, Medicina (Lithuania). MDPI AG; 2019.