Telepharmacy

Telepharmacy is delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with pharmacist. It is an instance of wider phenomenon of telemedicine, as implemented in the field of pharmacy.

Telepharmacy services include drug therapy monitoring, patient counseling, monitoring of formulary compliance with the aid of teleconferencing or videoconferencing.

Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes or other medical care facilities.
Rural residents and communities lack easy access to healthcare services often due to geographical and demographical factors.
Telepharmacy holds significant promise as a technology to improve access to pharmaceutical care for people living in rural and remote communities.
Telepharmacy is quickly becoming an integral part of modern pharmacy practice that has the potential to provide quality pharmaceutical services, such as medication management, dispensing, patient counseling, and drug information.
Inherent to the adoption of these practices are legal challenges and pitfalls that need to be addressed. A well-developed system, however, can change the practice of pharmacy that is beneficial to both the rural communities and the hospital or retail pharmacies that deliver these services.

1. NEHA KANSWAMI G.Pulla Reddy College of Pharmacy Course : ( Swayam ) UGC MOOC ;Academic Writing Application number: fa8e0400f0af11e9b29fa7940f9b4a22 TELEPHARMACY

2. Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. The World Health Organization (WHO) defines Telemedicine as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.” WHAT IS TELEMEDICINE? 2 CC BY-SA-NC

3. 3 Telepharmacy is delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with pharmacist. It is an instance of wider phenomenon of telemedicine , as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes or other medical care facilities. TELEPHARMACY CC BY-SA-NC

4. 4 In 2001, North Dakota became the first U.S. state to pass regulations allowing retail pharmacies to operate without requiring a pharmacist to be physically present. The next year, state agencies and grants established the North Dakota Telepharmacy Project , which now supports more than fifty remote retail and hospital pharmacy sites throughout North Dakota. In this program, a licensed pharmacist at a central site communicates with remote site pharmacy technicians and patients through videoconferencing. Implementation CC BY-SA-NC

5. How Does Telepharmacy Work? 5 Small pharmacies or clinics in remote, isolated areas are connected to a central pharmacy through novel software, videophone systems, and automated dispensing machines. Patients bring their prescriptions to the remote sites, which are staffed by either pharmacy technicians or nurses. The central pharmacist provides oversight via teleconferencing systems and processes the prescription faxed from the rural site. The pharmacist releases several items at the rural site, including the prescription label and the prepackaged medication from the automated dispensing machine. CC BY-SA-NC

6. STEPS INVOLVED: 6 CC BY-SA-NC

7. 7 EVALUATION THE PRESCRIPTION: CC BY-SA-NC It starts when medication orders from a physician in a rural hospital are sent to an urban hospital pharmacy via a scanning device. Nursing staff also enter the medication order into the patient’s electronic medical record.

8. 8 VERIFICATION : CC BY-SA-NC The urban hospital pharmacist reviews the order in the medical record system against the scanned copy. This process is used both to check the accuracy of the order entry and also to check the appropriateness of the order. In order to do this, the pharmacist must have access to the patient’s complete medical record.

9. 9 IDENTIFICATION OF MEDICINES: CC BY-SA-NC

10. CC BY-SA-NC 10 RESTOCKING OF ADM’S The telepharmacy program also allows the urban pharmacist to oversee the restocking of the automated dispensing device, using a specially mounted video camera. The camera, on a rolling cart, is positioned next to the cabinet that needs to be restocked. In this way, the urban pharmacist can actually see down into each drawer as it is being filled.

11. Step-by-Step Guide to Creating a Successful Program A. Starting A Telepharmacy 1.General principles & first point of contact 2.License Application (NCPDP National Council for Prescription Drug Programs and DEA federal Drug Enforcement Administration 3.Assess the Need 4.Develop Community Partners In determining the level of support for telepharmacy services and defining the scope of services needed in the targeted community, feedback from the following project partners may be beneficial: Individual Patients Senior Citizen Groups Rural Health Clinic Personnel Community Business leaders Local Community Leaders 11 CC BY-SA-NC

12. 12 Local Government Officials Pharmacist Practicing in the area State Board of Pharmacy Administrator State Pharmaceutical Association School of Pharmacy 5. Secure a Physical Location Criteria to consider for location of retail telepharmacy services: Convenient Access for the Public Proximity to other Health Clinic Facilities ,Proximity to Nursing Homes Leased after Development by Local Lease space in an existing business. Technology Transmission or Connectivity Capabilities in the Community CC BY-SA-NC

13. 13 b. Criteria to consider for starting hospital telepharmacy services B. Planning Construction 1. Retail Telepharmacies 2. Information Technology Considerations Installation of VPN (Virtual private network)-encrypts all information between endpoints and protects private info. 3. Personnel Considerations Pharmacy Technician Licensed Pharmacist Patient Considerations CC BY-SA-NC

14. Inpatient (remote order-entry review) Remote dispensing (retail/outpatient/discharge)  IV admixture Remote counseling DIFFERENT TYPES OF TELEPHARMACY: 14 CC BY-SA-NC

15. INPATIENT (REMOTE ORDER-ENTRY REVIEW ): Inpatient telepharmacy refers to a pharmacist at a remote location performing remote order-entry services for an inpatient pharmacy at a hospital. The remote pharmacist reviews medication orders before the hospital staff administers the drugs to the patient.   REMOTE DISPENSING (RETAIL/OUTPATIENT/DISCHARGE ): A remote-dispensing site, or retail community telepharmacy , is a licensed brick-and-mortar 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. 15 CC BY-SA-NC

16. 16 IV ADMIXTURE: The joint commission on accreditation of healthcare organizations (jcaho) defines iv admixture as, “the preparation of pharmaceutical product which requires the measured addition of a medication to a 50 ml or greater bag or bottle of intravenous fluid.” In layman's terms, iv admixture is the mixing of iv solution administered to patients in a hospital setting. REMOTE COUNSELING: Remote-patient counseling equates to providing patient counseling via a live-and-interactive video session, or by some means through telecommunications. CC BY-SA-NC

17. 17 TYPES OF TELEPHARMACY MODELS: CC BY-SA-NC

18. 18 . Traditional full service pharmacy Remote consultation sites Hospital telepharmacy Automated dispensing machines(ADMs) These telepharmacy sites have complete drug inventories that include prescription and over the counter medications along with other-health-and beauty aids and other general merchandise Prescriptions are prepared at the central pharmacy and are delivered to the rural sites. Audio and video computer links are used to deliver patient counseling and education Hospital pharmacist in urban medical center reviews processes and verifies the prescriptions that are issued and electronically sent from rural hospitals. Automated dispensing machine (ADM) is used to electronically release the prepackaged medication. Pharmacist at a central location upon receiving drug order (electronically or by fax) confirms the patient profile, conducts proper drug utilization review, and finally instructs the ADM to release the medication CC BY-SA-NC

19. 19 CC BY-SA-NC

20. 20 ADMs: Pyxis medstation, Omnicell. CC BY-SA-NC

21. 21 PROTOCOL FOR PROCESSING OF NEW PRESCRIPTIONS: CC BY-SA-NC

22. 22 Advantages CC BY-SA-NC

23. 23 One major benefit is that many areas especially the remote ones that have no access to pharmaceutical care or pharmacist will enjoy the services due to the introduction of these services. Telepharmacy is one way that many people living in remote areas will enjoy especially if they are unable to get basic experts in the pharmacy care thus reducing the cost of traveling to other places for the same services. Patients are also counseled, and drug administering is monitored from time to time. CC BY-SA-NC

24. Disadvantages 24 Pharmacy regulation laws Operational difficulties More time, effort, and money Security Reluctance to use technology Continuity of care CC BY-SA-NC

25. C onclusion : Rural residents and communities lack easy access to healthcare services often due to geographical and demographical factors. Telepharmacy holds significant promise as a technology to improve access to pharmaceutical care for people living in rural and remote communities. Telepharmacy is quickly becoming an integral part of modern pharmacy practice that has the potential to provide quality pharmaceutical services, such as medication management, dispensing, patient counseling, and drug information. Inherent to the adoption of these practices are legal challenges and pitfalls that need to be addressed. A well-developed system, however, can change the practice of pharmacy that is beneficial to both the rural communities and the hospital or retail pharmacies that deliver these services. 25 CC BY-SA-NC

26. 26 References: Angaran DM. Telemedicine and telepharmacy: current status and future implications. Am J Health Syst Pharm. 1999;56(14):1405–1426. [PubMed] National Advisory Committee on Rural Health and Human Services. 2006 Report to the Secretary. Available at: http://ruralcommittee.hrsa.gov/nacpubs.htm. Accessed October 28, 2006. North Dakota Telepharmacy Project. Telemedicine technical assistance documents: a guide to getting started in telemedicine. Chapter 10. Available at: http://telepharmacy.ndsu.nodak.edu/publications/TELEPHARMACY-TAD1.pdf. Accessed October 10, 2006. Peterson CD, Anderson HC. The North Dakota telepharmacy project: restoring and retaining pharmacy services in rural communities. J Pharma Technol. 2004;20:28-39. Retail Pharmacy Management. Telepharmacy making headway in remote states. Available at: www.retailpharmacymgmt.com/indexpub.cfm?pubid=10. Accessed October 26, 2006. CC BY-SA-NC

27. 27 Gulliford SM, Schneider JK, Jorgenson JA. Using telemedicine technology for pharmaceutical services to ambulatory care patients. Am J Health Syst Pharm. 1998;55:1512-1515. North Dakota Telepharmacy Project. Is a telepharmacy right for my community? Available at: http://telepharmacy.ndsu.nodak.edu/publications/communitymanual.htm. Accessed October 9, 2006. Integrated Pharmacy Research and Practice downloaded from https://www.dovepress.com/ by 175.103.25.178 on 27-Oct-2016pharmacist’s perspective on the clinical benefits and challenges. CC BY-SA-NC

28. Acknowledgement With great pleasure I pay deep sense of gratitude and heartfelt thanks to team Academic Writing for their constant encouragement and support. CC BY-SA-NC 28

29. Feed Back A very good learning platform for students pursuing post graduation and PhD. Several software's and various tools were provided for practice which was very helpful. The Animations in the lectures are very helpful and very effective .The notes provided is very good and clearly structured. Lectures are quite interesting to listen to and very well delivered. Overall it was a good learning experience. CC BY-SA-NC 29

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