Telepharmacy: improving access to medical care for rural patients – a hospital pharmacy approach

Access to outpatient appointments and specialist access, including pharmacy, has been a longstanding issue in Australia, especially for rural and regional people who may have long distances to travel to access appropriate medical care, resulting in increased cost for travel and time to the consumer. More recently the COVID-19 pandemic has made access much more difficult due to closure of clinics, staff shortages and consumers needing to self-isolate or concerned about visiting busy towns or clinics.

One of the few silver linings of the pandemic is the increased adoption of telehealth, proposed as an option to improve the health gap between rural Australians and their city counterparts. In the coming months and years, we expect you will be hearing a lot more about telepharmacy, a rapidly emerging field with the potential to transform and improve the delivery of pharmacy services for rural and remote Australians.

For patients living in rural communities, telepharmacy can help them access a range of services virtually that otherwise may have required a lengthy trip – and possibly multiple trips – to a community or hospital pharmacy. Reduced medication literacy has been reported as a barrier to medication use for consumers in rural and regional areas and the uptake of telepharmacy has been proven to increase access to pharmacists, resulting in improved medications compliance and health literacy.

Common telepharmacy services include:

• medication therapy management (MTM)
• medication reconciliation post-discharge (MRP)
• drug information, review and monitoring
• patient counselling and assessment
• remote patient monitoring
• telechemotherapy.

The benefits of telepharmacy are abundant and include improved medication adherence, more timely access to pharmacists and services, reduced need for urgent and emergent care, increased patient engagement in care and reduced patient costs.

Telepharmacy can also be beneficial for health professionals by creating an environment for upskilling and increased access to specialists. In Queensland and Western Australia, successful telechemotherapy models ensure hospital pharmacists in remote locations are supported to provide cancer care for patients near their home, with the expertise of a metro-based specialist oncology pharmacist.

Speaking from personal experience, working in a telepharmacy field has enabled co-author Nicole O’Shea to work within a tertiary hospital environment without the requirement to travel or move. Ms O’Shea’s field supports all of Australia and enables her to bring a rural/regional approach to her role which would have otherwise been absent.

An example of a successful telepharmacy approach is a large regional hospital that has developed a new model of care for outpatient clinics. It was learned that an incomplete medicine history was leading to delayed decision-making on patient care, longer appointments and the requirement of additional appointments. By scheduling a telehealth appointment with a pharmacist prior to a visit to the clinic, it was found the outpatient appointment was quicker, more patients were able to attend and patients felt confident with their medication management. In addition, patients made out-of-pocket savings due to reduced face-to-face appointments. In the 346 consultations reviewed, 16,375 kilometres of travel were avoided – a cost saving of $11,000.

There are some barriers to telepharmacy, and we need to ensure these can be overcome by working with regulatory groups and consumers. Some barriers can include technology access, cultural concerns, workforce and regulatory requirement.

Telepharmacy has been proven to be a successful approach to improve medication services for all consumers, but it is especially beneficial for rural and regional Australians. It can have significant benefits for consumers involved, not only from a cost- and time-saving perspective, but also by improving health outcomes.

There are still barriers around access, but it is important that these are overcome. Roll out of telepharmacy should be considered for many regions of Australia, to support (and not replace) the roles of local health professionals in delivering rural health care.