Virtual care technology showcases benefits of clinical pharmacy in rural and remote health care

The Western NSW Local Health District’s virtual clinical pharmacy service (VCPS) has successfully developed, implemented and evaluated an innovative model of care for providing telehealth pharmacy to inpatients in rural and remote NSW hospitals.

Clinical pharmacists use videoconferencing and the electronic medical record to provide medication review services including medication history and reconciliation, medication chart review, medication lists and counselling to patients prior to discharge from hospital. The VCPS commenced in April 2020 and has improved access to clinical pharmacy by providing the ‘right care, right place, right time’, ensuring rural patients receive the same standard of care they would expect in larger hospitals.

Prior to implementation of the VCPS, clinical pharmacy services were only available face to face in eight of 47 hospitals in Western NSW and Far West NSW Local Health Districts, which span an area of 450,000 square kilometres. Historically, the smaller bed numbers and large distances between sites proved to be a challenge for developing sustainable onsite models of care, meaning patients in these hospitals were unable to be offered essential clinical pharmacy services.

However, access to vital rural health research funding combined with digital enhancements over the last five years have enabled a virtual model of care. Key digital enhancements include the roll out of high-speed internet, an electronic medical record inclusive of medication management and the availability of wireless two-way videoconferencing carts at the beside which allow clinical pharmacists to contribute to patient care in smaller health services.

An interdisciplinary team including senior health administrators, doctors, nurses, pharmacists and health researchers collaborated to design the model. By working with telehealth and health information teams, the VCPS was able to be implemented with minimal additional technology costs. The virtual model has helped to overcome the challenges of recruitment of pharmacists to rural and remote regions and has supported social distancing by minimising patient and staff contact during the COVID-19 pandemic.

Patients have embraced the service and provided positive feedback on the virtual pharmacy service. Similarly, doctors and nurses have welcomed the support and have reported increased confidence in managing medications. The VCPS has demonstrated scalability over multiple hospitals and health districts, and Western NSW Local Health District is currently expanding the service to an additional 23 rural and remote hospitals.

The VCPS are wrapping up the research evaluation and expect multiple publications for the study in the coming months. It is expected the evaluation will show a significant increase in best-possible medication histories, medication reconciliation, patient medication lists and greater detection of potential medication-related harms. The VCPS has provided over 3716 episodes of care in the first 10 months and these activities help health services with medication safety, which is assessed under the National Safety and Quality Health Service accreditation standards.

The establishment and evaluation of the VCPS was made possible by a NSW Ministry of Health Translational Research Grant. The Rural Director of Medical Services for Western NSW Local Health District, Dr Shannon Nott, has led the research project titled Realising the benefits of clinical pharmacy in the bush: The efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote New South Wales health facilities. The VCPS has recently been recognised by The Society of Hospital Pharmacists of Australia’s NSW Branch Innovation Award and we anticipate there will be more recognition to come.

Project contact: Dr Shannon Nott, Rural Director of Medical Services, Western NSW Local Health District ([email protected]).