5 tips: How pharmacy-based telemedicine and integrated data can help improve patient outcomes

The uptake of telemedicine and virtual care has increased significantly since the beginning of the COVID-19 pandemic. Pharmacy-based telemedicine implies the use of technology to facilitate a medical service or care virtually within a pharmacy. In my practice, this involves hosting a high-speed web-based service on a computer screen in an acoustically private room in the pharmacy where a patient communicates with a prescriber (pharmacist, physician or nurse practitioner) over a video screen or phone on site. Depending on the presenting complaint, the patient may have vitals or certain medical directives performed on them by pharmacy staff prior to or after their virtual visit with the prescriber. The telemedicine service within the pharmacy is contractual. Clinician communication is internal, through a secure system that renders quicker responses than conventional methods (i.e., phone calls, faxes). This telemedicine service is meant to augment, not replace, in-person care. Implementing telemedicine in pharmacy can improve patient outcomes and enhance pharmacy practice in significant ways. Adopting a telemedicine platform in your pharmacy strengthens the physician–pharmacist relationship, helps improve access to care for diverse patient groups, increases professional satisfaction, can significantly improve your bottom line and, most importantly, can enhance patient health outcomes.1-4 Including an integrated health data platform amplifies the benefits, allowing you to make more informed patient care decisions. This article provides five tips for incorporating telemedicine in your pharmacy. 1. Understand why you should integrate telemedicine into your pharmacy practice About 70% of Canadians used virtual care for medical assistance during the COVID-19 pandemic, and more than 90% of those were satisfied with the experience.1,4,5 Approximately 15% of Canadians do not have a regular healthcare provider (physician or nurse practitioner).6,7 This figure is much higher in some regions within Canada, which is very concerning. In addition, more than 55% of Canadians that do have a primary care provider cannot access them for same- or next-day appointments, or in the evening or on weekends.7 On the other hand, more than 50% of Canadians see a community pharmacist up to 10 times more often than their family doctor, with more than half of Canadians visiting a pharmacy at least once weekly.8 The increased contact time with the healthcare system (both virtually and in-person) in a pharmacy whereby a patient can receive or have access to medical care reduces emergency room visits and improves patient outcomes. Think of patients who live remotely that cannot afford to travel for hours for access to care, or patients without a primary care provider who have a pharmacy nearby where they can inquire about their ailments through the pharmacy’s telemedicine platform. Telemedicine allows pharmacists to aid in the provision of treatments for many common conditions, as well as provide referrals to specialists (e.g., dermatology, cardiology, psychiatry, surgery) and bloodwork requisitions (e.g., for chronic disease management). 2. Foster collaboration with prescribers and specialists through telemedicine Telemedicine provides a great opportunity for working interprofessionally with physicians and nurse practitioners. Integrated data (e.g., access to digital health records to obtain patient test results) provides opportunities for provision of exceptional patient care and added opportunities for intervention. Proactive interventions can be made in real time with direct communication with physicians and nurse practitioners who have synonymous access to the same patient file. Telemedicine can also foster positive collaborative relationships with specialists in your area. Your pharmacy can act as the quarterback for “unattached” patients (i.e., patients without a physician or nurse practitioner), allowing you (through the telemedicine platform) to refer patients to specialists. This can enhance patient outcomes through fruitful interprofessional efforts. 3. Recognize the multifaceted benefits on your pharmacy business, patient retention and professional satisfaction Use of telemedicine allows you to interact with different patient populations based on your interest. For example, if you have a passion for diabetes care, mental health or sexual health, you can advertise these unique patient services in the community. When patients present to the pharmacy to use the video screen telemedicine service, this can increase traffic flow into the pharmacy. Telemedicine can also increase patient profile transfers from other pharmacies, prescription volume and OTC sales, as well as increase professional services offered and independent patient consults (covered and noncovered services). Providing care to unattached patients helps strengthen your clinical acumen, adds increased accountability and responsibility, and helps keep you up-to-date, which can all increase professional satisfaction. Telemedicine can also provide an opportunity for a strong pharmacist–patient bond, as the pharmacist is performing many non-conventional services for the patient (e.g., discussions about referrals to specialists, blood work requisitions, vitals), which can increase patient retention. The pharmacist may triage the patient first, then after seeing the physician virtually, the pharmacist is also involved in treatment options for the patient, so it is very clinically focused. 4. Appreciate the power of integrated data Integrated data is data combined from different sources into a single, unified view.2 Through my experience, I have found that meaningful, positive and successful clinician–patient interactions require having the right information at hand. This ranges from up-to-date medication lists, information on allergies, medical conditions and diagnoses, pertinent lab values, diagnostic imaging reports and interprofessional consult notes. Telemedicine with such integrated data enables you to see the patient from start to finish. As such, you and the prescriber are both able to make well-informed decisions for your patient because you have all the relevant information at hand. 5. Consider how pharmacy-based telemedicine can build patient confidence and trust in your pharmacy services Pharmacists across Canada who practise to full scope can maximize patient outcomes and provide timely and convenient access to care to diverse populations.9-13 Pharmacy-based telemedicine can provide a complementary (not alternative) service to patients from a diagnostic perspective (the physician) coupled with the treatment perspective (the pharmacist), and everything in between (lab requisitions, referrals, notes, advice).14,15 The optics of viewing the pharmacist as playing an integral role for patients navigating the healthcare system via consults in person and virtually surely helps build confidence and trust in pharmacists performing these duties routinely, and improves patient access and health outcomes.14,15 Summary The future is here. I reckon that telemedicine will soon simply be called medicine because it will be in such widespread use that it will become the norm. Pharmacy-based telemedicine is the ideal marriage between interdisciplinary healthcare delivery and timely access to the healthcare system, allowing for improved patient care. Samier Kamar (samier.kamar@utoronto.ca) is the pharmacist, manager and owner at High St Guardian Pharmacy in Peterborough, ON and Dellar’s IDA Drug Store in Tweed, ON. He was an early adopter of the telemedicine platform in Ontario pre-COVID-19 and one of the first in Ontario to gain access to Connecting Ontario through the Ministry of Health and Long-Term Care. He is heavily engaged in health advocacy work with refugees and Canadian newcomers, helping them to navigate and access health services, leading him to receive a national business innovation award. References: Report of the Virtual Care Task Force. Virtual care recommendations for scaling up virtual medical services. February 202. https://bit.ly/TelemedVirtual (accessed April 19, 2023). Talend Inc. What is data integration? http://bit.ly/integrateddata (accessed April 19, 2023). Canadian Society of Hospital Pharmacists. Telepharmacy: guidelines 2018. (accessed June 22, 2023). Canada Health Infoway. Consulting Canadians on the future of their health system. Executive summary, November 2020. (accessed June 22, 2023). Canadian Medical Association. What Canadians think about virtual health care. Nationwide survey results - May 2020. (accessed June 22, 2023). Canadian Institute for Health Information. How Canada compares. Results from The Commonwealth Fund’s 2016 International Health Policy Survey of adults in 11 countries. 2017. (accessed April 19, 2023). Statistics Canada. Primary health care providers, 2019. October 22, 2020. (accessed June 23, 2023). Raiche T, Pammett R, Dattani S, et al. Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system. Pharm Pract (Granada). 2020;18(4): 2171. (accessed June 23, 2023). Canadian Pharmacists Association. Pharmacists’ scope of practice in Canada. January 3, 2023.(accessed April 19, 2023). Tsuyuki RT, Beahm NP, Okada H, et al. Pharmacists as accessible primary health care providers: review of the evidence. Can Pharm J 2018;151(1):4-5. Sanyal C, Husereau DR, Beahm NP, et al. Cost-effectiveness and budget impact of the management of uncomplicated urinary tract infection by community pharmacists. BMC Health Serv Res 2019; 9:1-3. Al Hamarneh YN, Charrois T, Lewanczuk R, et al. Pharmacist intervention for glycaemic control in the community (the RxING study). BMJ Open 2013;3(9):e003154. Marra C, Johnston K, Santschi V, et al. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J 2017;150(3):184-97. Tsuyuki RT, Watson KE. Why pharmacist prescribing needs to be independent. Can Pharm J 2020;153(2):67-9. doi:10.1177/1715163520904366. Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists’ practice: implications for physicians. CMAJ 2013;185(14):1228-32; DOI: 10.1503/cmaj.121990.

5 tips: How pharmacy-based telemedicine and integrated data can help improve patient outcomes

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