Telehealth Services Successful in Expanding Clinical Ambulatory Care Pharmacy Services

Implementation of telehealth services was found to be successful in expanding clinical ambulatory care pharmacy services, according to a report from researchers at Yale New Haven Hospital in Connecticut. The results of the study were recently presented during the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings in Boston.

Patients often have difficulty attending in-person office visits due to financial constraints, lack of transportation, or lack of travel time. With the implementation of telehealth video visits in the ambulatory care pharmacy space, services can be expanded to include patients previously unable to attend in-person appointments.

Pharmacists at Yale New Haven Hospital worked with a telehealth task force to implement telehealth technology, while simultaneously ensuring that electronic medical records (EMRs) support the video visits and that regulatory and compliance standards were met. Video visit training was conducted before the system was implemented.

Patients who wished to participate were required to be in Connecticut during the time of the visit, be able to communicate in English, and have a compatible electronic device with access to their EMRs via a designated phone or web app. The video visits were given as an alternative to a clinic follow-up visit.

Telehealth visits were successfully implemented in the solid organ transplant clinic and in 2 accountable care organization primary care offices. Five full-time clinical pharmacists, a single PGY-2 solid organ transplant pharmacy resident, and a pair of PGY-2 ambulatory care pharmacy residents were trained to complete telehealth visits.

The percentage of completed visits was reliably higher via video as opposed to in-person visits. Between February and May, an average of 69.2% of video visits were completed, as opposed to 55.4% of in-person visits.

Visits requiring the pharmacist to see a patient’s home, their injection technique, medication containers, or when the patient is unable to access an in-person office are all available for telehealth visits.

Patients reported many positive aspects to the telehealth video visits, including time and cost savings, and 100% said they would recommend video visits to other patients. They also reported satisfaction with less time away from their responsibilities, whether at home or work.

The most common reason for declining telehealth video visits was that patients preferred in-person visits when possible. Some barriers identified included the need for interpreter services and the lack of patients with access to EHRs.

The report identified several opportunities for future research and expansion of telehealth services. Determining the effects of telehealth services on clinical outcomes requires further research, as does understanding the effect of pharmacist video visits on patient satisfaction and patient benefits, according to the investigators. Further steps may also include pursuing billing opportunities and other clinic sites system-wide, which may benefit from pharmacy telehealth video visits.

Yale New Haven Hospital has since expanded their pharmacy telehealth services to the pulmonology clinic, with potential expansion to the pediatric asthma clinic. The pharmacy technician role in the future will include facilitation of telehealth enrollment.

References

Tang S, Luon S, Wojtusik A, Cohen E, Renauer M. Implementation of telehealth in ambulatory care clinical pharmacy services within a large health system. Presented at: 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings; Boston, MA: June 8-12, 2019.