TECHNOLOGY EXPANDS PHARMACY REACH IN UNDERSERVED RURAL AREAS

Independent pharmacies arefew and far between in rural communities.Even the community drugstores that remain in sparsely populatedareas are threatened withextinction by a shortage ofqualified pharmacists.

In underserved rural areas, itis all too common for pharmacyowners to shutter theirstores once they retire, sincenew owners are difficult tofind. As a result, patients areforced to drive long distancesto the nearest pharmacy or torely solely on mail order pharmacyservices for all their medicationneeds.

Fortunately, technology ischanging all that?particularlyin North Dakota, where thestate has passed a law thatallows pharmacists to use cutting-edge telecommunicationstechnology to provide full-servicecare to patients at a distance.

Under state law, retail pharmaciescan operate in certain remote areaswithout a pharmacist physically present,as long as a supervising pharmacistcan monitor activities fromanother location. Through the use ofvideo-conferencing technology, licensedpharmacists at a central pharmacysite can supervise registeredpharmacy technicians at a remotesite. Technicians prepare the prescriptionand an off-site pharmacistverifies it and provides traditionaldrug utilization review through realtimevideo. The pharmacist can communicatewith the technician and thepatient face-to-face in real timethrough both audio and video links.

?It is very much pharmacy as usual,except it is done remotely,? saidAnn Rathke, telepharmacy coordinatorat North Dakota State University?s(NDSU?s) College of Pharmacy,Nursing, and Allied Sciences.

Working together, NDSU, theNorth Dakota Board of Pharmacy,and the North Dakota PharmacistsAssociation created the North DakotaTelepharmacy Project to addressthe issue of underserved rural communitiesusing this cutting-edgetechnology. Through the project,pharmacies that meet specific criteriacan get a grant to adopt telepharmacyto better serve their patients.CRITICAL NEED

?A survey done by the state boardof pharmacy revealed that 24 smallcommunities in North Dakota hadlost pharmacy services entirely, and adozen were at risk of losing services,?said Rathke. ?Communities served byan independent pharmacy are oftenat risk when the pharmacist/ownerwants to retire and no one wants totake his or her place. One communityhas been without an independentpharmacy for 18 years. Our goal is torestore and retain pharmacy servicesfor underserved communities.?

The program has accomplishedthat goal in Arthur,ND, where Kathy Nelson, ownerof Casselton Drug in nearbyCasselton, has opened a telepharmacy.?When I read aboutthe program, I wanted to put apharmacy in Arthur to servethe nursing home and the residents,?said Nelson. ?The areahas a population of about 180people, and some residentswere driving up to 50 miles toget their prescriptions filled.They had a pharmacy inArthur 20 years ago, but whenthe pharmacist retired, itclosed.?

Mail order and Internet services,although useful in many circumstances,cannot take the place ofpatient/pharmacist interaction. Inaddition, quality pharmacy servicescan be at risk when a pharmacist isleft out of the health care loop. This isparticularly true in rural locations.

?Casselton has one doctor, and heis only here in the mornings,? saidNelson. ?There is no doctor inArthur, so having a pharmacist available,even through teleconferencing,is important. The patients need accessibility.?

Through telepharmacy, Nelson isaccessible on a 19-inch monitor tocounsel patients while she is in heroffice in Casselton, and the patient isin a private consulting room inArthur. ?Patients are tickled pinkabout the service,? she said. ?Theymay call me on the phone later?theyknow where to get me. This is a townwhere, like the Cheers theme songsays, ?everybody knows your name.??

Teleconferencing technology hasallowed Dakota Pharmacy and WellnessCenter to continue to servepatients in New Salem, ND?a townwith a population of between 800and 900 that was in danger of losingits only pharmacy. ?The pharmacy inNew Salem had been around formany years, but with the pharmacistshortage, it was a challenge to keep itopen,? said Tony Welder, owner ofthe pharmacy and its parent pharmacylocated in nearby Bismark. ?Wehave a semi-retired pharmacist whogoes out there once or twice a week,but that is not sufficient. With telepharmacy,we can continue to servethose patients instead of requiringthem to drive 35 miles to Bismarkand back.?

Welder said that patients havecome to embrace counseling from apharmacist on camera. ?We have aprivate consulting area on both endsand a high-resolution camera,? hesaid. ?The only difference is that thepharmacist is not physically there.The patients also trust the technician,who has been with us for many years.My goal is still to get a full-time pharmacistout there, but since that isproving difficult, this is a big advantageto our patients, and that is mymain concern.?PHARMACIST INTERACTIONNEEDED

Econodrug in Wahpeton, ND(population 8500), has reached outto patients in Ottertail, Minn,through the new technology.

?We are really a part of the wholechange in technology,? said BrianSteeves who owns the pharmacywith his sister, Polly Steeves, RPh. ?Ifwe did not offer this service, peoplewould have to drive for 20 to 30miles or use mail order exclusively.?Brian Steeves said that the expenseof gas and the limitations of mailorder pharmacy services provideanother option necessary for manypatients.

?So many pharmacies are closing,?said co-owner Polly Steeves. ?There isno way you can afford to keep a pharmacyrunning with a full-time pharmacistwhen you are filling only 30 to50 prescriptions a day.?

Ottertail, a lake community comprisedof year-round residents whoseranks swell in the summer months,needed a pharmacy to serve itspatients. The Steeves opened a telepharmacythere in 2005.

?It is really a diverse population,?she said. ?We serve vacationing families,as well as seniors and lowincomepatients. Patients really needpharmacy services, and mail order isnot adequate in many situations?especially when a vacationing childhas an ear infection and needs medicationimmediately or when someonehas gone on vacation and forgottentheir prescription.?

She said that at first, some of herolder, year-round patients were reluctantto use the teleconferencing capabilities,but most have accepted thechange and have begun to embracethe new technology.PROVIDING VALUABLESERVICES

?The counseling aspect is reallyimportant to the patients,? she said.?We can talk to patients aboutsplitting their pills to save moneyor switching to a generic. We alsoare available to counsel on OTCproducts, since the store has a fullsupply of OTC drugs, and thepatient often needs to speak with apharmacist for a recommendation.?Pharmacists also counselpatients on Medicare D throughthe pharmacy?s teleconferencingtechnology.

Polly Steeves said the telepharmacyservices have helped a number ofpatients. ?There are some patientsthat get care they would not otherwisebe getting if we did not provideremote pharmacist interaction,? shesaid. ?We have one patient withsevere diabetes.We were able to convincehim of the importance of takinghis medications.We also got himon Medicare Part D. That is reallyrewarding.?

So far, the North Dakota TelepharmacyProject has been successful inrestoring valuable access to healthcare in remote, medically underservedareas of the state. ?About40,000 rural citizens have had theirpharmacy services restored, retained,or established through this project,?said Rathke.

Nelson is proud of the impact shehas had on health care in her part ofthe state. ?It makes work so muchmore fun when you can make a differencein someone?s life. There issuch a need in rural health care thatyou know you are making a significantcontribution. You are not justhere to make a buck, but to make adifference.?