New Technologies Boost Pharmacist's Role

Treatment modalities are expanding beyond medications to include digital therapeutics, which are software-based therapies that help manage, prevent, and treat disease.

The first prescription digital therapeutic (DTx) was cleared by the FDA in 2017 to treat substance use disorder (SUD),¹ and the first virtual reality (VR) therapeutic received FDA breakthrough device designation in 2020 to help treat chronic pain.² Sensor-enabled medications that record and transmit data on medication use have entered the market, supporting patients in taking care of their health and providing pharmacists with actionable insights to guide medication optimization.^3,4

The coronavirus disease 2019 (COVID-19) pandemic has accelerated digital health advances. Direct-to-consumer prescription delivery services, patient monitoring, and telehealth have been instrumental in maintaining essential services during a time when virtual care has been critical to continuity of care.⁵

Even beyond the pandemic, these technologies will continue to expand and integrate, creating a hybrid of in-person and virtual care. These hybrid models will augment, not replace, the human touch, enhancing the patient-provider experience and improving access, quality, and outcomes of care.

Pharmacists and student pharmacists should prepare for evolving roles that leverage advanced technologies to support patients' health, well-being, and treatment optimization.

WHAT IS DIGITAL HEALTH?

Technological advancements in health care have yielded a range of products and solutions under the umbrella term digital health. Examples include health apps, medication reminders sent via email or text, remote patient monitoring (eg, continuous glucose monitoring), wearables such as fitness trackers, and telehealth/telemedicine services.⁶ A framework categorizing these products and solutions has been developed by leading digital health organizations.⁷

As described by the FDA, "these technologies can empower consumers to make better-informed decisions about their own health and provide new options for facilitating prevention, early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional health care settings. Providers and other stakeholders are using digital health technologies in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalized for patients."⁸

EXPONENTIAL GROWTH OF TELEHEALTH

Telehealth (clinical and nonclinical remote services) experienced an exponential rise in use during the pandemic, offering continued, safe access to care. Before the pandemic, the use of telemedicine (clinical remote services) was less than 0.01% of all medical appointments.⁹ Between mid-March and early May 2020, the use of telemedicine increased 300-fold.⁹ It is anticipated that there will not be a return to prepandemic rates, as health care providers and patients both value the virtual experience. There were unexpected benefits, as described by a pharmacist who, noticing her patient was always in his vehicle during telehealth appointments, learned that he had been living in his van. It helped explain some of his challenges, and she was able to initiate social worker services, something she would not have observed during a traditional in-person clinic visit.¹⁰

It is estimated that telehealth may calibrate to 15% to 20% of care post pandemic.¹¹ A key element for sustainability will be overcoming integration challenges, such as the gap between those who have ready access to computers and internet and those who do not, known as the digital divide.

RETHINKING MEDICATION ADHERENCE TOOLS

Digital health companies have focused on ways to increase medication adherence. Technologcial advancements in the past decade have seen a push to go beyond notifications by a smartphone app in favor of sensor-enabled medications or the Internet of Things (IoT) integrated drug delivery systems. Studies have investigated the effectiveness of these devices and software on large-scale patient adherence with mixed results.^12,13

Trends include objective or subjective tracking of patients' self-administration of medications. For instance, an app may remind a patient to take their medication, and the patient then indicates if they followed through. Others include smart-pill bottles or packaging that lights up, alerting patients to take their medications. Once engaged (eg, the pill bottle is opened), the software indicates that the patient removed the medication. Fully integrated medications with built-in sensors, such as bioingestible drugs, smart inhalers, and smart injectable devices, also are available.

The advantage of these technologies is that pharmacists can remotely monitor how patients take their medication, allowing a targeted approach to support medication use, patient engagement, and treatment optimization. For instance, if a patient is using a rescue inhaler more frequently, it could be a sign that they are not using the maintenance inhaler as directed or there may be a need to escalate treatment.

REMOTE PATIENT MONITORING AND AT-HOME DIAGNOSTICS

IoT has enabled connecting commonly used products to a larger data set to observe use and provide insights into consumer habits. Integrating IoT with health devices was a natural evolution that led to blood glucose monitoring devices and smart blood pressure cuffs, enabling remote monitoring between patient visits. These devices will expand telehealth/telemedicine services by lessening the need for in-clinic objective measurements, as the data will be captured remotely, strengthening the trend away from episodic care toward continuous, proactive care and supporting hospital-to-home management strategies.

Another area that has seen growth is at-home diagnostics. Patients increasingly have access to a range of tests that provide results within minutes or that can be shared in an app for assessment via a combination of artificial intelligence and provider assessment. The accessibility of these products creates the opportunity for early detection of illness and connecting individuals to the health care system via telehealth and/or in-person patient care services.

SOFTWARE AS MEDICINE

DTx is "evidence-based therapeutic interventions that are driven by high-quality software programs to prevent, manage, or treat a medical disorder or disease."¹⁵ This category is focused on a central software platform that may integrate with external hardware, such as a sensor-enabled measurement tool or VR headset, or be paired with a medication for disease management.

Market examples include DTx focused on pain management with home physiotherapy delivered by an app, pulmonary condition management using smart inhalers to guide treatment, SUD with cognitive behavior therapy interventions, and sleep management. Ultimately, medications may come paired with DTx, and pharmacists will need to include them in the medication reconciliation process to ensure treatment continues.

PHARMACISTS' ROLE IN INTEGRATING DIGITAL HEALTH

Digital health products and solutions will increasingly be integrated into the care that pharmacists provide. Eventually, the term digital health may fade away as these treatment modalities become the norm. Pharmacists may find themselves serving as coaches, curators, and digital translators for patients, accessing data on remote patient monitoring platforms, assisting with setting up software or devices, engaging with patients via hybrid care models, and matching individuals with medication and a digital companion, all to contribute to health and wellness and support treatment optimization.