Safe medication

Safe medication practices in telepharmacy

By Autumn Chen, Annie Yao, and Certina Ho

Lisa returned home after a five-day hospital stay for her heart attack. She started on five new oral medications which she has not taken before. Since Lisa struggles to walk far with her chest pain, she wonders how her local pharmacy could help her (1) obtain the new medications, (2) understand the potential side effects, and (3) review and update her list of medications.

TELEPHARMACY

Telepharmacy services in Canada were covered in a previous Hospital News article, where telepharmacy was referred (by the Canadian Society of Hospital Pharmacists (CSHP)) to as “the use of telecommunications technology to facilitate or enable the delivery of high-quality pharmacy services in situations where the patient or healthcare team does not have direct (in-person) contact with pharmacy staff.” Readers can learn more about the Telepharmacy Guidelines published by the CSHP in 2018 at In the United States, there are other similar definitions of telepharmacy.

During the COVID-19 pandemic, various new health services have emerged or moved from in-person to virtual activities. Telepharmacy has become a prevalent solution for patients to seek care. While pharmacies have remained physically open throughout the pandemic, some professional services have adapted the use of information and communication technology, such as, clinical verification of medication orders, telephone medication reviews, and telephone counseling, etc. In this article, we will focus on the latter two telepharmacy services, through which Lisa’s medication needs could be addressed. Further information regarding pharmacy services that have been implemented or expanded since the pandemic can be found at a resource prepared by the Canadian Pharmacists Association.

TELEPHONE MEDICATION REVIEWS

Comprehensive medication reviews are one-on-one interviews between a pharmacist and the patient to identify and resolve any medication related issues. They are used to support patient education, safe medication practices, and promote interdisciplinary collaboration with other healthcare providers in the patient’s circle of care. In most provinces, medication review programs are publicly funded and available to eligible patients under the provincial drug plan. During the pandemic, provincial governments have allowed (in-person) medication reviews to be conducted via telephone or virtual appointments if they are deemed medically necessary, for instance, when patient has significant medication changes post-hospital discharge; when patient has a history of non-adherence or challenges with medication use; or when a medication review is requested by the patient’s primary care provider, etc.

TELEPHONE COUNSELING

Telephone counseling is not a new concept. Hospital pharmacies, specialty pharmacies, and community pharmacies have been offering telephone counseling services prior to the pandemic. During the pandemic, patients who previously preferred in-person medication consultation with their pharmacists were directed to telecommunication. This change has increased the demand of telepharmacy services. It is anticipated that the practice of telepharmacy will remain popular going forward.

TELEPHARMACY HAS BECOME A PREVALENT SOLUTION FOR PATIENTS TO SEEK CARE

SAFE MEDICATION PRACTICES IN TELEPHARMACY

Telepharmacy services can improve healthcare access, particularly, in rural communities, and to patients who may be homebound due to complex medical conditions or mobility challenges. While information and communication technology improve accessibility, convenience, and accommodate patient preferences during the pandemic, it is important to be aware of some of the limitations. For example, telephone medication reviews and telephone counseling will rely on an effective two-way verbal communication between the pharmacist and the patient. Communicating medication names or strengths, discussing medications that are packaged in blister packs or multi-medication compliance aids, or demonstrating proper administration techniques for inhalers and injections over the phone can be challenging. Without face-to-face dialogues or interactions, there may be reduced level of trust and rapport, as well as possible concerns pertaining to confidentiality and/or privacy.

RETURN TO LISA’S CASE

Lisa would greatly benefit from telepharmacy services, that is, telephone comprehensive medication review and telephone counseling with her community pharmacist. Being newly discharged from the hospital, changes to her medication regimen would require special attention. Telepharmacy will be helpful to identify and resolve potential drug-related problems that she may have during transitions of care.

Patients can (or should) always actively participate in their own healthcare needs and management. For example, Lisa can engage in the telephone conversation with her pharmacist by using the “5 Questions to Ask About Your Medications” tool, a resource that supports patients to communicate their medication needs with their healthcare providers at medical appointments or follow-up clinic visits, and their telephone (or in-person) interactions with their community pharmacists, etc.

GOING FORWARD

To further aid in accessibility and convenience for patients, pharmacies have information management systems that integrate electronic prescription processing and delivery services. Rather than providing a paper prescription to the patient or faxing the prescription to the pharmacy, a prescriber can utilize e-prescribing services. This is another safe medication practice where transcribing errors can be reduced, and clinical verification of the prescription by the pharmacist can be streamlined, while saving the patient a trip to drop off the prescription at the pharmacy. E-prescribing programs will also enable pharmacists to directly communicate with prescribers to advance safe and effective medication therapy management for patients. ■ H

Autumn Chen is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; Annie Yao is a combined PharmD/MBA Student at the Leslie Dan Faculty of Pharmacy and the Rotman School of Management, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.