Medicine has conventionally been limited to in person treatment. In the United States of America, health care practitioners have been mandated by law to care for patients in their place of practice.
Now, in the modern age where access to information is expected, another method of treating patients has come to light that is far less limiting than traditional doctors visits. “Telemedicine is the provision of health care services remotely, using telecommunications tools such as smart phones, telephones, and mobile wireless devices.”1 Within this umbrella of telemedicine, falls telepharmacy, a service specific to pharmacists. As defined by the National Association of Boards of Pharmacy in the United States, “telepharmacy is the provision of pharmacist care from a distance to a patient through the use of telecommunications and other technologies.”2 The current uses of telepharmacy include Mail Order, Patient Counseling by Telephone, Medication Therapy Management, Collaborative Drug Management, Central Processing and Remote Order Entry, Remote Supervision of Technician Dispensing, Automated Dispensing Systems, and Medication Kiosks with 24/7 RPh Counseling.
2 America is a union of states with independent laws bound together by the Constitution. Despite the wide range of applications and benefits, the growth of telepharmacy has been piecemeal due to the legislative process in the United States. The first state to pass telepharmacy legislation was North Dakota. In the late 1990s and early 2000s, significant numbers of rural pharmacies were forced to shut down due to financial hardship in the state, contributing to the growing number of medically underserved in the area. In order to combat this, North Dakota passed legislation in favor of telepharmacy. As a result of this pilot program, nearly 80,000 residents of North Dakota had their pharmacy services restored, retained, and established.
3 Due to this success, North Dakota enacted legislation that authorized the usage of telepharmacy throughout the state. Ever since, telepharmacy services have boomed rural communities. Currently, 23 out of the 50 states have passed legislation in favor of telepharmacy, with another 11 states that provide opportunities to trial and initiate it.4 Although these 34 states allow for the practice of telepharmacy, each individual state also carries with it rules, regulations and restrictions.
These limitations can be based on geography, facilities, permitted providers, staffing requirements, and inter-state accessibility, depending on the needs of the state.4 On the other hand, 16 states have not yet passed telepharmacy legislation. The barriers to the spread of telepharmacy include payment issues, licensure, online prescribing, and security concerns.2 Payment can be challenging with both governmental and private payers. Licensure can impede the ability to offer these services, specifically when practicing across state lines since it is required by law that a medical professional be licensed in the state in which they are practicing. Encryption and security is a primary concern for legislators because health records must be treated with the utmost care in order to protect patients.2 In order to capitalize on the potential of these services, these issues need to be addressed and resolved before the states which are hesitant to even pilot telepharmacy practices can authorize their usage.
Despite many challenges associated with the practice, telepharmacy is gaining national acclaim. The National Association of Boards of Pharmacy has noticed the growth of the telepharmacy in recent years and have created standard guidelines for telepharmacy practice in the states. The Task Force on the Regulation of Telepharmacy, a subsect of the NABP, recommends amending the language in The Model State Pharmacy Act and collaborating with the individual state boards of pharmacies in order to standardize pharmacy practice and foster the appropriate environment for the expansion of telepharmacy practice.
4 As more states successfully adopt telepharmacy legislation, it will become more likely that Congress will introduce its own form of telehealth legislation. Coinciding with this is a standard practice for telepharmacy across all 50 of the United States of America. Once telepharmacy is authorized and proven successful at the national level, it can continue to expand into the international level. Many of the telepharmacy initiatives that have been successful in the states may also be successful around the world.
In Scotland, many rural patients do not have access to medicine or pharmacist consultations, much like in North Dakota. A Telepharmacy Robotic Supply Service (TPRSS), a kiosk capable of dispensing over-the-counter and prescription medications and providing consultations through an audio-visual link, was piloted in a rural post office for patients to utilize.5 It was found that this kiosk is feasible and could address healthcare inequalities in remote areas.5 These kiosks have the potential to be an economically viable option in developing countries where there is a shortage of pharmacists to give patients access to medicine. A major concern of implementing this service in developing countries is the people’s level of health and technological literacy. Although in America and Scotland, the people may be accustomed to using technology in their daily lives, that may not be the same in many other countries around the world.
As such, implementing a TPRSS machine would also require a pharmacist to be cognizant of the possible lingual and technological barriers of their patient population. However, with modern innovation, these barriers can be easy to overcome by creating intuitive technology and educating the patient population on how to use the device. Telehealth legislation has not yet caught up to the rapidly advancing telecommunications technology and the many benefits that come along with that. Regardless, once legislators start seeing how utilizing these services at a critical mass will work to reduce healthcare costs and expand healthcare accessibility to different populations, it will only be a matter of time before national telehealth legislation is proposed and authorized. Until then, it is crucial for us as consumers and patients to serve as a voice that will propagate the use of these services.
Once we overcome these problems, telepharmacy and telehealth are both services that have the potential to spread around the world and benefit patients across international and socioeconomic lines.