Telehealth and telepharmacy have seen a surge in use and discussion with the arrival of COVID. For pharmacists across the country, it has been a challenge while also accelerating the move to digitised services such as electronic prescriptions.
Since April 2020, pharmacists have been able to perform Home Medicine Reviews (HMR), MedsChecks, Diabetes MedsChecks, and Residential Medication Management Reviews (RMMR) via video-conferencing technology or over the phone.
Traditionally, these services are one-on-one consultations between the pharmacist and patient to identify any issues the patient is experiencing while taking medication and ensure that their current medicines are having the desired effect. MedsChecks and Diabetes MedsChecks are typically held at the pharmacy, while HMR and RMMR services involve the pharmacist visiting the patient’s home or the aged care facility they live in.
These changes also included a broadening of the eligibility criteria for telehealth, and the inclusion of two additional follow-up appointments for HMRs and RMMRs.
How has funding (or a lack of it) impacted the uptake of telehealth services?
Since funding has been restricted to HMRs, RMMRS, and MedsChecks, the benefits of additional funding have been felt more by consultant pharmacists who offer these services and those in hospital contexts.
For local pharmacists, the real impact has come from the increased usage of fax, email and electronic prescription services such as the token model. Introduced late last year, the token model is the first step towards the widely anticipated Active Script List (ASL), a cloud-based service that gives pharmacists access to a patient’s list of current medication without the need for paper scripts.
“As a group of pharmacists, we’re all just waiting for [the Active Script List], which is going to be a real game changer,” says Ian Magill, the owner and pharmacist at Geeveston Pharmacy.
As with the introduction of any new technology, ensuring that it can integrate with existing infrastructure can present an issue. The need to upgrade computers or purchase modems that minimise the impact of patchy NBN service are among some of the challenges facing pharmacies. A lack of funding for pharmacy businesses has also placed the onus of upgrading equipment and preparing for the adoption of electronic services on pharmacy owners.
So, who has benefitted the most from telehealth and digital prescriptions?
Telehealth can be used to great effect for the dispensing of prescription medications in everyday kinds of contexts and for improving the accessibility of medical services for people who would otherwise not have the time to attend doctor’s appointments in person.
However, the move from home visits to virtual or telephone appointments can mean that pharmacists miss out on or rely on other people for key pieces of information. This can be felt especially when treating patients with complex needs or those who gain social benefits from attending in-person appointments.
Of using video conferencing technologies to conduct HMRs, Magill says, “When you’re dealing with medication reviews and dealing with a person … you’re not just dealing with the drugs, you’re dealing with emotions, and you’re dealing with the home environment … the whole point of home medication reviews is that you’re in the home and seeing what it’s like and seeing where the struggles are.”
In terms of remote and rural areas, some have argued that telepharmacy can be cost-effective and improve the health outcomes in these communities. But, in areas where pharmacies can act as a meeting place for the community, the missing social interaction can have a negative impact on patients who are more isolated.
“Everyone benefited from [telehealth]. But I think from a more holistic view, … elderly people who have multiple chronic illnesses … probably suffered because they lacked that social interaction [of face-to-face visits],” Magill says.
With the isolation, lockdowns and work-from-home arrangements that many have had to adopt, smaller, local pharmacists have seen a surge in business. This also came with a decline in physical sales of larger, chain pharmacies who tend to have storefronts in shopping centres and major shopping precincts that were avoided at the height of state-enforced lockdowns.
Looking to the future of telehealth and digital prescription services, Magill says, “All of the medical bodies were pushing for [these services] and then COVID came along and pretty much forced the government’s hand to make that available. So COVID has definitely expedited a lot of these services.”
And with South Australia considering implementing legislation to integrate telehealth as a permanent part of healthcare, it looks like these services will be here to stay in the long term.