Telepharmacy: Pharmaceutical Care in a Digital Era

By: Aral Cetiner 

Bridging the Gap in Pharmaceutical Care 

Telepharmacy is a practical extension of telemedicine.1It uses telecommunications to deliver pharmaceutical care to patients, without pharmacists' direct, in-person, physical contact. Telepharmacy promises to address shortages in pharmacy services, disproportionately affecting rural and underserved areas. An increasingly common problem in North America is the closure of pharmacies in rural areas. Given that the quality of medication used at telepharmacies serving rural regions is similar to traditional pharmacies, its implementation is highly promising.2 Telepharmacy enables various services: drug therapy monitoring, patient counseling, medication dispensing, prescription review, and educational support through videoconferencing and other remote technologies. However, telepharmacy is not without its criticisms; regulatory issues exist, with over 22 states in the U.S. not permitting it and 7 states having an overall restrictive telepharmacy grade, infrastructure costs are high, averaging around $20,000 for initial setup, and data security concerns are present, with a reported target of 24% of all cyberattacks within the past few years being aimed at healthcare.3,4,5 This article summarizes the current state, benefits, challenges, and examples of telepharmacy. 

Fig. 1: Virtual telehealth consultation depicted with a doctor and digital healthcare icons.6

Telepharmacy emerged as a response to demands for pharmacy care in locations where recruiting or sustaining pharmacists proved challenging. This could be due to financial pressures, corporate expansion, increased workload, a poor market, or a combination. Using telepharmacy, a study connecting seven rural hospitals to a central pharmacy found that medication order entry time decreased from 26.8 minutes to just 14 minutes per patient, significantly enhancing access to pharmaceutical services.7 By providing essential pharmacy services (e.g., medication dispensing, patient counseling, and drug therapy monitoring), telepharmacy is gaining traction in rural communities and underserved regions with limited healthcare access in the English-speaking world and the international community. 

Benefits and Obstacles in Telepharmacy Services 

Telepharmacy enables facilities to share pharmacists across sites, reducing operational costs and potentially enhancing patient safety through consistent medication counseling and monitoring.7 However, concerns include the reduced in-person interaction between patients and pharmacists, potential errors due to remote handling, and increased risks associated with electronic data storage, including HIPAA compliance and data security.8 

Analyzing User Engagement and Compliance 

Medication adherence is an important area of concern. A study found that it is lower among users of telepharmacy than users of a traditional pharmacy for statins and angiotensin-converting enzyme inhibitors (ACEs)/angiotensin II receptor blockers (ARBs), while adherence to non-insulin diabetes medications (NIDMs) are similar across both cases.9 Further research is needed on the influence of telepharmacy on long-term adherence and outcomes. 

Global Examples of Telepharmacy Practices 

States with vast rural populations benefit from telepharmacy adoption. North Dakota pioneered telepharmacy regulation, inspiring a model for programs and laws in other states to follow called the North Dakota Telepharmacy Project, which demonstrates how telepharmacy can deliver pharmacy services effectively in rural settings.10 To improve medication access and adherence in remote communities, Alaska and Washington pursued similar programs. However, in other regions, adoption has been slower due to regulatory, financial and infrastructural barriers. 

Since 1942, the Royal Flying Doctor Service (RFDS) of Australia has provided healthcare through a form of telepharmacy, distributing medications and basic healthcare equipment to remote communities across a vast waiting area of 7.69 million square kilometers.11 This service enables prompt access to essential medications through telehealth support, allowing healthcare providers to administer these drugs to individuals in geographically isolated areas. While telepharmacy has begun to supplement pharmacy services in rural hospitals, its broader adoption has been slow, largely due to the staffing challenges faced by other healthcare providers in these remote locations. Nevertheless, the RFDS remains committed to ensuring that even the most isolated communities receive timely medical care and support. 

In response to a nationwide pharmacist shortage, Canada implemented telepharmacy in remote hospitals. Cranbrook, British Columbia, saw one of the earliest programs, where pharmacists remotely supervised technicians in nearby towns. Drug dispensing units in Ontario allow patients to receive medication through remote oversight by a pharmacist using a two-way video system, addressing logistical challenges in underserved areas – inspiring the United Kingdom. 

Overcoming Barriers to Adoption 

Given the existence of different regulatory frameworks, infrastructural costs, and local healthcare practices, telepharmacy implementation varies regionally. The absence of uniform guidelines and the cost of equipment coupled with data security present significant obstacles to widespread adoption. For example, a typical telepharmacy installation in a retail setting in North Dakota is estimated to cost around $17,300 per site, with additional expenses for hospital setups.12 Ensuring data privacy in compliance with regulations like HIPAA adds cost and complexity. 

Telepharmacy effectiveness also depends on a robust telecommunication infrastructure. A telepharmacy will fail to provide reliable service in an area with limited internet access. Furthermore, patients and healthcare providers may experience hesitancy or discomfort with reduced face-to-face interactions, altering the perceived quality of care.

Fig. 2: Diagram of an integrated healthcare information system featuring telepharmacy, digital platforms, AI, and cybersecurity.13 

Conclusion

Telepharmacy is transforming pharmaceutical treatment, especially in isolated and rural areas where it may be difficult to find a pharmacist. Despite obstacles, the international adoption of telepharmacy supports its affordability and accessibility. In the future, secure and affordable telecommunications solutions should be prioritized and regulatory frameworks be clarified. Future studies should examine how telepharmacy affects clinical outcomes, patient satisfaction, and medication adherence. Without a doubt, the rapid development of telepharmacy technology can revolutionize the way that different people receive equitable healthcare in society.

References 

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10. Peterson, C. D., & Anderson, H. C. (2004). The North Dakota Telepharmacy Project: Restoring and retaining pharmacy services in rural communities. Journal of Pharmacy Technology, 20(1), 28–39. https://doi.org/10.1177/875512250402000107 

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