The era of telehealth pharmacy practice

APhA–APRS

Telehealth by the numbers

After a decade of modest growth, the telehealth sector exploded during the coronavirus disease 2019 pandemic. Estimates from various sources are that telehealth utilization jumped 50-75 times during the height of the pandemic, with the majority of outpatient visits being conducted by telehealth in the spring of 2020.^{1 , 2} Approximately 80% of providers engaged with telehealth during the pandemic, as did 22% of consumers.¹ While the waning of the pandemic is leading to a resurgence of in-office visits, telehealth continues to play a much more significant role in health care compared with the prepandemic world, with more than 20% of outpatient visits being delivered through telehealth during 2021.² The medical specialty seeing the highest usage of telehealth is psychiatry.²

Nau

The majority of providers are now comfortable with telehealth for selected situations. A recent survey of 1040 clinicians in Michigan found that 72% agreed that they can replicate the quality of care of an in-person visit through a video visit.³ Similarly, 75% agreed that they can build the same level of rapport with patients over video as they can in-person. A survey by McKinsey² also found that the majority of physicians would like to continue offering virtual visits provided that the reimbursement for these visits is similar to in-office visits.

A survey by Sykes⁴ in April 2021 detailed the extent to which Americans are warming to telehealth. Of note, 85% of respondents said that telehealth has made it easier to get the care they need; 62% said that they were afraid of going to the physician, but those fears were eased during their telehealth visit; and 51% say that they are able to see their physician more often. More than 87% of respondents said that they want to continue using telehealth consultations for nonurgent situations after the pandemic. However, a different survey indicates that older adults may be more hesitant to engage in telehealth.

In June 2020, the University of Michigan National Poll on Healthy Aging surveyed a national sample of U.S. adults aged 50-80 years about their experiences related to telehealth visits.⁵ When comparing office visits with telehealth visits, the majority of respondents perceived office visits as providing better communication with health care providers (54%) and higher overall quality of care (56%). However, telehealth visits were thought to be more convenient than office visits (56%). Another national survey found that 86% of telehealth users were satisfied with their visit, although satisfaction was lower among rural and low-income respondents.⁶

There is evidence that care delivered through telehealth models is as effective as that through in-office visits. Multiple evidence reviews supported by the Agency for Healthcare Research and Quality (AHRQ) have found that telehealth is especially useful for remote, home monitoring for patients with chronic conditions, such as chronic obstructive pulmonary disease and congestive heart failure, communicating and counseling patients with chronic conditions, and providing psychotherapy as part of behavioral health.⁷ Additional evidence reviews have found that telehealth can effectively enable specialists to support remote intensive care unit and emergency medical services.⁸ Analyses of more than 40 studies showed that patient outcomes can be improved through remote support in emergency situations. More evidence can be found on the AHRQ website at https://www.ahrq.gov/topics/telehealth.html.

The utilization of pharmacist-provided telehealth visits also appears to be growing. In addition to the traditional model of telephonic visits for medication therapy management, new players are offering video visits with pharmacists. For example, Aspen RxHealth has been rapidly expanding its network of pharmacists to keep pace with demand for video visits with members of several health plans. The network now has more than 5000 pharmacists and has completed more than 100,000 video encounters with patients, as shown on its website at aspenrxhealth.com.

The evidence base for the effectiveness of pharmacist-delivered digital and telehealth services is continuing to grow. A recent systematic review identified many studies of these services, but most of the studies had a small sample size or did not use rigorous research designs.⁹ The review found that some of the digital or telehealth services were associated with positive outcomes, whereas others showed little effect. One notable study in the United States found that pharmacists can effectively support long-term hypertension management through remote patient monitoring and telehealth consultation of patients.^{10 , 11}

Former Centers for Medicare & Medicaid Services Administrator Seema Verma, MD, stated, “I think the genie is out of the bottle. . . .” when asked about the growth of telehealth during the pandemic.¹² The pandemic created the necessity for telehealth, but now that most people are comfortable with it and like its convenience, we will continue to have a significant portion of care delivered through telehealth. Pharmacists should see this as an opportunity to extend their reach and connect with patients who prefer this mode of communication and service.

Are you ready?

Biography

David Nau, PhD, FAPhA, Professor, Raabe College of Pharmacy, Ohio Northern University, Ada, OH; 2020–2022 APhA–APRS President; E-mail: davidnau21@gmail.com