Joshua D Niznik1, Harvey He2, Sandra L Kane-Gill3. 1. School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States. Electronic address: jdn18@pitt.edu. 2. School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States. 3. School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Pittsburgh, PA, United States.
Abstract
BACKGROUND: Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE: Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS: A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence. RESULTS: Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4). CONCLUSIONS: Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
BACKGROUND: Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE: Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS: A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence. RESULTS: Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4). CONCLUSIONS: Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
Authors: Margaret Gartland; Pedro Cahn; Edwin DeJesus; Ricardo Sobhie Diaz; Robert Grossberg; Michael Kozal; Princy Kumar; Jean-Michel Molina; Fernando Mendo Urbina; Marcia Wang; Fangfang Du; Shiven Chabria; Andrew Clark; Louise Garside; Mark Krystal; Frank Mannino; Amy Pierce; Peter Ackerman; Max Lataillade Journal: Antimicrob Agents Chemother Date: 2022-05-03 Impact factor: 5.938
Authors: Insaf Mohammad; Helen D Berlie; Melissa Lipari; Amber Lanae Martirosov; Andrea A Duong; Maggie Faraj; Opal Bacon; Candice L Garwood Journal: J Am Coll Clin Pharm Date: 2020-07-07
Authors: Leah L Zullig; Shelley A Jazowski; Clemontina A Davenport; Clarissa J Diamantidis; Megan M Oakes; Sejal Patel; Jivan Moaddeb; Hayden B Bosworth Journal: J Gen Intern Med Date: 2019-10-28 Impact factor: 5.128