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Rural populations report significantly poorer healthcare quality, partly due to limited healthcare resources, including pharmacy services[1]. COVID19 further exacerbated this access gap, highlighting an even greater need to protect vulnerable patients with multiple comorbidities. Telemedicine has been identified as an effective option to deliver patient care. Remote delivery of pharmacy services provides an opportunity to care for patients who would otherwise not have access. Despite its potential impact, this delivery model not been extensively researched[2]. Understanding the feasibility and effectiveness of implementing clinical pharmacy services via telehealth is critical to increasing access to care, improving patient health, and reducing healthcare costs related to medications.

The collaborative project between the University of North Carolina (UNC) Eshelman School of Pharmacy Center for Medication Optimization (CMO) and the University of Arkansas for Medical Sciences (UAMS) Center for Implementation Research aims to implement and evaluate remote delivery of Comprehensive Medication Management (CMM) for complex patients with diabetes in rural communities.

As part of this project, clinical pharmacists will be delivering CMM via telehealth over 15-month in four North Carolina and five Arkansas primary care practices to prevent, identify and resolve medication therapy problems (MTPs) in complex patients with diabetes. In response to COVID19, the services provided were also expanded to include COVID education and referrals for patients in need. To facilitate integration of this service into the clinics prior to implementation, the project team worked collaboratively with each clinic to orient the clinic providers and staff to the new service, develop workflows and cheat sheets, set up the telehealth infrastructure, establish data documentation systems, and train the pharmacists. The clinics also benefit from regular coaching and opportunities to participate in a community of learning. In addition, to ensure sustainability, the project created an advisory committee responsible for identifying telehealth reimbursement models for clinical pharmacy services.

Despite its potential as an impactful intervention, CMM has yet to be implemented via telehealth, and formally be evaluated using this delivery mode. This model has the potential to transform delivery of pharmacy services, while being an opportunity to evolve the role of the clinical pharmacist beyond the traditional boundaries. Generating learnings on optimal approaches to implement telepharmacy interventions is critical to facilitating their adoption and scaling, especially during a pandemic.

Stay tuned to the CMO blog to learn more about the project activities and insights.

[1] Patient Engagement HIT. Strategies for Rural Patient Healthcare Access Challenges.; 2017.

[2] Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Soc Adm Pharm. 2018;14(8):707-717.

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