Continuity of care between hospital pharmacies and community pharmacies, and costs avoided: a pilot experience in times of COVID-19 in Spain

Abstract

Introduction: In March 2020, due to the pandemic caused by COVID-19, a pilot experience of pharmaceutical continuity of care received by hospital outpatients was launched in Cantabria, a Spanish autonomous community. Thanks to this experience, the medication was dispensed by the hospital pharmacy through the community pharmacy of the patient’s choice. Our objective was to estimate the costs avoided by this practice during the months of April and May 2020.
 Methods: The analysis of the economic impact was carried out in terms of saved costs, from the hospital and from the social perspective. Savings associated with the avoided home delivery of medication and avoided labor productivity losses were calculated, as well as the time associated with avoided trips in monetary terms.
 Results: A total of 2,249 hospital-dispensed drugs were delivered through the community pharmacy in the analyzed period, with an average of 57.7 daily deliveries. The experience, which involved one hospital and 262 pharmacies of Cantabria, saved patients 93,305 km in trips to the hospital, associated with an average time saving of 1,374 hours. In terms of costs, the hospital saved on shipments by courier, estimated at €30,205, since it was the community pharmacy and the distribution warehouses that delivered the drugs. From a social perspective, this initiative saved €23,309 due to the trips (€8,907) and productivity losses (€14,402) that were avoided.
 Conclusions: This exceptional situation may be a good opportunity to improve the coordination between hospital pharmacies and community pharmacies in Spain, not only during the pandemic but also in the post-COVID-19 era.

Developing a telepharmacy programme with home medication dispensing and informed delivery in a tertiary hospital: description of the model and analysis of the results

“…It also saves time for patients, which provides them with a better work-life balance, and therefore leads to improved quality of life, together with economic savings both directly, through avoiding travelling expenses, and indirectly, through the time spent travelling and loss of labour productivity. Other studies corroborate these benefits; in this way, Zozaya et al estimate that a total of 1939 shipments in 2 months had avoided trips associated with a total saved time of 1374 hours and had saved the patient a total of €23,309, including the costs of avoided trips and avoided productivity losses 13…”

“…In a survey of 185 Spanish public hospitals, 83.2% of PS did not include medication delivery as part of their remote pharmaceutical care service prior to the health crisis 11. The declaration of the state of alarm on 14 March 2020 presented PS with an opportunity to develop and implement new models of remote care and remote medication dispensing 12–15…”

“…Nevertheless, the telepharmacy experiences described are limited and include different dispensing and informed delivery models (community pharmacy or home) 15–23. Furthermore, most of them present descriptive results in small patient groups selected according to pathology,17 18 24–26 with certain drugs, such as thermolabile or narcotic drugs, excluded in many instances 1 13. Moreover, the degree of implementation is heterogeneous; in the USA, for example, in a study carried out by the American Society of Health-System Pharmacists (ASHP) on pharmaceutical practice in hospital settings, only a quarter of the 265 hospitals surveyed performed telepharmacy 27.…”

“…The use of telephones for patient contact is a safe system that most patients prefer to videoconferencing,29 therefore the majority of studies use this tool to contact patients 13 15. The main problem in the study is the ability to guarantee confidentiality during shipment.…”

“…This study is one of the first to describe a telepharmacy model with direct home delivery of hospital medication and to offer an analysis of the long-term model, in addition to including chronic patients without discrimination on the basis of pathology or medication. Currently, there are studies limited to the first months of the pandemic that proved the viability of telepharmacy;5 6 11–16 however, they do not specify whether this service continued after this period. In the study hospital, however, the service is currently available to all patients likely to benefit from the process, in line with the principle of equity.…”