Evaluation of a clinical pharmacist team-based telehealth intervention in a rural clinic setting: a pilot study of feasibility, organizational perceptions, and return on investment

Abstract

Background Remote, centralized clinical pharmacist services provided by board-certified clinical pharmacists have been shown to effectively assist in chronic disease management. We assess the feasibility of implementing a pharmacist-led, remote, centralized pharmacy service to improve A1c levels in patient with diabetes in a rural clinic setting. Methods This was a non-randomized pilot and feasibility study. Participants were enrolled in a pharmacist-led telehealth intervention service, with data prior to enrollment used as baseline data for control. To be included, patients needed to have A1c readings of greater than 7% to be considered uncontrolled. A1c changes were reported for two groups based on A1c ranges: between 7 and 10% and ≥ 10%. Clinical pharmacists and clinical pharmacy interns initiated contact with patients via telephone communication and managed the patients remotely. The following outcomes were evaluated: organization perceptions (patients, providers, and clinic staff), changes in A1c, medication discrepancies, impact of an internally operated Patient Assistance Program, and potential return on investment (ROI). Results Fifty-two patients were initially identified and referred to the service with 43 patients consenting to participate in the intervention. Patient and provider survey responses were recorded. In the initial analysis occurring during the first 3 to 5 months of the program, there was considerable improvement in diabetes control as measured by A1c. For patients with uncontrolled diabetes with a baseline A1c > 7% but less than < 10% and ≥ 10%, the intervention resulted in an A1c decrease of 0.57% and 2.55%, respectively. Clinical pharmacists and clinical pharmacy interns identified at least one medication discrepancy in 44% of patients, with number of discrepancies ranging from 1 to 5 per patient. At the conclusion of the study window, 42 potentially billable encounters were documented, which would have generated a net profit of $1140 USD, had they been submitted for reimbursement. Given the potential revenue generation, the service theoretically yields a ROI of 1.4 to 1. Conclusions Initial results suggest that a pharmacist-led telehealth intervention has potential to decrease A1c levels in patients with diabetes, assist in identification of medication discrepancies, provide a positive return on investment for rural clinics, and potentially increase reimbursement for providers and clinics tasked with managing patients with uncontrolled diabetes.

Describing the delivery of clinical pharmacy services via telehealth: A systematic review

“…Telehealth can reduce health care‐related costs associated with patients' lost wages, lost productivity, and travel time 6 . Telehealth facilitates more engaging and efficient management of chronic conditions and allows members of the patient care team, such as pharmacists to connect with patients and thereby improve patient outcomes 5,7‐9 . Telehealth interventions by pharmacists can improve the control of blood pressure and reduce serum levels of hemoglobin A1c when compared with the usual standard of care afforded by primary care providers alone 8,10,11 …”

Offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice: A rapid review of the literature

“…Figure 1 displays the study selection process. Five of the six studies were identified during the initial database search, [13][14][15][16][17] and the final study 18 was identified when hand-searching the reference list of a review article.…”

The era of telehealth pharmacy practice

“…Studies over the past 10 years have highlighted multiple benefits of telehealth, two of the largest being increased patient access to care and improved patient outcomes. [1][2][3][4][5][6][7] With the advent of reimbursement expansion due to the pandemic, these advantages can now be applied to a diverse set of patients, not only those who reside in rural areas or areas with shortage of health care providers. This can lead to enhanced access to care and improved patient outcomes for both rural and urban residing patients and patients with other barriers to accessing care such as transportation or childcare difficulties.…”