Pharmacist involvement in a comprehensive remote monitoring and telemanagement program

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the role of the pharmacist in and initial outcomes of a remote monitoring and telemanagement program implemented to proactively provide outreach to high-risk patients during the coronavirus disease 2019 (COVID-19) pandemic. Summary A remote monitoring and telemanagement program was developed at a large, nonprofit, multicenter, academic health system as an innovative way to manage patients at risk for decompensation of their chronic diseases in the midst of the COVID-19 pandemic. The program mobilized an interprofessional workforce including nurses, medical assistants, social workers, virtualists, patient schedulers, and ambulatory care pharmacists. Patient outreach included a combination of telephone calls and digital outreach. The goal was to monitor patients’ health status remotely and assess for early signs of decompensation. Pharmacists conducted telephone outreach to answer patients’ medication questions and address signs and symptoms of worsening chronic conditions. Pharmacists were able to utilize an existing collaborative practice agreement (CPA) to adjust medication therapy and order laboratory tests as needed for safety and efficacy monitoring. Since the program’s inception in April 2020 through January 2021, pharmacists have addressed over 1,600 medication questions or instances of worsening clinical signs and symptoms. Conclusion A comprehensive remote monitoring and telemanagement program utilized a multidisciplinary team to monitor high-risk patients during the COVID-19 pandemic. Pharmacists contributed to chronic disease management via the use of a comprehensive CPA, allowing medications to be started, stopped, or adjusted on the basis of patients’ needs, to improve population health management and reduce workload for primary care providers who were addressing new and emerging issues during the pandemic.

A remote hypertension management program clinical algorithm

“…Innovative hypertension programs focus on telehealth and remote management. In many remote management programs, the pharmacist calls the patient and discusses lifestyle modifications and medication adherence and makes medication changes 6,7,24,25 . Studies demonstrate the positive impact pharmacists can have on improving BP control 24,25 .…”

“…5 Programs with pharmacists working under a CDTM agreement have demonstrated positive impacts on patient care and helped reduce physicians' workloads by providing care via telemedicine and other digital communication avenues. 6,7 Chronic disease states like hypertension are particularly wellsuited for remote management and thus CDTM-guided care. 7 Further, telehealth and remote management strategies became vital during the COVID-19 pandemic and are likely here to stay.…”

“…6,7 Chronic disease states like hypertension are particularly wellsuited for remote management and thus CDTM-guided care. 7 Further, telehealth and remote management strategies became vital during the COVID-19 pandemic and are likely here to stay. 8 We have previously reported on the clinical success of our remote management program at MGB.…”

“…State legislation provides CDTM agreements as a mechanism for pharmacists to prescribe under care algorithms designed with physicians 5 . Programs with pharmacists working under a CDTM agreement have demonstrated positive impacts on patient care and helped reduce physicians' workloads by providing care via telemedicine and other digital communication avenues 6,7 …”

“…5 Programs with pharmacists working under a CDTM agreement have demonstrated positive impacts on patient care and helped reduce physicians' workloads by providing care via telemedicine and other digital communication avenues. 6 , 7 …”