Progress 06/01/09 to 06/30/10
Outputs
OUTPUTS: The purpose of this research was to examine the overall issues facing pharmacies as it relates to the delivery of Medication Therapy Management (MTM) and identify how a proven telepharmacy model may be applied to this need. No research or current models were available for MTM services being provided through such systems. Research Objective 1. What are the current delivery methods for MTM Research Objective 2. How can technology driving the current telepharmacy model be utilized to deliver remote MTM services to rural areas Medication therapy management provides for a greater role for the pharmacist in a patient's care by providing information, interaction, and life style management changes primarily to clients with multiple diagnosis. Tele-pharmacy methods allow a pharmacist to provide services in several locations via a local pharmacist technician with remote camera oversight and interaction. Under our first objective, we interviewed a number of consultant pharmacists, community telepharmacists, representatives of McVille Hospital, Catholic Health Initiatives (owners of numerous of critical access hospitals nationwide, including more than a dozen in North Dakota and Minnesota), and St. Mary's Medical Center in Evansville, Indiana to assess both their current use of technology in medically under served areas and their perceptions about the expansion of the technology in these communities. Under our second objective, we identified several options for bundling software and hardware with tele-pharmacy systems to achieve MTM services. We interviewed rural pharmacists about the provision of telepharmacy delivered MTM services. For this task, the Principal Investigator identified pharmacies within this geographic area of each of the four included states (12 pharmacies total) who were regarded as knowledgeable of (but did not necessarily practice) both MTM and telepharmacy. First, the researchers identified a geographic area (within the U.S.) within (approximately) a 300 mile radius of Dickinson, ND; the location of the study's Principal Investigator. This includes the entirety of North Dakota, the (approximately) eastern half of Montana, the majority of South Dakota (with the exception of the southeastern portion of the state; the study does not include Sioux Falls) and the northeastern portion of Wyoming. The area is interesting to study as it is very sparsely populated and has limited access to health care. Having identified the thoughts and concerns of the small panel of experts, it was possible to create a survey which was disseminated to all community pharmacy owners and/or managers in the target area. The general format of the survey was similar in nature to the structured interview. The complete universe of pharmacies totaled 359, of which 190 were located in North Dakota, 57 were located in South Dakota, 77 were located in Montana, and 35 were located in Wyoming. Surveys were mailed through the U.S. Postal Service, and included self-addressed, stamped return envelopes. Surveys were initially mailed late in the spring of 2010 with a second mailing followed three weeks thereafter. PARTICIPANTS: Project Investigator: Ryan Jilek Company Name: Custom Data, Inc. 677 Tenth St. E., Dickinson, ND 58601 Contact Information: 701.483.3036 jilek@customdata.com ....Project Researchers: Dr. Dan Friesner, Interim Dean for Student Affairs and Associate Professor College of Pharmacy, Nursing and Allied Sciences, North Dakota State University Fargo, ND 58108, 701-231-9509, Daniel.Friesner@ndsu.edu; Mark Schroeder, Ph.D., Assistant Professor, Electrical Computer Engineering Department, North Dakota State University, Fargo, ND 58105, 701-231-8049 mark.j.schroeder@ndsu.edu ....Project Contributors: Ann Rathke, Telepharmacy Coordinator, North Dakota State University, Fargo, North Dakota; Charles D. Peterson, Pharmacy Dean, North Dakota State University, Fargo, North Dakota; Howard C. Anderson, Jr., R.Ph., Executive Director, North Dakota Board of Pharmacy, Bismarck, North Dakota; Special acknowledgement to the pharmacists in South Dakota, Montana, Wyoming and North Dakota who participated in the face to face interviews and Community Pharmacy Surveys as well as their prospective state Boards of Pharmacy TARGET AUDIENCES: Not relevant to this project. PROJECT MODIFICATIONS: Not relevant to this project.
Impacts
Objective 1. This research led the team to the conclusion that telepharmacy-based MTM, at the current time, is most effectively delivered and expanded through a clinic or hospital-based health system. From our research, we believe partnerships with health systems, rather than individual providers, present the ideal potential delivery system. Doing so allows the current research to abstract from complications such as converting and/or sharing medical records and billing system information across different firms. We believe this provides an over all reduction in project costs. Collaboration across independent providers remains within the realm of possibility, but is left as a suggestion for future research. Despite this simplifying assumption, there are hurdles to overcome. Of greatest concern will be protecting privileged health information as it is transmitted across sites within the health system. More specifically, using an Internet-based technology will create confidentiality concerns when the central site practitioners attempt to access client records and information at the remote sites. Objective 2. We found the start up software and hardware costs to be $13,000 to $18,000 depending on the existing technology currently available within the telepharmacy and the targeted satellite locations. We found that rural pharmacies are not being reimbursed for face to face MTM services. We found them to be isolated from interactions with other health care providers on an individual client basis. We found insurance companies have little or no incentive to provide MTM reimbursements and we see little movement within the insurance community to embrace MTM on a viable scale in the near future. Therefore, the additional cost of necessary MTM adapted telepharmacy equipment is a barrier because there is no way to recoup the cost. We found that pharmacists outside of North Dakota (which pioneered telepharmacy) were interested but cautious about telepharmacy. Some rural pharmacies outside North Dakota saw telepharmacy as a threat to their occupation and had reservations and concerns about this form of prescription delivery much less using technology for MTM service delivery. Some are concerned about telepharmacy being used to drive out traditional pharmacies. Others simply see it as not economically viable due to fear of the technology in general and/or quality considerations. Because of the barriers identified early in our research, the project did not progress towards in- depth questions on exactly how and at what cost tele-pharmacies or rural pharmacies can provide MTM services at this time. We didn't proceed to creating a commercial plan. Therefore, our project cost was significantly reduced from $79,849 to $43,648. We believe that our research was ahead of the curve on telepharmacy delivered MTM services. Our primary barrier is the lack of MTM reimbursements currently available. We hope to revisit the other questions and other barriers identified by our research at such a time as reimbursements for medication management therapy are more readily available and present a viable revenue stream for participating pharmacists and telepharmacies.
Publications
- No publications reported this period
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