Initial Experience of Clinical Pharmacy Services Delivered byComputer Communication via Cisco Jabber Video in a US Veterans AdministrationMedical Center

摘要

>Background/Objective: Clinical video telepharmacy is a new initiative of the Department of Veterans Affairs (VA) to provide rural patients access to clinical pharmacy services. This article describes some of the obstacles that pharmacists faced as they initiated this service and early outcomes in diabetes and hyperlipidemia patients. >Methods: This study was approved by the institutional review board. This was a single-center, retrospective review of patients seen by 3 clinical pharmacists who developed and administered the telepharmacy clinics. Patients were referred by their primary care providers. Patients traveled to their local community-based outpatient clinic where a nurse set up video conferencing and then paged the pharmacist at the Lincoln VA. Patients were referred for management of anticoagulation, diabetes, hyperlipidemia, or hypertension, with 112 patients screened and 12 patients meeting criteria for hemoglobin A1c (HbA1c) evaluation and 25 patients meeting criteria for low-density lipoprotein (LDL)-cholesterol evaluation. Pharmacists also saw new patients for medication reviews, patients just out of the hospital, and patients with questions about their medication regimens. This study looked specifically at the effect that the pharmacist hadon HbA1c and LDL-cholesterol reduction and meeting goals for these 2 parameters.>Results: Patients in the diabetes group had a mean ± standarddeviation reduction in HbA1c of 1.08 ± 0.85 (95% confidence interval =0.53-1.62; P = .001). The mean HbA1c decreased from 9.1% to 8%after pharmacist intervention. Patients in the hyperlipidemia group had a mean ±standard deviation reduction in LDL-cholesterol of 23.74 ± 7.76 mg/dL (95%confidence interval = 7.76-39.75; P = .005). The meanLDL-cholesterol decreased from 145 to 121 mg/dL after intervention. There wereno significant changes in the number of patients attaining their HbA1c orLDL-cholesterol goals after intervention. >Conclusions: This studyshows that telepharmacy allows patients to have access to pharmacy services in arural environment with minimal inconvenience to the patient. This study alsosuggests that outcomes of disease management are similar to face-to-facevisits.