Impact of the clinical pharmacy specialist in telehealth primary care

Abstract

Purpose: A telehealth-based chronic disease management program including clinical pharmacy specialists (CPSs) and the program's impact on primary care outcomes in a population of veterans are described.

Summary: A telehealth program including CPS services was developed to improve healthcare access and quality for veterans in rural areas of the Pacific Northwest. Outcomes of medication management services provided by a CPS team during both clinical video telehealth and telephone encounters with 554 patients from October 2014 to March 2017 were assessed. Patients were targeted for diabetes (DM), hyperlipidemia (HLD), and hypertension (HTN) control and tobacco cessation; the respective primary outcomes were the mean changes from baseline in glycosylated hemoglobin (HbA_1c) and blood pressure values and rates of guideline-indicated statin therapy and tobacco cessation. Patients in the DM and HTN groups had a mean absolute HbA_1c reduction of 1.61% (95% confidence interval [CI], 1.39-1.83%; p < 0.0001) and a mean systolic blood pressure reduction of 26.00 mm Hg (95% CI, 22.99-28.50 mm Hg; p < 0.001), respectively. In the HLD group, 93% of patients were discharged on a lipid-lowering medication. Tobacco cessation was achieved in 42% of targeted patients.

Conclusion: CPSs providing primary care comprehensive medication management services solely via telehealth improved disease management and access to healthcare in a population of rural veterans. Statistically significant improvements in DM and HTN outcomes were demonstrated along with clinically significant improvements in the areas of lipid management and tobacco cessation.

Keywords: clinical video telehealth; disease state management; health services accessibility; pharmacists; primary care; telemedicine.