Telepharmacy brown bag medication management clinics for rural veterans

Objective: Medication reconciliation (MR) and patient education (PE) are important elements to quality of care and patient safety. Rural Veterans utilizing both Veterans Health Administration (VHA) and non-VHA providers adds considerable complexity to the task of MR. An innovative project was initiated to reach these at-risk patients via Clinical Video Telehealth (CVT) technology.

Methods: A pilot project began in Fiscal Year (FY) 2012 at three rural VHA Community Based Outpatient Clinics (CBOC) in Maine. The project has goals of 1) training pharmacy residents and sixth-year pharmacy students to conduct MR/PE via CVT with rural patients, and 2) address polypharmacy issues with rural Veterans. The project is ongoing for FY13.

Results Feedback from patients has been very positive. Virtually all patients have indicated comfort with CVT format and believe they received good care. Semi-structured interviews were conducted at the end of FY12 with staff. Overall impressions were positive: decreased patient burden (drive-time), patient education, and reduction of medication side effects. Some conflicting opinions were gleaned regarding the perceived benefit to staff (workload burden, role-confusion). Individual clinics were tasked with identifying/recruiting patients for CVT visits. These various methods had mixed results.

Conclusions: These results indicate that this innovative approach to ME/PE has much positive potential to affect a population with particular complexities. Increased efforts and resources have been dedicated for FY13. Lessons-learned include improved staff communication and systematic efforts at patient recruitment.