July 21, 2017
A Vietnam-era Veteran hobbles into the Statesboro, Georgia VA clinic. As much as he savors pizza, chicken-fried steak, and cheddar cheese, his primary care doc’s advised the old soldier to cut back and take medication to lower his LDL.
This visit’s his first follow-up to talk about his high cholesterol and how the meds are working. Following the small talk, blood pressure and temperature checks, he steps into a room and meets … a $20,000 rack of technology. Moments later, the screen lights up and on pops Eva Wong, a clinical pharmacist working for Charlie Norwood VA Medical Center from her home near Atlanta. After some small talk, they get down to business about that high cholesterol.
Connecting with a pharmacist 146 miles away is made possible thanks to a new service offered at the Statesboro VA clinic called telepharmacy. About a month old, telepharmacy has the capacity to see eight to 10 patients per day, or about 300 per month, with a goal of 85 percent direct patient contact.
Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing.
The service fills a void in Statesboro – one of VA Augusta’s fastest growing areas -- and comes on the heels of both necessity and new funding, according to Dr. Jennifer Blanchard, Chief of Pharmacy service for the Charlie Norwood VA Medical Center and a 2003 graduate of the University of Kentucky College of Pharmacy.
“The Statesboro clinic is too small to put an actual pharmacist in to do these kinds of appointments. Also, because Statesboro is so rural, it would have been difficult to recruit in that area,” she said of the necessity.
The funding arrived via a grant from the VA’s Office of Rural Health, about $180,000 annually. It bought a full-time pharmacist, support, and equipment needed to carry out the program for three years.
According to Blanchard, telehealth takes workload off VA primary care providers. Clinical pharmacists see patients dealing with conditions like diabetes, high blood pressure and high cholesterol. Telehealth also creates more access to appointments for Veterans and saves them a two-hour drive north to Augusta.
Dr. Lee Bell, associate chief of pharmacy for clinical programs at VA Augusta, said as VA modernization goes, telehealth is one service that’s probably not used enough.
“The telehealth technology has been out there but it hasn’t been utilized to the extent it needs to be,” she said.
VA Secretary Dr. David Shulkin said making use of telehealth vital to VA’s future. “One of the most important ways we deliver health care to our Veterans today is through telehealth,” Shulkin said in 2016. “We believe telehealth is such an important component of addressing the access issue for VA.”
According to a 2014 article in U.S. Medicine, telepharmacy services have expanded outside primary care to include other specialties such as mental health, heart failure, hepatitis C, women’s health and anticoagulation therapy management. Furthermore, telepharmacy has been incorporated into multidisciplinary group clinics, such as pain clinics, smoking cessation, fitness programs and diabetes management classes.
In 2015, VA conducted 2.1 million episodes of telehealth. That included 400,000 telemental health visits. This year, Charlie Norwood has done 2,148 telehealth encounters, according to April Harris, telehealth coordinator for VA Augusta.
“Charlie Norwood telehealth participates in the modernization initiative by offering Clinical Video Telehealth to improve access to care for Veterans in underserved areas, “ Harris said. “CVT offers many benefits which include decrease travel time, increase access to specialty care, and increasing convenience for our veterans.”
Pharmacology via telehealth gets pharmacists even closer to Veterans.
“One of the things we struggle with is making sure the work meets the level of the practitioner. We often get lumped into filling prescriptions and tracking packages, which are important services, but not necessarily something that should be directed to a clinical pharmacist,” Blanchard said.
In performing direct patient care, the pharmacists’ goals are to get Veterans to their lab goals, get conditions under control, and meet the goals for their disease state.
“And as they get toward goal, they’re usually going to feel better and see decrease risks of other diseases or issues,” Wong added.
As that Vietnam Vet walks out of the clinic and heads for home 15 minutes away instead of two hours away, telepharmacy continues to take shape and grow in Statesboro and beyond.
“We anticipate there will be additional opportunities to integrate and this kind of service within our network in the southeast,” Blanchard said. “We’re excited to be able to offer this service.”
VA file photo | A contractor conducts training with telehealth equipment in 2012. Equipment like this will be used by clinical pharmacists from Charlie Norwood VA Medical Center to help hundreds of Veterans in the Statesboro, Georgia, area.