Virtual care in a virtual world

By Crystal Zhang, Gigi Lai, and Certina Ho

I am currently under self-quarantine and I’m confused about the new prescription delivered to me this afternoon. Can you help me?

With limited face-to-face interactions during COVID-19, technology has played an increasingly crucial role to ensure safe and effective medication use and the continuity of patient care.

What is telehealth?

“Telehealth” refers to the use of technology (e.g. phone calls, smartphone applications, video calls) to facilitate remote communication between patients and healthcare providers with the purpose of promoting clinical care. Telehealth is definitely not a new concept. Traditionally, barriers including lack of support for technological infrastructure and concerns regarding patient privacy have limited its adoption. However, social distancing measures enforced for COVID-19 have led to a surge in digital healthcare tools. Videoconferencing and audio calls provide patients with access to healthcare providers for those who may be self-isolating or immunocompromised, or who may have mobility challenges or difficulties in physically accessing healthcare, among other reasons.

As healthcare delivery enters the age of technology, telehealth is certainly here to stay beyond the pandemic. How can we, as healthcare providers, leverage the advancement in technology to improve patient care?

Role of pharmacists in virtual care

Let’s take a look at how pharmacists, for example, can use or have adopted telehealth to enhance healthcare. As medication experts, pharmacists can utilize virtual care throughout the medication use process when in-person interactions are limited or not feasible.

Before prescription order entry

A best possible medication history (BPMH) is a complete and up-to-date list of a patient’s medications along with other health information including medication allergies, medical conditions, and social history. With telehealth, pharmacists can conduct BPMH interviews with patients (or patient caregiver), identify and resolve medication discrepancies, and prevent miscommunications among healthcare providers within the patient’s circle of care. When new medications are prescribed, an up-to-date profile can help pharmacists identify/prevent potential drug therapy problems and optimize medication regimens accordingly.

During preparation of a prescription

Medication regimens can be overwhelming for patients, especially when undergoing emotional stress from a newly diagnosed condition. Therefore, pharmacist-patient communication is important in helping patients understand their medication(s) and achieve safe and effective therapeutic outcomes. For instance, pharmacists can demonstrate medication administration techniques (e.g. for inhalers) through videoconferencing and provide counselling on medications over the phone. Similarly, patients can use telehealth to connect with pharmacists, ask questions, and clarify concerns regarding their medications.

Medication therapy management

After a new medication is initiated, it is important to monitor the efficacy of the treatment option, check for any potential adverse effects, and evaluate patient’s adherence to the therapy. Undoubtedly, telehealth allows for greater accessibility as pharmacists can monitor patients over the phone or via videoconferencing. At the same time, patients can connect with their pharmacists remotely to discuss concerns regarding their medications. Additionally, telehealth enables pharmacists to virtually collaborate with prescribers to resolve drug therapy problems and optimize patient care.

Is virtual care for everyone?

Despite the benefits of telehealth, patient factors and technological security should be considered before implementing virtual care. Remote communication is not a replacement of, but rather an alternative or a complementary option to, in-person visits. Patient factors, including the type of assessment required from a healthcare provider and a patient’s technological literacy, are important considerations when determining a patient’s eligibility/suitability in using and/or receiving care via telehealth. Sometimes, video calls alone are not adequate if physical assessments are required (e.g. for chest pain); face-to-face follow-up visits may be necessary for comprehensive examination and care. On another note, the security, privacy, and confidentiality of virtual platforms in providing and supporting telehealth should be carefully evaluated. Before a virtual care interaction, an informed consent from patients pertaining to potential risks associated with telehealth communication should be obtained by the care provider. While telehealth has brought convenience to healthcare, its limitations should always be acknowledged to ensure not only patient safety, but also equity, diversity, and inclusion.

Going forward

COVID-19 has significantly accelerated the development and adoption of telehealth, advancing healthcare into the digital age. Telehealth can be considered as a complementary tool to enhance patient care. However, it is imperative that healthcare providers evaluate the appropriateness of virtual care according to individual patient care needs and carefully assess the security of telehealth platforms in order to maintain continuity of patient-centred care.

The Canadian Medical Association, together with the Royal College of Physicians and Surgeons of Canada, and the College of Family Physicians of Canada, developed resources and tools to help physicians and patients adopt virtual care. For example:

Crystal Zhang and Gigi Lai are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.