The North Dakota Telepharmacy Project Restoring and Retaining Pharmacy Services in Rural Communities

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The North Dakota Telepharmacy ProjectRestoring
and Retaining Pharmacy Services in Rural
Communities

• Charles D. Peterson, Pharm.D.
• Dean and Professor
• College of Pharmacy
• North Dakota State University
• Fargo, North Dakota
• Funded by the Office for the Advancement of
  Telehealth, HRSA, of Health and Human Services

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North Dakota Demographics2000 Census Highlights

• 642,200 population, ranks 47th in nation
• population growth 0.5 (1990-2000)
• population shift from rural to urban
• only 6 of 53 counties gained population
• 50 of ND counties lost at least 10
• 36 of 53 counties classified as frontier
• 14.7 over 65, vs 12.4 nationally

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Access to Pharmacy Services in North Dakota

• Of the 373 cities, 73 have pharmacies
• Of the 53 counties, 9 do not have a pharmacy and
  11 have only one Rx
• North Dakota 51 ownership law

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ND Rural Health Care CrisisCommunity Pharmacy
Closings

• 26 rural community pharmacy closings
• 12 additional pharmacies at risk of closing
• pharmacist retirements - no replacement
• national pharmacist shortage
• negative impact on rural health

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Exploring SolutionsTelepharmacy Rules

• required changes in pharmacy practice act
• telepharmacy rules established by NDBDPh
• pilot project in 2001 ? permanent rules
  established in June 2003
• allow pharmacists to supervise a technician at
  remote site
• dispense prescriptions
• pharmacist - patient consultation
• 
  

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Boards of PharmacyTelepharmacy Regulations

• Approximately 25 states currently either have
  telepharmacy regulations or are very close to
  adopting regulations. There is a good chance by
  the end of the year, there could be 30 pharmacy
  boards with regulations in place.
• Carl Geberbauer, V.P.
• AutoMed Technologies, Inc

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Telepharmacy Grant Awarded NDSU College of
Pharmacy

• Congressionally mandated federal grant via the
  support of Senator Byron Dorgan
• Office for Advancement of TeleHealth, Health
  Resources and Services Administration of HHS
• First Initiated September 1, 2002
• Approximately 2.5 million federal support to
  date

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Goals of Telepharmacy Grant

• RESTORATION - restore pharmacy services in rural
  communities which have lost their services
• RETENTION - retain pharmacy services in rural
  communities which are at risk of losing their
  services
• ESTABLISH establish pharmacy services in rural
  communities which have previously not had
  services

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North Dakota Telepharmacy ProjectA Historical
Look
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Telepharmacy Project Partners

• NDSU College of Pharmacy
• North Dakota State Board of Pharmacy
• ND State Pharmaceutical Association
• Licensed rural community pharmacies
• Targeted rural communities
• 
  

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Telepharmacy Grant Budget

• Assist in the telepharmacy start-up costs
• 50 OAT Grant/50 North Dakota
• Technology Hardware, Software, Connectivity
• Registered Pharmacy Technician
• Pharmacy Fixtures
• Drug Inventory
• Travel
• 
  

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Pharmacy Technician Responsibilities Remote
Telepharmacy Site

• Maintains drug inventory at remote site
• Processes all prescriptions orders including
  controlled substances
• Computer order entry, filling, billing, labeling
• Takes original prescription orders by phone
• Prepares prescription for dispensing by
  pharmacist
• Connects patient to the pharmacist for private
  consultation via audio and video link

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Pharmacy Technician Training Requirements
Telepharmacy Sites

• Registered with Board of Pharmacy
• ASHP accredited program or equivalent
• Minimum of one year experience in dispensing
  prescriptions
• Salaries are 15/hour or more
• Reciprocity from other states requires PTCB
  certification

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Pharmacist Responsibilities

• Final check of technician Rx preparation
• Dispenses drug to the patient
• Drug utilization review
• Patient education counseling
• Remote site visits

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DemographicsRemote Telepharmacy Sites
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DemographicsRemote Telepharmacy Sites
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DemographicsRemote Telepharmacy Sites
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DemographicsRemote Telepharmacy Sites
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Telepharmacy Technology

• Standard PCs with Pharmacy Software
• Polycom VSX 7000
• Sonic Wall TZ170 or Tele 3, Cisco Firewall
• AVerMedia - AVerVision 110 Document Camera
• DSL over the Internet or dedicated T-1 line
• Rx Software and audio video link run in parallel

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Benefits to North Dakota from Telepharmacy

• Improved access to health care for rural citizens
• Rural economic development
• Improved quality of care/pharmacist consults
• Increased patient pharmacist satisfaction
• Increase financial viability of rural pharmacies
• Provide relief for pharmacists for vacations,
  etc.
• Increased educational opportunities for students
• Increased retention of pharmacy graduates

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Economic Impact of Telepharmacy

• Has added a 500,000 per year business to the
  rural community
• Thus far, has added an estimated total of 12.0
  million annually to the North Dakota rural
  economy
• Has added an estimated 40-50 new jobs to the
  North Dakota rural marketplace
• Has added 50 increase in prescription sales to
  combined pharmacy operation

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Addl Economic Development Benefits of
Telepharmacy

• Helps build the local community economy
• Helps attract other businesses and families to
  community because basic health care
  infrastructure is present
• Pharmacy can be used for other business retailing
  not currently available within the community

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Student Involvement

• Incorporate telepharmacy technology in NDSUs new
  Concept Pharmacy Lab
• Trains students on the latest advances in
  pharmacy technology
• Teaches students how to deliver pharmacy services
  in a unique and innovative way to smaller rural
  communities
• Helps attract graduates to rural practices

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Student Activities

• Provide pharmacists at the Central Pharmacy with
  drug information and disease state management
  assistance
• Provide patient education counseling to remote
  telepharmacy sites

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Future Goals of the ND Telepharmacy Project

• 50 telepharmacy sites in five years
• develop a model for serving rural hospitals
• assist other states in implementing telepharmacy
  services in rural areas
• establish a state-wide data video network
• establish equipment standards
• conduct a formal medication error study

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Telemedicine Technical Assistance Document A
Guide to Getting Started in TelemedicineIncludes
14 Telemedicine Areas

• http//muhealth.org/telehealth/geninfo/TAD.html
• 35 page chapter providing guidelines for how
• to implement telepharmacy services

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For more information visit our website at
http//telepharmacy.ndsu.nodak.edu/