key: cord-0918225-tcw9o6aq authors: Park, Jamie Y; Zed, Peter J; Vera, Mary A De title: Perspectives and experiences with telepharmacy among pharmacists in Canada: A cross-sectional survey date: 2022-01-10 journal: Pharm Pract (Granada) DOI: 10.18549/pharmpract.2022.1.2609 sha: 0ea5c782f32a0a37235c6f9e7e47073c7532110f doc_id: 918225 cord_uid: tcw9o6aq OBJECTIVE: This study aims to understand Canadian pharmacists’ use, experiences, and perspectives of telepharmacy. METHODS: We conducted a cross-sectional online survey. Individuals were eligible to participate if they were currently a registered, licensed pharmacist practicing in Canada. We collected perspectives of both telepharmacy users and non-users by creating a survey logic that asked specific and shared questions between the two groups. Data was analyzed using descriptive statistics including means and standard deviations (SD) for continuous variables and proportions for categorical variables. RESULTS: Between October and December 2020, 136 pharmacists completed the survey, including 61 (52.6%) telepharmacy users and 55 (47.4%) non-users. Among those who use telepharmacy, the majority of participants (39, 72.2%) expressed that telepharmacy augmented their clinical practice and feel comfortable managing minor ailments using telepharmacy (41, 80.4%). Among non-users, 45 (84.9%) indicated that telepharmacy will augment their clinical practice and 48 (90.6%) would feel comfortable managing minor ailments using telepharmacy. Important considerations for successful implementation of telepharmacy for those who use telepharmacy included easier system implementation (29, 19.3%), better privacy & data protection (28, 18.7%) and simple to learn technology (23, 15.3%). CONCLUSION: Despite the growing recognition of benefits of telepharmacy, our findings suggest that utilization among pharmacists in Canada is still quite low. Nonetheless, our study identified areas of consideration for better integration of telepharmacy in pharmacy practice including optimizing workflow, addressing barriers, and providing training to pharmacy students. Over the past 5 years, the use of telemedicine in health care has been increasing. 1,2 Telemedicine encompasses health care services such as web applications (e.g. teleconsultations, conferences via the Internet), mobile applications and remote patient monitoring. 3 With the advancement of technology, telemedicine has offered greater accessibility, cost-effectiveness and continuity of care to patients. 4 With the COVID-19 pandemic, there have been rapid implementation of telemedicine services, particularly in the fields of medicine and nursing as well as ongoing advocacy for continued optimization in order to safely connect patients to their health care providers. [5] [6] [7] Many pharmacies, in both community and institutional settings, currently utilize technology to process prescriptions, manage their inventories, deliver medications and communicate with patients and their health care team. 8 In 2018, the Canadian Society of Hospital Pharmacists has defined telepharmacy as "the use of telecommunications technology to facilitate or enable the delivery of high-quality pharmacy services in situations where the patient or healthcare team does not have direct (in-person) contact with pharmacy staff." 9 There is a wide variety of the types of telepharmacy interventions that are available and they demonstrate an overall positive impact on health outcomes. Niznik et al. (2018) conducted a systematic review to investigate the impact of clinical pharmacist telepharmacy interventions in outpatient or ambulatory settings on three types of clinical outcomes (clinical disease management, patient self-management, adherence). 10 34 studies that compared clinical outcomes against a comparator were identified. Types of interventions included pharmacist-led telephonic clinics, post-discharge follow-up, medication counselling, and monitoring lab values and vital signs. Over half of the interventions (23/34, 67.6%) resulted in an overall positive outcome based on one of three types of clinical outcomes reported (clinical disease management: 19/28, 67.8%; patient self-management: 2/2, 100%; adherence: 5/8, 62.5%). As the need to better understand utilization of telepharmacy continues, this study's objective was to understand Canadian pharmacists' use, experiences, and perspectives of telepharmacy. Individuals were eligible to participate if they were currently a registered, licensed pharmacist working in any type of practice setting in Canada (e.g., community, hospital). We recruited participants using four methods adapted from previous studies: 1) posting in investigators' and organizations' social media channels (e.g. Twitter, Facebook); 2) posting in online pharmacy communities; 3) advertising on pharmacy associations' online newsletters; 4) emailing pharmacists from our past studies who had previously agreed to be contacted to participate in future research studies. 2,11 We conducted a cross-sectional study. We designed an online survey, in English and French, to gather information about the participants' experiences and perspectives regarding telepharmacy (Supplemental File 1). We consulted a clinical expert in pharmacy practice throughout the survey development process and also conducted a pilot testing of the survey with our colleagues in the Faculty. The survey comprised two sections. The first section captured information on demographic characteristics with 10 questions altogether including those on age, gender, and workplace. The second section gathered information on whether participants currently use telepharmacy in their practice; with survey logic providing the opportunity to ask specific and shared questions between two groups. Specifically, participants who indicated that they use telepharmacy were asked 22 questions regarding their direct experiences including types of technology tool(s) used, clinical services that utilizes telepharmacy and the logistics of telepharmacy in their practice. For participants who do not use telepharmacy, we were interested in their perspectives and as such, 9 questions, which were also asked to the telepharmacy users, were asked. These questions included the potential impact on their clinical practice, ability/barriers to communicating effectively with telepharmacy, and important considerations for successful implementation of telepharmacy. Survey data was analyzed using descriptive statistics including means and standard deviations (SD) for continuous variables and proportions for categorical variables. We categorized participants according to reported use of telepharmacy and compared characteristics and experiences using Chi-square tests. Microsoft Excel, Qualtrics XM Stats, and SPSS software programs were used to support the analyses. Ethical approval was granted by the University of British Columbia Research Ethics Board (H20-02988). UBC's Survey Tool provided by Qualtrics was used to gather and store data as well as obtain the participant's informed consent. Participant confidentiality was maintained, and data access restricted to the research team. Between October 29, 2020 to December 10, 2020, 136 pharmacists completed the survey including 61 (52.6%) who indicated that they use telepharmacy and 55 (47.4%) who do not use telepharmacy. The average time to complete the survey was 6.6 minutes. Altogether, 68.0% of the participants were female and the mean (SD) age was 38.3 (11.6) ( Table 1) . Of particular interest are the experiences of participants who indicated their use of telepharmacy in current practice (as summarized in Table 2 ). The most frequently utilized Figure 1 provides an overview of telepharmacy clinical services according to technology tools used to deliver them; compared to video and "other" technology tools, phones are mostly used to deliver clinical services such as medication review and counselling. We contrasted experiences of participants who reported using telepharmacy with perspectives of those who did not (Figure 2) . The majority of participants utilizing telepharmacy (39, 72.2%) expressed that telepharmacy augmented their clinical practice; among those who do not use telepharmacy, 45 (84.9%) indicated that they think telepharmacy would augment their clinical practice. In addition, 50 (94.3%) telepharmacy users indicated that they are able to communicate effectively with the patient, 38 (74.5%) are comfortable assessing minor ailments, and 41 (80.4%) are comfortable making recommendations for managing minor ailments using telepharmacy. When asked similar questions on their perspectives, most of the non-users indicated that they think they will be able to communicate effectively with the patient (48, 90.6%), would feel comfortable assessing minor ailments (45, 84.9%) and would feel comfortable making recommendations for managing minor Finally, we asked questions to inform successful implementation of telepharmacy (Figure 3) . Among users, the most frequent considerations are: easier system implementation (29, 19.3%), better privacy & data protection (28, 18.7%) and simple to learn technology (23, 15.3%). The most important considerations for successful implementation of telepharmacy included easier system implementation (28, 17.6%), simple to learn technology (27, 17.0%) and being more cost-effective (25, 15.7%). To our knowledge, this survey is the first of its kind to explore pharmacists' use and experiences with telepharmacy in Canada. The participants practiced in a wide range of pharmacy practice, including community, hospital, family health team, ambulatory care clinic, long-term care pharmacy, government, academia, and industry. Just over half of the participants indicated that they use telepharmacy in their practice, mainly through phone and video calls. Participants who utilize telepharmacy indicated that telepharmacy augmented their clinical practice and feel comfortable making recommendations for managing minor ailment(s) using telepharmacy. When asked about their perspectives, participants who did not currently use telepharmacy expressed feeling that their clinical practice would be augmented by telepharmacy and that they would feel comfortable making recommendations for managing minor ailment(s) using telepharmacy. Key considerations for implementing telepharmacy among users were easier system implementation, better privacy & data protection, and simple to learn the technology; while for non-users these were easier system implementation, better privacy & data protection, and being more cost-effective. Altogether, along with providing a description of current experiences with telepharmacy in Canada, our study identified areas to support better integration and optimization of current and future telepharmacy interventions. With 52.6% of participants indicating use of telepharmacy to provide clinical services, our study suggests that in Canada, uptake of telepharmacy is still quite low despite previous evidence on the frequent use of other digital health tools (e.g., provincial drug information systems (DIS), laboratory information systems, and electronic clinical decision-making tools) in pharmacy practice. To allow for better implementation of telepharmacy in pharmacy practice, it is important to utilize the end-users' feedback and address potential barriers. In our study, key considerations for successful implementation of telepharmacy for users (easier system implementation, better privacy & data protection, simple to learn technology) were slightly different from non-users (easier system implementation, simple to learn technology, more cost-effective) of telepharmacy. These differences may be due to the fact that responses from users reflect actual experiences with telepharmacy while those from non-users reflect their perspectives. Nonetheless, these considerations were consistent with potential barriers of implementing telepharmacy reported by Ameri et al. in their study of barriers of implementing telepharmacy of 40 randomly selected pharmacists working in Iran. 11 The pharmacists were presented with 20 questions regarding challenges with telepharmacy implementation and they answered using a 5-point Likert-type scale. In our study, one of the important considerations for successful implementation of telepharmacy indicated by both users and non-users of telepharmacy included more exposure to telepharmacy during school/conferences/workplace. Providing sufficient training about telepharmacy to pharmacy students can help them prepare for their clinical practicums and later as a pharmacist. Park et al. (2020) conducted a mixed-method study to explore the current state of pharmacy students' self-rated digital health literacy in British Columbia. 12 Some students found it challenging to learn the technology tools at their practicum site due to their limited role as a pharmacy student and was stressful to learn on the spot. Students shared that they mainly learned the technologies during their practicum from the pharmacy manager/staff members and one student consulted a manual. 40% (2/5) of the participants who took part in the interview mentioned that they would like to learn how to navigate various pharmacy management and EMR systems. Limitations of this study include having a smaller sample compared to previous studies, which could be attributed to the short recruitment period (October to December 2020) and the busyness of pharmacists due to the start of the flu season overlapping with the COVID-19 pandemic. In addition, since we mainly utilized email and social media platforms to recruit participants, there could be participant bias of having more of tech-savvy pharmacists. Due to our recruitment methods, we were also unable to calculate the survey response rate. It is important to also acknowledge that our findings may be difficult to generalize to pharmacists globally due to the differences in scope of practice and access to technological tools. Despite the growing recognition of telepharmacy, its implementation and utilization of telepharmacy by pharmacists is still quite low. Our study provides a current landscape of telepharmacy, which will aid the next steps of telepharmacy advancement and implementation for pharmacists, professional associations, and government officials. Future areas of research include cost evaluations of telepharmacy and comparing the effectiveness of different technology platforms used to deliver telepharmacy. World Health Organization Technology and managed care: patient benefits of telemedicine in a rural health care network Telemedicine and the COVID-19 pandemic, lessons for the future AMA's recent and ongoing advocacy efforts Committee on Pediatric Workforce. The use of telemedicine to address access and physician workforce shortages Health information technology: a new world for pharmacy Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: a systematic review Investigating pharmacists' views on telepharmacy: prioritizing key relationships, barriers, and benefits Exploring Canadian pharmacy students' e-health literacy: a mixed method study None. None. Authors declare no conflicts of interest. shifts from 2016 to 2019. 2020.