The document provides an overview of telepharmacy, which involves delivering pharmaceutical care through telecommunications, highlighting its types, working mechanism, advantages, and disadvantages. It details four types of telepharmacy: inpatient, remote dispensing, IV admixtures, and remote counseling, while also discussing a seminar on drug delivery systems. Additionally, it reviews recent articles on telepharmacy's effectiveness during COVID-19 and regulatory issues in rural hospitals.

1. TELEPHARMACY
NAME:- SWADHIN ROUTRAY
REGD. NO. :- 2161611005
M.PHARM(PHARMACEUTICS)
SUB CODE:- MPH106S/A
SEMINAR ON DRUG DELIVERY SYSTEM

2.  INTRODUCTION
 TYPES OF TELEPHARMACY
 WORKING
 INFORMATION TECHNOLOGY CONSIDERATION
 ADVANTAGES
 DISADVANTAGES
 ARTICLES
 REFERENCES
CONTENTS

3. INTRODUCTION
• Telepharmacy is the delivery of pharmaceutical care via telecommunications to
patients in locations where they may not have direct contact with a pharmacist.
• It includes and retains the active role of the pharmacist as the primary health
care provider in the delivery of pharmacy services.
• Telepharmacy services include drug therapy monitoring, prior authorization and
refill authorization for prescription drugs, and monitoring of formulary
compliance. (1)

4. TYPES OF TELEPHARMACY
There are 4 types of Telepharmacy:
1. Inpatient (remote order-entryreview)
2. Remote dispensing (retail/outpatient/discharge)
3. IV admixtures
4. Remotecounseling

5. 1) Inpatient (remote order-entryreview)
 Inpatient telepharmacy refers to a pharmacist at a remote location performing
remote order-entry services for an inpatient pharmacy at a hospital. The remote
pharmacist reviews medication orders before the hospital staff administers the
drugs to the patient.
 USE- Real time medication review (2)
2) Remote dispensing (retail/outpatient/discharge)
 A remote-dispensing site or retail community telepharmacy is a licensed
brick-and-mortar pharmacy staffed by a certified pharmacy technician. A
pharmacist supervises the technician, reviews prescriptions and performs his
or her duties from a remote location viatechnology.
 USE- Discharge pharmacy settings, access to prescription medicines (2)

6. 3) IV admixture
 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
defines IV admixture as, ‘the preparation of pharmaceutical product which
requires the measured addition of a medication to a 50ml or greater bag or
bottle of intravenous fluid. ‘In layman’s terms, IV admixture is the mixture of
IV solution administered to patients in a hospitalsetting.
4) Remote counseling
 Remote- patient counseling equates to pharmacists providing patient
counseling and interactive video session, or by some means through
telecommunications.
 USE- consult and provide a variety of pharmacy-care services
(2)

7. SCHEMATIC OF TELEPHARMACY WORKING

8. WORKING OF TELEPHARMACY
PRESCRIPTION
ARRIVES AT
RURALAREA
AND FILLED
RURAL CENTRE
IS CONNECTED
WITH URBAN
CENTRE
CENTRAL
PHARMACIST
REVIEWS THE
PRESCRIPTION
RELEASE THE
APPROPRIATE
ITEMS TO
RURALAND
LABEL
BAR CODE IS
SCANNED AT
RURAL TO ENSURE
THAT IT MATCHES
WITH THE LABEL
MEDICATION IS
SUPPLIED TO
PATIENTS WITH
ATTACHED LABEL
THE CENTRAL
PHARMACIST
PROVIDE A VIDEO
CONSULATION AT
THE END

9. TECHNOLOGICAL INFORMATION,
ADVANTAGES, DISADVANTAGES
o Computer:- QS-1, Midco data, PDX, Rx30, IsoRx
 Patient medication profile
 Screening for drug interaction
 Generating prescription via labels with patient instruction.
 Billing third party payers
ADVANTAGES:-
• Effective patient counseling
• Reduced workload and errors
• Improve timeliness for medicationdelivery
DISADVANTAGES:-
• Operational difficulties
• Downtime system failure andinflexibility
• Literacy rate and diversity in languages (3)

10. ARTICLE:-1 EVALUATION OF TELEPHARMACY
SERVICES IN LIGHT OF COVID-19
• Md Ibrahim et al. 2019 aimed to evaluate the predictors for effective
telepharmacy services by exploring factors associated with pharmacist
interventions and dispensing errors in community pharmacies .
• Pharmacy interventions and dispensing errors across pharmacies with and
without telepharmacy services were monitored during the COVID-19 outbreak
in the United Arab Emirates. This was a prospective observational study
conducted for 4 months (March 2020–July 2020) in community pharmacies in
the UAE during the outbreak.
• G*Power software20 was used for sample size calculation (power = 0.8, a £
0.05, effect size = 0.8). (4)

11. Association of COVID-19–Related Recommendation Categories (n = 79,253) With Pharmacy Status (With
vs. Without Remote Services)

12. RESULT
• Contact the nearest testing center (adjusted odds ratio [AOR] = 7.93), maintain
home quarantine (AOR= 5.64), and take paracetamol for fever (AOR= 3.53), all
were significant results (p < 0.05). Rates of medication dispensing errors
(MDEs) and its subcategories, prescription-related errors, and pharmacist
counseling errors across pharmacies with telepharmacy versus those without
remote services were (15.81% vs. 19.43%, p < 0.05), (5.38% vs. 10.08%, p <
0.05), and (10.42% vs. 9.35%, p > 0.05), respectively. However, pharmacies
with telepharmacy were more likely to include wrong patient errors (AOR=
5.38, p < 0.05).

13. ARTICLE:- 2 CURRENT PRACTICES AND
STATE REGULATIONS REGARDING
TELEPHARMACY IN RURAL HOSPITALS
• M. Casey et al. 2012 purposed telepharmacy practices in rural hospitals of
several states were examined, and relevant policies and state laws and
regulations were analyzed, along with issues to be addressed as the use of
telepharmacy expands.
• Telepharmacy initiatives in rural hospitals were identified through a survey of
the 50 state offices of rural health. It was analyzed to identify and to assess
whether state laws and regulations followed by the NABP and the American
Society of Health- System Pharmacists apply to telepharmacies. (5)

15. RESULT
• North Dakota- North Dakota has historically been the most active in
addressing telepharmacy regulatory issues.
• Montana - The rules are not specific to hospitals. To be licensed as a remote
telepharmacy site, a site must be located beyond a 10-mile radius of an existing
pharmacy.
• South Dakota- They allow a hospital pharmacy to contract with a “central
pharmacy” to provide after hours pharmacy services via electronic.
• Texas- Hospitals with 100 or fewer beds must have a pharmacist on site 24
hours a day, seven days a week under continuous onsite supervision.

16. ARTICLE:-3 TELEPHARMACY AND QUALITY
OF MEDICATION
USE IN RURAL AREAS
• Mitchell Haynes et al. 2020 obtained dispensing data for the first 18 months of
operation from 3 telepharmacies and 3 traditional pharmacies located in the
upper Midwest.
• They evaluated adherence for noninsulin diabetes medications, renin-
angiotensin system antagonists, and statins, as well as inappropriate use of high-
risk medications in older adults. All metrics were calculated using Medicare
Part D specifications; they estimated the differences between telemedicine
pharmacies and traditional pharmacies using generalized linear regression. (6)

18. RESULT
• A total of 2,832 patients contributed 4,402 observations to the quality measures.
After covariate adjustment, we observed no significant differences between
telepharmacies and traditional pharmacies for noninsulin diabetes medications,
renin-angiotensin system antagonists, statins, and high-risk medications.
However, statin use in persons with diabetes was higher in telepharmacies than
traditional pharmacies.

19. REFERENCES
1. Margolis, S, Ypinazar, V.A, et al. Tele-pharmacy in remote medical practice: the
Royal Flying Doctor Service Medical Chest Program. Rural Remote
Health. 2008;8(12): 937.
2. Fatima, ROOHI, Ahmed, SANA, et al. Telepharmacy. European Journal of
Biomedical and Pharmaceutical Sciences. 2018;5(3): 176-182.
3. Yellowlees P. Successfully developing a telemedicine system. Journal of
Telemedicine and Telecare 2010;11(2):331-5.
4. Smith AC, Thomas E, Snoswell CL, Haydon H, et al. Evaluation of telepharmacy
services in light of covid-19. J Telemed Telecare 2020;26(1):309–313.
5. Casey M, Moscovice I, Davidson G. Current practice and state regulation regarding
telepharmacy in rural hospital. J Rural Health. 2012; 22(1):321-30.
6. Mitchell H, Peterson GM, Jackson SL. Telepharmacy and quality of medication use
in rural areas. A narrative systematic review. Int. J Pharm Pract. 2020;28(1):3–12.