School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States.
School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States.
Res Social Adm Pharm. 2018 Aug;14(8):707-717. doi: 10.1016/j.sapharm.2017.10.011. Epub 2017 Oct 28.
Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied.
Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings.
A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence.
Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4).
Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
远程医疗的应用使药剂师能够扩大临床干预的范围，将他们与患者和提供者联系起来，但这些服务的整体影响仍未得到充分研究。
确定临床药师远程医疗干预对临床结果的影响，随后将这些结果定义为临床疾病管理、患者自我管理和遵医嘱，这些结果发生在门诊或流动环境中。
从数据库建立到 2016 年 5 月，在 Medline、SCOPUS 和 EMBASE 中进行了文献检索。使用了“远程医疗”、“远程保健”和“电话”等广泛术语，并与“药剂师”或“药房”和“远程药房”结合使用。搜索和提取过程遵循 PRISMA 指南。筛选结果以确定药师干预措施，并对门诊或流动环境中的研究进行审查。排除了非临床结果（即配药或产品准备）和没有对照的研究。根据报告的结果类型对最终研究进行分类：临床疾病管理、患者自我管理和遵医嘱。
只有 34 项研究与对照比较测量了临床结果，这与研究问题一致。大多数研究采用预定的护理模式（n=29）。电话是最常见的沟通方式（n=25）。最常用的干预措施是药剂师主导的电话诊所（n=10）。大多数研究都集中在成年人的慢性疾病管理上，包括高血压、糖尿病、抗凝、抑郁、血脂异常、哮喘、心力衰竭、艾滋病毒、创伤后应激障碍、慢性肾脏病、中风、慢性阻塞性肺疾病和戒烟。23 项研究具有积极影响，一项研究报告结果为负面。与响应式（25%，1/4）相比，预定（72.4%，21/29）和连续（100%，2/2）模型的阳性影响率更高。
在门诊或流动环境中，临床药学远程医疗干预措施主要通过电话进行，对慢性病管理、患者自我管理和遵医嘱等方面的临床疾病管理结果具有总体积极影响。具有积极影响的研究有共同之处，包括利用电话进行连续或预定模式，以及频繁监测和干预。确定的研究没有评估视频功能优于电话或成本效益的好处，这两者都是未来研究的有用方向。
