In an effort to bolster front-line medical care and improve health in small towns and rural areas across the state, a team of University of Iowa College of Pharmacy researchers has created a virtual, web-based service that allows doctors and nurses in distant locations to consult on a variety of medical issues with clinical pharmacy experts on the Iowa City campus.

As part of the service—called Centralized Healthcare Solutions (CHS)—university pharmacists and pharmacy students also regularly talk with patients via telephone or virtually through a web site to ensure they are keeping up with their medications, making healthy lifestyle choices, and staying in contact with their primary care provider.

In an early test of the service, UI pharmacy researchers selected 12 Iowa primary care offices without an on-site pharmacist and randomly selected six of those offices to receive additional pharmacy monitoring. The multi-year study showed that patients in offices with the additional monitoring had better health outcomes than those without, including improved diabetes management and an overall reduction in risk for potentially deadly cardiovascular disease.

The team also conducted another study with larger health care centers, including many in other states, and found that even when clinical pharmacists are part of the on-site medical team, the added back-up from UI clinical pharmacists resulted in improved patient care and disease management.

“When people think of pharmacists, they often think of the pharmacists they see at the pharmacy,” says Christopher Parker, a pharmacy specialist with the UI College of Pharmacy and executive director of operations for CHS. “But pharmacists are key members of the health care team and can provide much more than expertise about medications. We can work with patients to help them perform home monitoring for conditions such as diabetes or high blood pressure, and we can give them strategies to better manage their conditions.”

For doctors, the addition of a virtual pharmacist means they are able to attend to patients with more serious or complex medical conditions. And for on-site clinical pharmacists, the benefit is having more time to talk with patients about medication side-effects and to help find the best drug therapy possible. Parker says these benefits and others were documented in the CHS research.

“CHS is able to provide a tailor-made medication regimen for each patient,” he says. “We can look at dosing requirements for specific conditions that doctors may not be aware of, and we can provide ongoing feedback about patient progress. We provide doctors with patient-reported home monitoring results for conditions like high blood pressure and diabetes and provide clinical recommendations to go along with those results.”

UI pharmacy research shows that, in a majority of cases, about 89 percent of the time, doctors agreed with patient recommendations made by CHS clinical pharmacists, including those to increase medication doses, change medications, provide flu or pneumonia vaccines, and prescribe colorectal cancer screenings.

“Our team has a common vision of using technological innovation to improve the level of care provided to patients in a wide variety of settings,” says Parker. “We started CHS in Iowa to serve Iowans and we’ve had very positive results. Now we’re looking to serve an even broader patient population.” 

Niral Tilala, a physician with Genesis Family Medical Center in Davenport, Iowa, says he appreciates the virtual service because it stabilizes chronic disease care for patients, which in the long-term decreases clinic visits and reduces costs for medical facilities and patients alike. Genesis Health Group, which provides health care services in Iowa and Illinois, participated in early trials with CHS and is currently in negotiations to sign a commercial contract with the virtual pharmacy service.

Patient care and outcomes are more important than ever because changes to Medicare set to go into effect Jan. 1, 2019, will mean that doctors with poor patient outcomes will receive less money from the federal government. Doctors with improved patient outcomes, on the other hand, will receive more money and could qualify for bonuses.

“The UI’s virtual pharmacy service is definitely helping us do a better job of caring for our patients,” Tilala says. “Also, our patients appreciate the advice and care they get from the remote pharmacists. Some find that the follow-up with a pharmacist makes them more accountable for taking their medication or for quitting bad habits like smoking.”

Rachel Finkelstein, a pharmacy specialist in the UI College of Pharmacy and director of education for CHS, says she enjoys working one-to-one with Iowa residents to help them overcome health problems. Finkelstein and other clinical pharmacists, including a select group of pharmacy students, often talk with patients over the telephone or text them on their cell phone. They sometimes work outside of regular business hours in order to accommodate the work schedules of their patients.

Pharmacists and patients also can exchange information via a secure website created especially for the purpose of regularly updating a patient’s health status. Pharmacists also have direct access to medical facility electronic medical records so they can easily and quickly inform doctors about changes in medication or lifestyle.

“Patients benefit because they get a follow-up conversation with a pharmacist at least once a month to address the efficacy or side-effects of their medication, as well as lifestyle changes like diet and exercise,” Finkelstein says. “They tell us they enjoy the extra care and appreciate it when we help them find lower-cost medications or patient assistance programs.”

With doctors and patients on board, and health care systems lining up to access CHS’s virtual pharmacy services, UI researchers are faced with a new challenge: meeting the demand, in and outside the state. One of the main hurdles to expanding service beyond Iowa is finding licensed pharmacists in other states to oversee virtual pharmacy services, says Parker. Other challenges include expanding medical services to meet client needs.

“We’re working hard to identify the needs of our partner clinics, but sometimes we don’t know what they need until we start working with them,” he says. “Once we know, we feel confident that we can help them, in large part because of the expertise and talent we have here on the University of Iowa campus. In the long run, we’d like to tap into all of that expertise, whether it’s expertise in cancer treatment, mental health, or diet and exercise.”

As the CHS team looks beyond Iowa’s borders, members say they have yet to find anything that matches this virtual clinical pharmacy model. UI College of Pharmacy professor Barry L. Carter, an expert in reducing health risks through collaborative doctor–pharmacist teams who also served as lead researcher on two CHS studies, says he’s proud of Iowa’s leadership role in healthcare innovation.

“Iowa has consistently led the nation in the delivery of advanced pharmacy services that improve public health and conducting the research required to continue to improve these services,” he said. “I am very proud of the talented and dedicated research team members who do the critical work to make these projects successful.”