Telemedicine visits with a clinical pharmacist offer many advantages, such as social distancing, flexible scheduling, and the ability to use nonverbal cues to convey understanding.
Although telemedicine has existed for years, the COVID-19 pandemic has certainly proliferated its use and has brought on more innovative uses of telemedicine to safely provide optimal care.
Telemedicine visits with a clinical pharmacist offer many advantages, such as social distancing, flexible scheduling, and the ability to use nonverbal cues to convey understanding—a major limitation of phone visits. Telemedicine also has the ability to help narrow current gaps in health disparities among various populations, including those most financially vulnerable.
However, certain phenomena such as digital health literacy must be taken into account. Digital health literacy is similar in concept to health literacy; that is, the ability of a patient to access and comprehend health information or services.1 Digital health literacy encompasses a number of skills, including computer literacy. As such, if telemedicine is not properly arranged, it can actually end up exacerbating gaps in health disparities.1
A recent cohort study examined 148,402 patients who had scheduled telemedicine visits.1 The study found that older age, Asian race, and a primary language that is not English were associated with fewer completed telemedicine visits (both phone and video). Other studies have shown lower video use associated with lower household income, Latinx ethnicity, Black race, and older age.2
Reasons for these results might be explained by lower digital health literacy. For those in older age groups, less frequent use of technology in general, impaired eyesight, and diminished hearing and motor skills make telemedicine a challenge.2 Additionally, families with a median household income below $50,000 had a lower utilization rate of video telemedicine use.2 These findings may be attributed to availability of internet access or devices. COVID-19 has placed further financial strain on lower income families, and this may further widen the digital inequality divide among lower income families and minorities.
Now that telemedicine is so prevalent and is becoming a standard of care, it is important to address disparities in access to telemedicine. The most important factor to increase telemedicine access among older adults is to improve the usability and ease of us for websites and technology platforms. It would be beneficial for patients to be provided with well-designed websites that are simple to access and developed in a literacy appropriate method. It should be functional across a variety of populations in order to be easily accessible for those who have low digital literacy.
Many of the lessons learned regarding telemedicine also apply to telepharmacy. Telemedicine and telepharmacy have the potential to expand the reach of health care, especially for those in rural areas. However, some issues have to be addressed in our health care systems in order for telemedicine to reach its full potential.
In order to address these issues, pharmacists and pharmacy managers can learn from these and other study results. First and foremost, training all staff to be aware of health access issues is paramount. Additionally, pharmacies looking to expand telepharmacy services should consider digital health literacy and other factors that would impede optimal outcomes. Pharmacy managers should also look to collaborate with physician providers to combine or bundle telemedicine and telepharmacy services that even further optimize care and generate revenues for both practices.
Additional information about Managing Technology that Supports the Medication Use Process and Creating and Managing Value can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.
ABOUT THE AUTHORS
Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at Touro University California.
Ashley Woodard is a PharmD Candidate at Touro University California.
1. Smith B, Magnani JW. New technologies, new disparities: The intersection of electronic health and digital health literacy. Int J Cardiol. 2019;292:280-282. doi:10.1016/j.ijcard.2019.05.066
2. Eberly LA, Kallan MJ, Julien HM, et al. Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic [published correction appears in JAMA Netw Open. 2021 Feb 1;4(2):e211913]. JAMA Netw Open. 2020;3(12):e2031640. Published 2020 Dec 1. doi:10.1001/jamanetworkopen.2020.31640