The role of technology in pharmaceutical care was explored in a session organised by the International Pharmaceutical Students Federation at the 74th International Pharmaceutical Federation Congress in Bangkok on 2 September 2014.
Cody Midlam, from San Diego, California, a young clinical pharmacist with experience of using technologies in patient care, informed the audience that healthcare was currently in a state of transition. There had been a sharp decline in the number of primary care doctors in the US over the past 50 years, and World Health Organization statistics showed that there was a worldwide shortage of healthcare professionals. The appropriate use of technology was now essential to address the changing healthcare environment, he argued.
Midlam took the audience on a whistle-stop tour of a wide range of technological innovations already marketed that would benefit pharmaceutical care. These included personal health record systems, electronic blood pressure monitoring, electronic blood glucose monitoring and recording, and inhaler use checking and monitoring. In addition, there were adherence monitoring systems, from medicine cap devices to invasive “smart pill” systems.
Furthermore, large technology providers, such as Apple and Samsung, were now encouraging application developers to produce smartphone healthcare apps for personal use, and many of these were available. However, all new technologies brought with them the challenge of how to use the data they generate to provide optimal patient care.
Pharmacists have an important role in facilitating the use of these technologies. “Pharmacies are the place for these to be used,” said Midlam. “Pharmacists are a trusted resource, so who better to ask for these devices.”
Enhancing delivery of care in a changing environment
Michael Katz, from the college of pharmacy at the University of Arizona, described how technology could enhance the delivery of care in a changing healthcare environment. He described some of the changes in healthcare — more ambulatory patients, increased patient complexity and also the need to generate increased efficiency of care from more limited resources.
He reminded the audience of the strategic significance of patient-centred care. “We, as a profession, are not the centre of healthcare,” he said. “If patients are not there, there is no need for the hospital.” Then, in an interactive session, the problems of delivering patient-centred care were highlighted. These included having access to timely and accurate information, maintaining workflow efficiency, prioritising patient needs, communication with patients, medication errors, privacy of patient information and — perhaps most importantly — the coordination of professional activity to support seamless patient care.
Katz described how technology could help with these issues. He emphasised that the definition of technology was a process for completing a task — it was not specifically about computers — and that technology should be flexible to support the tasks that professionals actually do. He explained that large electronic health record systems were often expensive and complicated to install and maintain, and yet still achieved little.
He went on to describe a range of technologies that were futuristic, but currently available — and which might be easier to implement, with clearer benefits. These included microchip tattoos for point-of-care (POC) testing, hospital medicine transfer systems (e.g. Tug), “smart beds” with electronically interfaced fabrics and disinfectant robots.
Internet medicines supply: a complicated web
Aldo Alvarez-Risco from Peru described the growth of internet medicines supply over the past 20 years, and the implications for pharmacists and patients. With internet supply, a pharmacist was not present at the time of medicine supply (an asynchronic process) and patients did not have access to real-time advice from the pharmacist. Written medicines information on the internet was not always readily understood, and the availability of the pharmacist’s professional advice was vital, Alvarez-Risco argued.
Alvarez-Risco described some of the major issues in the regulation of internet medicine suppliers. A legal infringement in one country often could not be prosecuted if it arose from activity in another country. Internet medicine suppliers were not obliged to produce extensive information on the products they supplied and, if they did, it might relate to a licensed indication in a different country, which could be misleading to patients. The reputation of the internet for medicines supply had been tarnished by dubious advertisements for supplements and sexual performance enhancers. Nevertheless, the internet had potential to increase access to medicines and medicines information. One way of ensuring pharmacist input was to introduce clear professional requirement that pharmacists should advise patients on internet medicine supplies, as was the case in New Zealand.
The use of counselling software: good or bad?
The final session of the afternoon was an interactive debate about whether the use of counselling software could improve the access to validated medicines information for patients. A software tool for patient counselling could have various benefits. It would enable patients to receive medicines information at their convenience in their own home, which would perhaps be more private for sensitive consultations. The information would be consistent for each patient, and independent of the pharmacist’s competence or working environment. Also, information would be compliant with guidelines.
The case against counselling software was that it might undermine the pharmacist-patient relationship. It was also suggested that the technology might be difficult for older patients (and older pharmacists), that an IT tool could introduce new errors to the counselling process, and that there would be issues concerning the implementation of the software and reimbursement for its use.
The speakers added their comments to the debate: Katz said the reality was somewhere in the middle — the software might add value to the counselling process, but could not be a substitute for face-to-face communication between a pharmacist and a patient. Midlam indicated that there were some routine counselling situations (e.g. inhaler technique) where the software would provide some consistency of process, but that some scenarios would always require personal communication. Alvarez-Risco said that, for reasons of convenience, patients sometimes told the pharmacist what they thought they wanted to hear, and that face-to-face communication helped to identify when this was happening. He said it was important that pharmacists retain their reputation as interactive healthcare professionals.