We live in the digital era and this brings many exciting possibilities.
Internationally, healthcare systems have slowly been embracing models of care whereby health-related services are offered via telecommunication. A recent global study (Benetoli et al, 2017) has shown that pharmacists recognise the potential of e-health. However, they are sceptical about implementing it. Some main barriers are establishing the boundaries of a professional relationship and fear of providing misleading health information.
At Cardiff School of Pharmacy, we wanted to start equipping the students with some of the skills they need to enable them to engage fully with telehealth activities in their future career. For the first time in March 2017, we organised an e-health placement in collaboration with Carers Trust. As a school, we have been engaging with Carers Trust for a few years to expose students to challenges that carers face in their everyday life. An online pharmacy Q&A event was set up on Carers Space, an official online community of Carers Trust nationally. Any registered user could initiate discussions that related to support available from local pharmacies, services which can be offered by community pharmacists or any issues around medicines management. All replies were public to any internet user, whether they were registered to the website or not.
During a full week (20–26 March 2017), Cardiff pharmacy students discussed requirements for delivery and collection of medication, repeat medication, the NHS Minor Ailment Scheme, perceived variability in bioavailability of risperidone, suggested contents for a medicines cabinet, scabies, potential side effects of medicines, medicine use reviews, recommendations for seeking advice from different healthcare professionals, and supplements for vegan diet. Answers provided links to NHS or other websites for further information. Care was taken to explain the context before offering some suggestions to individual users who posed a question.
And what a response we had. Carers welcomed this opportunity to ask pharmacy-related questions. We had comments on the website that they “really enjoyed this event”, “I’m so glad you’ve explained about how they [pharmacists] share information with the GP. I was wondering how this worked.”, “Thanks Cardiff University Pharmacy Students, that’s really helpful. I will ring my GP and pharmacy and see how/if they can help me and make sure I keep in touch with both if they are able to set up deliveries for me — it would make a massive difference to me.” The event could still be viewed even after the closure date, and a total of 165 users have accessed it so far.
Feedback from students participating in the placement was captured via a structured evaluation form. Students rated their experience with the placement as “excellent”. Their comments confirmed that this type of activity can address some of the issues that prevent practising pharmacists from delivering online health services, particularly dealing with situations in the absence of the full background. Students also experienced the power of signposting people to resources, allowing them to learn under their own volition whilst respecting professional boundaries. For example, they said: “I have learnt a great deal about phrasing answers to lay people, and also learnt about the skill of giving advice by not actually giving advice, rather signposting and equipping the person with the information to make their own decisions.”
“What I found most challenging about this placement was writing answers which were not black and white. I found it challenging to prioritise information and write an answer back without being able to question the patient further about what they were trying to ask. In most of our answers we then had to prioritise the information we thought was relevant after re-reading the question.”
Previous evaluations of a range of pharmacist-led schemes globally all highlight a lack of confidence of pharmacists in their own abilities. This perceived lack of preparedness has been linked to fear of new responsibilities and discomfort with ambiguous situations (Rosenthal et al, 2010). An e-health placement at an undergraduate level can be ideal in removing students from their comfort zone and forcing them to apply their knowledge under new circumstances, creating less risk-averse graduates who are ready to embark on future exciting opportunities. We will seek to develop similar opportunities with other organisations in the future.
 Benetoli, A., Chen, T.F., Schaefer, M. et al. Int J Clin Pharm (2017) 39: 364. DOI: 10.1007/s11096-017-0444-4 Available at https://link.springer.com/article/10.1007%2Fs11096-017-0444-4
 Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice change? Can Pharm J (Ott) 2010;143:37-42 DOI: https://doi.org/10.3821/1913-701X-143.1.37 Available at http://journals.sagepub.com/doi/abs/10.3821/1913-701X-143.1.37