Implementation and outcomes of a pharmacist-managed clinical video telehealth anticoagulation clinic.

ABSTRACT

PURPOSE: The use of clinical video telehealth (CVT) technology to optimize the deployment of clinical pharmacy specialist resources in a community-based outpatient clinic (CBOC) is described. SUMMARY: In 2012, clinical pharmacy specialists at a Veterans Affairs (VA) medical center began using CVT technology to provide anticoagulation therapy management services to patients at a CBOC about 12 miles away. Using videoconferencing technology (video cameras and high-definition widescreen monitors), the remotely located pharmacists conduct patient interviews, evaluate International Normalized Ratio (INR) values, and gather other clinical data for use in therapeutic planning. Under the supervision of pharmacists, CBOC telehealth technicians perform targeted physical assessments (e.g., point-of-care INR values, measurements of vital signs), and the results are transmitted to the medical center for pharmacist evaluation. CVT policies and procedures jointly developed by pharmacy, telehealth, and CBOC nursing staff require focused training for clinic personnel and informed patient consent to receive CVT services. During the first few months of CVT clinic operations, the mean percentage of time patients' INR values were within the therapeutic range remained stable (about 81%, compared with about 77% under the previous face-to-face clinic model), and a high level of patient satisfaction was maintained. Implementation of CVT anticoagulation monitoring services enabled pharmacist resource reallocation to other duties. CONCLUSION: Through the use of CVT technology, high-quality anticoagulation services and patient satisfaction were maintained and the allocation of clinical pharmacy specialist resources was optimized.