Current practices and state regulations regarding telepharmacy in rural hospitals.

PURPOSE: Telepharmacy practices in rural hospitals in several states were examined, and relevant policies and state laws and regulations were analyzed, along with issues to be addressed as the use of telepharmacy expands. METHODS: Telepharmacy initiatives in rural hospitals were identified through a survey of the 50 state offices of rural health. Telephone interviews were conducted with board of pharmacy directors in selected states with successful telepharmacy programs. Interviews were also conducted with the individual hospitals regarding the type of telepharmacy activities, funding, and impact on medication safety. The information was analyzed to identify themes and to assess whether state laws and regulations followed recommendations by the National Association of Boards of Pharmacy (NABP) and the American Society of Health-System Pharmacists. RESULTS: Although telepharmacy is addressed in NABP's model pharmacy practice act, many state boards are just beginning to address it. The model act addresses the practice of pharmacy across state lines, and the state board directors interviewed generally agreed that pharmacists should be licensed in the state where they are providing the service. States differed on whether a pharmacist should be required to be physically located in a licensed pharmacy and how much time the pharmacist should have to spend onsite. Telepharmacy models being implemented in hospitals in several states incorporate long-distance supervision of pharmacy technicians by pharmacists. The models being implemented vary according to area, state regulations, hospital ownership, and hospital size and medication order volume. Most hospitals reported that they track medication error rates, and some said error rates have improved since telepharmacy implementation. CONCLUSION: The application of telepharmacy in rural hospitals varies across the United States but is not widespread, and many states have not defined regulations for telepharmacy in hospitals.

Public health systems: a social networks perspective.

OBJECTIVE: To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains. DATA SOURCES/STUDY SETTING: During the fall and the winter of 2007-2008, primary data were collected on the organization and composition of eight rural public health systems. STUDY DESIGN: Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences associated with public health governance (centralized, decentralized), urbanization (micropolitan, noncore), health status, public health domain, and collaboration area are described. DATA COLLECTION/EXTRACTION METHODS: Site visit interviews with key informants from local organizations and a web-based survey administered to local stakeholders. PRINCIPAL FINDINGS: Governance, urbanization, public health domain, and health status are associated with public health system network structures. The centrality of local health departments (LHDs) varies across public health domains and urbanization. Collaboration is greater in assessment, assurance, and advocacy than in seeking funding. CONCLUSIONS: If public health system organization is causally related to improved health status, studying individual system components such as LHDs will prove insufficient for studying the impact of public health systems.

The evolution of rural health networks: implications for health care managers.

This article examines the development and operation of rural health networks in the United States based on data collected from telephone surveys of rural health networks containing at least one rural hospital in the United States in 1996 and four years later in 2000. The implications of network development for health care managers participating in, or considering participation in, a rural health network are discussed.