Remote Disease Management Program Improves Outcomes in the Northwest

by U.S. Medicine

August 3, 2018

BOISE, ID — A telehealth-based chronic disease management program which included clinical pharmacy specialists (CPS) had positive outcomes on primary care outcomes in a rural area, according to a new study.

The report in the American Journal of Health System Pharmacy described the program’s impact on healthcare access and quality for veterans in rural areas of the Pacific Northwest.1

Researchers from the VISN 20 V-IMPACT Hub at the Boise, ID, VAMC assessed outcomes of medication management services provided by a CPS team during both clinical video telehealth and telephone encounters with 554 patients from October 2014 to March 2017.

The program sought to improve care for diabetes (DM), hyperlipidemia (HLD), and hypertension (HTN), as well as helping with tobacco use cessation. Primary outcomes included mean changes from baseline in glycosylated hemoglobin (HbA1c) and blood pressure values and rates of guideline-indicated statin therapy and tobacco cessation.

Results indicated that patients in the DM group had a mean absolute HbA1c reduction of 1.61% (95% confidence interval [CI], 1.39-1.83%; p< 0.0001), while those in the HTN group had a mean systolic blood pressure reduction of 26.00 mm Hg (95% CI, 22.99-28.50 mm Hg; p < 0.001). In terms HLD, 93% of patients were discharged on a lipid-lowering medication.

Tobacco cessation was achieved in 42% of targeted patients, meanwhile.

“CPSs providing primary care comprehensive medication management services solely via telehealth improved disease management and access to healthcare in a population of rural veterans,” study authors concluded. “Statistically significant improvements in DM and HTN outcomes were demonstrated along with clinically significant improvements in the areas of lipid management and tobacco cessation.”

Beginning in 2014, clinical pharmacy specialists at the regional VA Telehealth Hub based at Boise VA Medical Center in Idaho have provided telehealth services for 16 clinics, according to an article last year in the same journal.2

In one telehealth model, a pharmacist and other remotely located primary care team members (a medical provider, a medical support assistant, a social worker, and a psychologist) conduct telehealth visits with veterans located at VA clinics, with support provided by clinic-based nursing staff. The model has been used to improve medication management services for veterans in sparsely populated areas.

In the second VA telehealth model, a remotely located pharmacist uses telehealth technology to participate in clinical encounters along with primary care team members located at the patient site. That model allows on-demand remote coverage in the event of planned or unplanned absences of clinic-based pharmacists.

Since the Telehealth Hub was begun, pharmacists have engaged in video encounters and provided other telehealth-based clinical services to more than 1,200 veterans with diabetes, hyperlipidemia, hypertension, and other chronic conditions.

1Litke J, Spoutz L, Ahlstrom D, Perdew C, Llamas W, Erickson K. Impact of the clinical pharmacy specialist in telehealth primary care. Am J Health Syst Pharm. 2018 Jul 1;75(13):982-986. doi: 10.2146/ajhp170633. PubMed PMID: 29941537.

2Perdew C, Erickson K, Litke J. Innovative models for providing clinicalpharmacy services to remote locations using clinical video telehealth. Am J Health Syst Pharm. 2017 Jul 15;74(14):1093-1098. doi: 10.2146/ajhp160625. PubMed PMID: 28687554.

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