Small rural communities often have a hard time attracting pharmacists. To solve the problem, a growing number of small towns are turning to a telepharmacy, a service that connects patients or nurses to pharmacists via video link.
The concept, which has spread to 20 states, including Minnesota, was pioneered in North Dakota when small town pharmacies there began closing in alarming numbers a decade ago.
Today there are 72 telepharmacy sites in North Dakota. Some are retail pharmacies.
Others connect rural hospitals with a pharmacist, as Catholic Health Initiative does from ePharmacy in Fargo. Program director Shelley Johnsen said a telepharmacy can ease the workload for small town pharmacists.
In rural settings, she said, a pharmacist may work alone Monday through Friday, and also have to staff the office weekends and holidays.
"They get called at home all the time," Johnsen said. "People aren't going to stay in that environment."
Pharmacists in Fargo have access to all the patient records. Using cameras they can see the medication and read the label on the bottle.
That allows Johnsen to connect by video conference with Jill McRitchie, a pharmacist in Lisbon, about 75 miles southwest of Fargo.
McRitchie, who runs a retail pharmacy, also is the only pharmacist at the local hospital and a veterans' nursing home. Before having access to a telepharmacy, she spent most of her time just filling prescriptions.
Over the video connection McRitchie said a trained technician can now do that work supervised by a pharmacist in Fargo.
"One of my goals is to really be in the pharmacy very, very little, because my goal would be to get out and do more of the patient counseling, do more of the clinical services," she said. "When there's only one pharmacist you really don't get an opportunity to do those things."
The Catholic Health Initiative ePharmacy went on line in March of 2009. It now serves 16 hospitals in North Dakota and Minnesota.
Minnesota law doesn't allow telepharmacies, so each one requires an annual waiver by the state board of pharmacy. Minnesota now has nine approved telepharmacies. The board is considering possible changes in the law.
Access to a pharmacist is critical for small hospitals that simply can't afford to have a pharmacist on site around the clock, said Ann Rathke who heads the telepharmacy program at North Dakota State University in Fargo.
"Medications are being dispensed that are never reviewed by a pharmacist," she said. "This gives those small rural hospitals access to, if they choose to have it, 24/7 clinical pharmacist coverage."
Rathke said telepharmacists have actually caught medication errors in hospitals with no pharmacist on site. For example, she said, in October the pharmacists at Fargo-based ePharmacy caught eight errors.
Some errors are memorable, including one involving a six-day-old baby, said Johnsen, the ePharmacy director.
"There was a couple of antibiotics ordered on this baby. One of them was ordered in an excessive dose that could have caused permanent hearing damage or kidney damage," she said. "We made that intervention and in the long run the baby did get the correct dose. That's pretty significant."
Johnsen said one pharmacist in the Fargo office can typically cover several small hospitals because the number of patients is relatively low.
There were questions when the telepharmacy project started. Skeptics wondered if pharmacists would make more mistakes filling prescriptions over a video link. Rathke says North Dakota State University recently completed a four-year study which found no difference in the error rate.
Tim Weippert, vice president of pharmacy operations for Minnesota-based Thrifty White Pharmacy, said the most important thing telepharmacy provides is access. The company runs a retail telepharmacy operation in Fargo.
Weippert said if a community can't support a full-time pharmacist, telepharmacy is the next best thing. He said the critical component is one-on-one communication between pharmacist and patient, in person or over a video link.
"If there was no pharmacy services there at all it could be a mail order type situation where they're getting their prescriptions via the mail," Weippert said. "The personal access to a health care professional is really what makes telepharmacy what it is today and what we really need out there in the rural communities."
Thrifty White currently has four telepharmacy sites in North Dakota and four in Minnesota.
Weippert said he expects continued growth in telepharmacy in the six Midwestern states Thrifty White covers.