The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions

Telepharmacy, remote reviewing and profiling of medication orders by an offsite pharmacist, has been shown to be an effective method for reducing medication order inaccuracy rates, but there is a lack in studies examining harm reduction and potential cost avoidance by such services. Methods: Retrospective data, collected over a one-year period, were examined for medication order deficiencies; a deficiency was defined as the telepharmacist being required to advocate for clinical action. Based on published rates of adverse drug reactions and expenses related to their treatment, a potential cost avoidance was calculated. Results: Over the course of the one-year study period over 218,000 orders were reviewed by a telepharmacist with 2,292 orders flagged as deficient which included 16,224 individual medication deficiencies. The most common deficiencies included patient allergy to medication, or class of medications, (31.2% of deficiencies) and medication dose adjustment via renal and/or hepatic guidelines (24.1% of deficiencies). There were also a number of deficiencies for specific medications found on the Institute for Safe Medication Practices’ high-alert medication list for ambulatory/community healthcare settings such as insulins and heparinoids. Based on adverse drug reaction incidence rates and treatment expenses, potential cost avoidance was calculated to be as high as over $1.4 million US dollars. Telepharmacists aided in enhancement of pharmacy services by continuing to review medication orders and provide clinical interventions even when an onsite pharmacist was unavailable. Conclusions: Use of the telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions.