ABSTRACT
Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
ABSTRACT
BACKGROUND: During the COVID-19 pandemic, as health care services shifted to virtual modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for Veterans with limited virtual care access. We sought to examine how the pandemic influenced characteristics of Veterans who received and used VA-issued tablets. METHODS: We analyzed VA data for 42,594 Veterans who were sent a tablet between 3/11/2019-9/10/2020. We evaluated sociodemographic and clinical factors associated with video care utilization for 1) primary care and 2) mental health encounters within 6 months of tablet shipment using generalized linear models. To account for effect modification of COVID-19 on use, we stratified models into two cohorts: 1) 6,733 Veterans who received tablets at least 6 months prior to the start of the COVID-19 pandemic (3/10/2020), and 2) 35,861 Veterans who received tablets on 3/11/2020 or later. Models were adjusted for patient demographics (age, race, ethnicity, gender, rurality, VA priority group, history of homelessness, and region) and clinical characteristics (number of chronic conditions, any mental health conditions, and prior use of VA healthcare services). RESULTS: Compared to the pre-pandemic cohort, those who received tablets during the pandemic were more likely to be older (64 vs. 59 years, respectively), urban-dwelling (67.9% vs. 55.5%, respectively) and have a history of homelessness (24.0% vs. 15.1%, respectively). Compared to pre-pandemic recipients, those who received tablets during the pandemic were more likely to use tablets for at least one video visit (54.7% vs. 69.6%) and had a higher average number of video visits per recipient (2.3 vs 5.7 encounters) in the first 6 months after shipment. Pandemic tablet recipients who had a primary care video visit were less likely to be older than 65 years, homeless, or live in highly rural areas, and were more likely to be female and have multiple chronic conditions compared to pre-pandemic recipients. In contrast, pandemic tablet recipients who had a mental health care video visit were more likely to be homeless and have fewer chronic conditions but less likely to be rural dwelling and have a mental health condition compared to prepandemic recipients. CONCLUSIONS: In this national study of VA's tablet distribution program to Veterans with virtual care access barriers, we found that the pandemic was associated with striking changes in characteristics of tablet recipients and utilization. Notably, individuals with indicators of increased clinical and social need were more likely to receive tablets during the pandemic, and these factors were associated with differential tablet use for primary care vs. mental healthcare. These findings suggest that health systems aiming to enhance access through video-capable devices should consider organizational, external and patient level factors influencing the uptake of video-based virtual care.