North West telepharmacists ensure high-quality virtual prescription renewals

North West Telepharmacy Solutions is a banner of The North West Company and is known to lead an innovative telepharmacy practice. This article highlights a program incorporating telepharmacists to deliver best practices in virtual, team-based care.

A virtual pharmacist team managed by North West Telepharmacy Solutions provides pharmacist services to HealthLink BC as part of a provincial telehealth model. These virtual pharmacists were invited to collaborate with a team of virtual physicians and clinical program support staff to increase access to a publicly available prescription renewal service.

The virtual Provincial Prescription Renewal Support Service (PPRSS) was launched in early 2023. This service receives requests directly from community pharmacists across the province for patients who lack a dedicated primary care provider and require a prescription renewal for one or more chronic therapies (not including cancer medications, cannabis, narcotics, and controlled substances). The PPRSS team aims to process each request within five days or less of receiving.

In the first year of operation, the PPRSS team issued a total of 1,621 prescriptions over the course of 578 eligible patient encounters. There were 325 additional patient encounters where prescription renewals could not be provided and reasons included the request was for an out-of-scope prescription or virtual assessment was considered inadequate to determine health status.

Approximately 10 percent of all patient encounters resulted in referral for in-person evaluation, and another 10 percent were returned to the community pharmacist for follow-up.

PPRSS Workflow: Community pharmacists submit an electronic request. In BC, community pharmacists may adapt a prescription by changing of medication form or dose, or renewing prescriptions when existing refills are used up and the prescriber is otherwise unavailable.

However, in some scenarios, the adaptation or renewal is not reasonable for the community pharmacist to complete without additional information or support.

The PPRSS service enables community pharmacists to submit a request by completing an electronic form (eForm) using a secure portal, noting the medications needing renewal, required contact information, and relevant information about the patients.

Requests are made when the prescription is expired (two or more years old) or the community pharmacist is unsure whether the patient is stable for renewal/adaptation and would like the opinion of a physician.
Community pharmacists exercise their best judgment in determining whether to provide an emergency supply of medications while the PPRSS team is consulted.

PPRSS team manages cases virtually: For every submitted eForm, a patient file is created in a secure shared record system. All files are transferred to the Virtual Pharmacist [VPharm] first.

The VPharm consults the provincial view-only electronic health record to confirm health history, including laboratory results and the record of prescription medications dispensed. He or she then telephones the patient to verify actual medication use, including effectiveness and tolerability.

Obtaining a best possible medication history [BPMH] is considered a key step in a safe virtual prescription renewal process and is a foundational part of the VPharm’s assessment. The VPharm identifies prescription renewal needs, documents their assessment and recommended next steps, and queues the file to a Virtual Physician, noting the best time for a follow-up call to the patient.

After reviewing the record, the Virtual Physician telephones the patient to finalize their assessment and determine the prescription renewals they can provide. In some cases, they direct the patient to obtain lab work or recommend an in-person assessment (e.g. at a walk-in clinic or Urgent and Primary Care Centre).

The PPRSS physician follows up on any lab work they order by contacting the patient once results are available.
When prescription renewals are issued by a PPRSS virtual physician, they are faxed electronically to the pharmacy that submitted the eForm.

With patient consent, once an assessment is complete, the PPRSS team documentation is uploaded to the provincial view-only electronic health record to be available for review by future care providers.

Case Situation: A vulnerable adult with unstable health who is presenting to a ‘new’ community pharmacist for the first time. [CPharm]

Background: 83-year adult ‘unattached’ (i.e., without dedicated primary care provider) for unknown period of time. In the past year, complicated by grief due to sudden loss of adult child who advocated for parent’s health needs. A newly appointed power of attorney contact – a friend – is involved and keen to arrange care and support, part of which is establishing a relationship with a new community pharmacist.

The community pharmacist submits a renewal request to PPRSS for medications that include:
• Atorvastatin 10mg daily
• Candesartan 16mg/Hydrochlorothiazide 12.5mg daily

The PPRSS virtual pharmacist consults the provincial electronic health record to review recent records of care, laboratory tests and medication dispense record. It shows three ER visits in the past month with a diagnosis of right leg deep thrombosis and new medications prescribed. Another ER visit indicates a diagnosis of viral pneumonia. There is much more to the patient’s recent history, and this case is highlighted to demonstrate the layers of complexity and health instability that may underlie what ‘on surface’ seems like a request for a few ‘simple’ prescription renewals.

In summary, a virtual team-based approach led by experienced telepharmacists can improve safe access to prescription medication renewals, particularly for a province with a significant number of citizens lacking attachment to a regular primary care provider.

A key goal of the service is to support community pharmacists throughout a geographically large province to provide optimal care to the citizens in their own communities.

Sally Ginson Duke is Pharmacist Services Lead, HealthLink BC. Kevin McDonald is Director, North West Telepharmacy Solutions.