In recent years, the social and demographic changes, along with improvements in public health and continued therapeutic advances, have caused a dramatic increase in the volume of chronic patients attended at Hospital Pharmacy Services (HP)1. Meeting the population's needs as effectively as possible is a challenge for national health systems2.

In Spain, to standardize the evolution of outpatient hospital pharmacy care, the Spanish Society of Hospital Pharmacy (SEFH) launched the MAPEX project (Outpatient care strategy) in 2014 by adopting an anticipatory and updated perspective of hospital pharmacy care3. Based on this new approach, Morillo-Verdugo et al.4 developed a new definition of pharmaceutical care (PC) based on the three primary needs of patients: individualized dynamic care; target-oriented pharmacotherapy; and continued follow-up based on the use of new technologies.

The use of Telemedicine in pharmaceutical care is not a novelty5. This service, called Telepharmacy, has been developed and tested by numerous authors who have pioneered Telepharmacy in their countries6,7. Different international scientific societies have defined the concept of Telepharmacy. In Spain, the SEFH defined Telepharmacy as “remote pharmacy practice based on new technologies” and established four scopes of application: drug therapy monitoring; patient education and information; communication with a multidisciplinary team; and remote dispensing and informed delivery of medication8. The latter is the most widely known service, as the SARS-CoV2 pandemic generated multiple experiences and studies. The ENOPEX study in 9,442 patients revealed that 96.7% of patients reported being “satisfied” or “very satisfied” with Telepharmacy and considered it a complementary activity to standard follow-up by the Hospital Pharmacy9.

Despite the growing demand for Telepharmacy services, a national or international document for professionals and patients has not yet been published. A guide was necessary to foster the development of Telepharmacy and describe its advantages as a complementary service to face-to-face pharmaceutical care. A guide for the implementation of Telepharmacy will assist pharmacists in providing remote pharmaceutical care. In addition, the guide for patients will help patients make real-time decisions about their drug therapies with the counseling of their professionals of reference.

This study aims to develop a practical structured guide on Telepharmacy for professionals and another for patients. These guides will define Telepharmacy and describe the most common technologies, potential benefits, and the keys to helping users understand the purpose and use of Telepharmacy services.

Between December 2020 and January 2021, the Board of Director of the SEFH, in collaboration with the coordinators of the MAPEX project and the Telepharmacy Strategy, developed a plan to favor the development and spread Telepharmacy. This plan included four courses of action: development of methodological guidelines, healthcare support, innovation and research, and technological support.

An open, public call was issued among SEFH members to recruit 24 candidates to develop the first course of action. Candidate hospital pharmacy specialists were required to have previous experience in the development and use of Telepharmacy and to have taken part in some of the initiatives developed within the framework of the MAPEX project. A geographically representative sample of professionals was recruited to ensure that the particularities of the different autonomous communities were considered during the drafting of the documents.

This first course of action resulted in the development of seven methodological guidelines aimed at meeting the methodological needs for the implementation of Telepharmacy in Spain: “Patient prioritization model”10; “Guide for pharmaceutical teleconsultation”11; “Effective, Safe Telepharmaceutical Care”12; and “Health Indicators”13; “Validation of Technological Tools”14 and two reference guides for patients and professionals.

The “Guide of Telepharmacy for professionals”15 was established as the core document, and the other documents would be based on this guide to ensure homogeneity and coherence. The “Guide of Telepharmacy for Patients”16 is considered an adaptation of the core guide for professionals.

This Guide was developed between May-October 2021 in four stages: literature review; consensus interviews using the nominal group technique (with direct communications among experts and face-to-face discussion); development of online workshops to discuss the essential aspects of the documents drafted; and drafting and validation of final documents.

To the best of our knowledge, these are the first practical guides for healthcare professionals and patients providing guidelines for developing and incorporating Telepharmacy in its different scopes of application.

Mixed pharmaceutical care combining face-to-face and remote care is a reality17. However, developing a Telepharmacy system with adequate characteristics that meet the needs of healthcare professionals and patients is challenging. In this sense, each Hospital Pharmacy must define and incorporate the Telepharmacy program that best adapts to the HP, patients, and healthcare center18. Hospital Pharmacies planning to incorporate a Telepharmacy program must consider relevant aspects such as the program's purpose, the technologies that will be employed, the resources available, and the technical skills of healthcare professionals and patients.

These guides will assist HPs in implementing and initiating the program and promoting the use of Telepharmacy in its four scopes of application, namely: patient training and education; drug therapy monitoring; healthcare team coordination; and remote dispensing and informed delivery of medication, which require further development. Additionally, these documents will ensure that Telepharmacy programs are developed and implemented homogeneously to meet standard goals, regardless of variability in each HP's human and material resources. These programs will benefit both patients –the main beneficiaries– and health professionals.

According to Tortajada-Goitia et al.19, remote consultations were made available in 87.6% of hospitals during the pandemic. In contrast, a study conducted by Koster et al.20 in community pharmacies in the Netherlands revealed a lower percentage, 44.2%, which was explained by the low level of agreement between physicians and pharmacists added to confidentiality issues related to the information provided to patients.

In line with other initiatives concerning coordination of healthcare professionals, this Guide highlights that Telepharmacy offers an opportunity to improve communication among professionals at different levels of healthcare, promote the dissemination of information among professionals, foster joint activities, and position HP as a reference in the healthcare community. Making the role of HP visible will positively impact the level of satisfaction and experience of patients21.

A range of studies confirms that one of the most frequent demands to healthcare services during the COVID-19 pandemic in different countries and regions was the remote provision of health information through ICTs, even during the hardest times of restrictions, limitations to mobility, and information volatility22. These studies highlight the significant role that Telepharmacy may play in patient training and information. Telepharmacy in this scope will help confront current challenges to health systems and provide rapid truthful information to counter generalized misinformation. The Guide identifies three key points related to the role of HPs: information management leadership, content generation, and information dissemination. Telepharmacy also enables collaborative learning, raises awareness of the use of medicines among patients, and promotes patient autonomy. In addition, it improves clinician-patient communication and awareness on the therapeutic needs and therapies of the patient.

Although Telepharmacy is not a novelty, studies conducted before and during the pandemic have yielded promising results, as it reduces medication errors and improves the quality of pharmaceutical care23,24. Although some authors are certain that Telepharmacy has come to stay, it should be clarified that it complements face-to-face pharmaceutical care. The best example is that Telepharmacy enables remote drug therapy monitoring, which allows teleconsultation, telemonitoring and other activities that will help provide more individualized care, highlighted in the two Guides.

Some experiences in Spain reveal that ICT-based telemonitoring by hospital pharmacists was effective in improving clinical outcomes. In this line, Gomis et al. reported that Telepharmacy improved treatment adherence and patient understanding and use of medicines, reduced therapeutic complexity and adverse events, and enhanced the satisfaction and experience of complex cases such as heart transplant recipients. More than half of these patients could be monitored remotely, and face-to-face appointments were reserved for selected cases, which reduced wait times at the HP25. Collado-Borrell et al. demonstrated that drug therapy monitoring in cancer patients through a mobile app improved treatment adherence and health-related quality of life and reduced resource consumption26.

Telepharmacy makes it possible to anticipate patient needs and provide effective individualized care, which benefits our patients. The benefits of Telepharmacy have been widely demonstrated during the COVID-19 pandemic in the scope of remote dispensing and informed delivery of medication.

Offering different delivery points requires flexibility in logistics to adapt to the patient's needs, which may vary across patients and change over time. Although the different options have their advantages and disadvantages, it is important to note that the delivery of medication is as important as the provision of information and rapid action of multidisciplinary teams. Although Telepharmacy has been successfully implemented during the COVID-19 pandemic27, some authors highlight that it is necessary to design, develop and integrate Telepharmacy apps that include drug therapy monitoring and remote dispensing and delivery of medication. This would guarantee their traceability and control, reduce demand on the health system, and provide patients with timely access to pharmaceutical care, even when they are far from their health center.

Other key elements have been identified to contribute to attaining the goals described in this Guide. Firstly, to accelerate the development and implementation of Telepharmacy, it is necessary to identify the challenges, barriers, and enablers found in previous initiatives in a more advanced stage. Establishing an observatory of innovative practices is crucial for the HP community to take advantage of the lessons learned and previous experiences of other HPs. In addition, creating digital training centers will help patients and professionals get the most out of Telepharmacy tools. Training courses will enhance the digital skills, resources and abilities required to optimize the use of Telepharmacy technologies.

Finally, innovative, robust, multicentric, multidisciplinary, and international studies are needed to demonstrate the full range of advantages that Telepharmacy offers. Attaining this ambitious goal will require the leadership and support of the different scientific societies and healthcare entities.

This practical guide for professionals and patients was developed to ensure the standard development, implementation, and spread of Telepharmacy in all its scopes of application. This Guide is intended to help Hospital Pharmacy professionals benefit from Telepharmacy as a complementary tool to face-to-face pharmaceutical care.

No funding.

We thank all members of the group responsible for the development of the “Methodological support documents for the development of Telepharmacy” of the MAPEX-SEFH project.

To Ascendo Consulting for its consulting and advisory services in the development of this document.

No conflicts of interest.