e-Health pharmaceutical services challenges: linking patients, pharmacists and physicians - lessons learned from ePharmacare Project

Background: The utilization of Information Systems and Technologies
(IST) for the provision of healthcare services—e-Health—is a
trend in health systems that will probably have an important impact
on the definition of new roles for the community and hospital
pharmacist.
Purpose: The ePharmacare project was designed to explore the
development of online pharmaceutical services. This project aimed to
develop a prototype of a web-based patient management service,
establishing its acceptability, feasibility, sustainability, and adaptability
to future changes, involving end users in the development of
the application.
Method: Following a literature research, an online survey on the use
of IST in Portuguese pharmacies and an observational study to study
pharmacists’ workload were organized to address system design
requirements. The web-platform was tested in two different settings:
(a) Three community pharmacies and; (b) A community pharmacist
using the platform and scheduled meetings outside the pharmacy
setting. Patients recruited were aged between 64 and 75, with at least
a chronic medicine prescription. Initial training was given to pharmacists
and to patients. The final evaluation of the web-platform
included an eye-tracking test and a survey to both end users focusing
on usability and utility of the application.
Findings: Overall, the use of the platform by pharmacists has shown
no signs of impact on their workload. However, the re-organization of
pharmacy work, with clear roles assigned to each professional, and
the possibility of using IST to improve pharmacy and patient management,
are critical steps in the way to e-Health pharmaceutical
service implementation across pharmacies. The frequent communication
between patient and professional allowed the early
identification of possible adverse reactions and showed some signs of
possible impact on health outcomes that need to be further explored.
Moreover, with the development of the work done in ePharmacare,
the need to integrate several health information systems from the
different healthcare providers became evident. Besides supporting
chronic patients this system’s integration should provide disease
management stakeholders with mechanisms that assure accountability,
credibility, and acceptability among other dimensions, which in
turn would impact on factors such as communication, trust, professional
recognition and needs assessment.
Conclusion: This work highlights the potential value and challenges
e-Health pharmaceutical services may bring to the profession not to
mention patients. Future research should focus on the impact of an
integrated primary-care e-Health pharmaceutical service on patients’
health status, professionals’ workload, patterns of pharmaceutical
services provision and costs.