Differences between Rural and Urban Health
Rural health is commonly known as rural medicine and refers to the multidisciplinary study of health status of different people residing in remote environments. The concept of rural health has often been associated with midwifery, telemedicine, telehealth, economics, sociology, and geography. There is mounting evidence for the fact that the healthcare needs of people living in rural regions are quite different from their urban counterparts (Russell et al., 2013). Furthermore, lack of adequate access to healthcare facilities in remote locations is a common problem that results in poor health outcome of the inhabitants (Todd, Copeland, Husband, Kasim & Bambra, 2015). Some of the major differences can be attributed demographic, geographic, workplace, socioeconomic, and personal health factors. Most rural communities have been found to comprise of a great proportion of aging people and kids. With comparatively limited people belonging to the working age of 20–50 years, these rural communities manifest an increased dependency ratio (Nakakaawa, Moll, Vedeld, Sjaastad & Cavanagh, 2015).
People living in remote areas are also subjected to subordinate socioeconomic conditions, poor educational attainment, greater mortality rates, and increased rates of alcohol and tobacco consumption, in comparison to their urban counterparts (Doogan et al., 2018). Telepharmacy refers to the delivery of different kinds of pharmaceutical care services with the use of telecommunications, to patients or clients who live in locations. It is generally difficult to establish direct communication and/or contact with the pharmacists in such remote locations (Poudel&Nissen, 2016). The assignment will elucidate on the different challenges and benefits of telepharmacy, from the perspective of a pharmacist and will also suggest recommendations to overcome the challenges.
The article selected elaborates on the fact that telemedicine is the delivery of care services at locations where the distance makes it difficult for healthcare professionals to reach and deliver optimal care services(Poudel & Nissen, 2016). Telemedicine can be suggested as a product of the 20th century that has taken into account the different facets of information technologies and telecommunication (Flodgren, Rachas, Farmer, Inzitari&Shepperd, 2015). The specialised technology also has the capability to transfer relevant clinical information, health informatics, and imaging data from one person to another, without distance acting as a major barrier. Of the different categories of telemedicine such as, telenursing, telepharmacy, telerehabilitation, emergency, and teletrauma care services, the focus of this assignment is on telepharmacy. Telepharmacy services most commonly include monitoring of drug therapy, counselling patients, previous authorization and fill-up authorization for drugs, and observing the formulary acquiescence with the help of videoconferencing or teleconferencing. Distant administration of medications with the use of automated labeling and packaging systems are other attributes of telepharmacy (Weinstein et al., 2014).
These telepharmacy services are also delivered either through nursing homes, hospitals, and other medical care centres, or at different retail pharmacies. Furthermore, clinical telepharmacy has also been found imperative in delivering remote health services or outsourcing them for supplementing a range of in-house resources that are available on-demand or at specific schedules (Skrei & Rundquist, 2017). Poor socioeconomic condition has been identified as the primary issue in relation to rural health. In nations where the mainstream population exists in rural areas, there occurs a concentration of all resources in the towns and cities (Sarkar et al., 2018). All countries report difficulties with regards to communication and transport, and are subjected to various challenges that arise in remote and rural zones.
Socioeconomic Conditions of People Living in Remote Areas
People belonging to rural regions are subjected to increased rates of smoking, and subsequent exposure to second-hand smoke. Furthermore, they have also been associated with increased obesity rates, in comparison to their non-rural counterparts (Poudel & Nissen, 2016). Additionally, people living in rural regions are also subjected to poorer rates of consumption of fresh fruits and vegetables, even in regions that report abundant farming practice (Marcin, Shaikh & Steinhorn, 2015). Another issue that is quite prevalent in the rural regions is the significant number of deaths that occur due to suicide, and poisoning. Furthermore, absence of adequate critical infrastructure and appropriate developmental opportunities in the rural regions has been found to directly impede the health status of the people (Rodríguez-Pose & Hardy, 2015). Poor quality of water and overcrowding in households have also been identified as major risk factors that significantly contribute to high rates of disease in remote and rural locations (Long, Hanlon &Pellegrin, 2018). Thus, an analysis of the articles helped in gaining a deeper understanding of the potential advantages of telepharmacy.
The scholarly literature that is being discussed is in accordance to Wakerman’s definition of remote health who identified the differences between rural and remote health (Wakerman, Bourke, Humphreys & Taylor, 2017). It elaborates on the fact that the technology of telepharmacy had been devised with the intent of providing healthcare services to people belonging to a population that is medically deprive, owing to their geographical location in remote areas. The definition clearly states that remote health is characterised by geographical isolation of practitioners (Norris, Horsburgh, Sides, Ram & Fraser, 2014). This was consistent with the article since it elaborated on the impact that geographical factors created on rural health. Moreover, consistency with the definition can be established by the detailed explanation on rural health where the authors suggested that healthcare practitioners focus on using evidences and different communication technologies for exchanging effective information(Poudel&Nissen, 2016). Hence, it validates the definition by stating that these technological advances are used in rural health, principally for diagnosing, treating and preventing diverse injuries and diseases, researching and evaluating, and continuing education among themselves (Tan, Emmerton, Hattingh& La Caze, 2015).
The article was accurate in stating that all the changing and overlapping roles of the teams are directed towards the best interest in bringing about an advancement in the health of the rural individuals and their groups. Another essential factor present in the definition that could be identified in the article is ‘professional’. The shortage and isolation of trained and qualified healthcare professionals in regional and rural locations, which in turn contributes to poor health outcomes in the local population has also been identified (Humphreys, Wakerman, Pashen & Buykx, 2017). Furthermore, telepharmacy models have also been found to eliminate active involvement of the pharmacists, including vending machine models, internet pharmacies, and mail-order pharmacies (Garrelts, Gagnon, Eisenberg, Moerer&Carrithers, 2010). Hence, both geographical and professional isolation of practitioners were adequately discussed in the article.
Small pharmacies, rural hospitals, and/or clinics located in isolated regions are generally associated to a service models that are commonly utilized in greater urban centres having improved access to pharmacist staff. This connection usually facilitated by presence of novel software, videophone systems, and automated dispenser machines (Mrosek, Dehling & Sunyaev, 2015). People residing in smaller communities, across rural regions often show an interest to gain a sound understanding of their healthcare providers. Thus, establishment of cross-cultural competency is a major attribute of telepharmacy (Vaughan, 2007). Absence of cultural competency among the health professionals who act as caregivers in rural region has often been associated with disparities in delivering healthcare services, thereby resulting in dissatisfaction among the clients (Betancourt, Green, Carrillo & Owusu Ananeh-Firempong, 2016). Furthermore, lack of cultural competence also leads to reduction in client adherence to the medical regimen that is recommended by the healthcare staff (Grobler et al., 2009).
Potential Advantages of Telepharmacy
However, the article was helpful in elaborating on the cultural competency aspect that is present in Wakerman’s definition. Regardless of the distance between the patients residing in the remote locations and the healthcare providers located in urban areas, telepharmacy has the potential advantage of allowing the providers to effectively deliver care services that are able to meet the cultural, linguistic and social needs of all patients (Poudel&Nissen, 2016). With the use of communication and information technology, the providers are able to demonstrate adequate competence while caring for rural people having diverse feelings, beliefs, and values (de Bittner & Zaghab, 2011).
GP substitution is most often practiced in developed countries where the practitioners are substituted by physician assistants, nursing professionals, in response to the challenges that are encountered in a clinical setting (van der Biezen et al., 2016). This was explained in terms of sessional employment where the lack of practitioners in rural hospitals or inability of the settings to retain or recruit full-time pharmacists often made sessional employment necessary. This was considered as an essential approach in medication management and absence of inpatient medical pharmacy (Tan, Emmerton, Hattingh & La Caze, 2015). Hence, even without the presence of adequate general practitioners in the healthcare settings, telepharmacy would allow GP located at distant places to effectively monitor and manage the remote patients.
Rural settlements are often considered as dispersed small units that are characterised by compact number of people belonging to poor socioeconomic conditions. This aspect of the definition was elaborated by the fact that pharmacists who are based in metropolitan or regionally areas, and responsible for providing outreach care do not hold any knowledge or perception on the dispersed population, which in turn hinders the care continuum and holistic management of health (Banbury, Roots &Nancarrow, 2014). Thus, use of telepharmacy approaches help the community pharmacists to view the needs and demands of people belonging to small rural communities, and providing the adequate services.
Owing to the fact that people living in rural regions often find it difficult to reach hospitals at times of emergency and do not have facilities for routine screening and check-up, their healthcare needs are quire severe, when compared to the urban people. Hence, telepharmacy is considered as the frontier of pharmacy practice that has the potential of producing similar quality of healthcare outcomes among rural patients, as the conventional modes, besides providing range of different value-added features that are absent in outmoded pharmacy practices (Win, 2017).
The digital age has been found to usher in an upsurge of novelty and invention, with prolonged access to an assembly of life-changing developments in medicine and health. These advancements are primarily directed towards the consumers, besides the healthcare professionals who are responsible for delivering necessary healthcare services. With an increase in the struggles of health systems, hospitals, and retail pharmacies under the burdens of monitoring cost and enhancing health outcomes, telepharmacy services were found to deliver measurable benefits. The hiring of telepharmacy options in the rural regions serve as a cost-effective method, in comparison to the recruitment of additional practitioners and pharmacists in hospitals, and other clinical systems (Fensterheim, Gunn, Pokuta, Straszewski & Marks, 2015). Thus, telepharmacy has the attribute of provide a hassle-free 24/7 pharmacy consultation, medication guidance and medication verification to all people living in remote regions, thereby significantly saving costs (Soon & Levine, 2011).
Delivery of Telepharmacy Services
Telepharmacy options are also found to operate in a seamless manner, in the form of an extension of large pharmacy teams. Further benefits are related to reduce the after-hours following a drug approval to a few minutes, besides decreasing the medication error rates that are commonly encountered in rural hospitals due to understaffing or huge workload (Keeys et al., 2014). The technological advancement has also shown considerable improvements in enhancement of the clinical roles of all pharmacists owing to its benefit of providing round-the-clock prescription filling, and patient monitoring (Niznik, He & Kane-Gill, 2017). However, the major disadvantages of telepharmacy include absence of a control related to medication dispensing to clients. Although there occurs a routine monitoring of the pharmacy specialists, there still remains risk of regulation infarction. Another major obstacle is the lack of adjustment to the concept in most remote regions (Stading et al., 2014).
Establishing a first point of contact by taking into account the federal and state laws of the rural regions in relation to pharmacy operation should be the first step. The state must have legislation for the allowance of telepharmacy operation in the remote sites. Establishing connection with the State Board of Pharmacy is another vital step to ensure that telepharmacy developments are in accordance to the laws (Rushworth et al., 2015). A licensed pharmacist having the charge of remote and central pharmacy sites must process the telepharmacy application. This should be followed by procurement of registration from the drug councils. With regards to the rural telepharmacy programs across hospitals, medication dispensing usually happens at facilities where the patients are hospitalized (Peretti, Amenta, Tayebati, Nittari& Mahdi, 2017).
Claims must be submitted by the hospitals for patient care, without affecting the reimbursement practices. Provision must also be created for the hospitals to enter contractual agreements and pay dues to the telepharmacy programs for the health services they obtain. Operation of a telepharmacy program under the experienced equipment-driven supervision of licensed pharmacists would be another major approach in this regard. Delegation of a dispensing model that gives the prescription processing information to different non-pharmacist healthcare specialists is another future potential for implementation of telepharmacy services. Provisions for off-site prescription verification must also be created in order to better facilitate recordkeeping (Le, Toscani&Colaizzi, 2018).
Assessing the primary health needs of the rural population that is being offered the telepharmacy service should be determined for the program feasibility. Addressing questions related to availability of pharmacy services in the community, presence of health personnel, convenience of a cost-effective location, and support for establishing the telepharmacy service are imperative in the process (Pratt, 2015). Furthermore, efforts must also be taken to assess the willingness of the concerned licensed pharmacist and effectiveness of a business plan for assessment of the projected revenue and expenses. Seeking help from the rural health personnel, community business leaders, local government, officials, and state pharmaceutical association is crucial. Other recommendations should encompass securing a proper physical location prior to planning the construction (Tzanetakos, Ullrich&Meuller, 2017).
Conclusion
Importance of Clinical Telepharmacy
Thus it can be concluded, people living in rural societies are considered as the disadvantaged population, in comparison to cities that contains adequate hospitals, ambulance services, and emergency departments. In comparison, people residing in the rural areas are often more focused on their needs and sense of security. This need is most commonly expressed in terms of the community’s chief focus on enlisting and retaining a doctor or doctors and establishment of hospitals in the region. The provision of health services in rural and remote areas is significantly affected by limited funding and other resource constraints.
Additionally, there exists considerable poverty in remote and rural regions, which is concomitant with presence of restricted health resources and facilities that can be accessed by all. In the remote areas of most developed countries as well, recent trends elaborate on the reduction of adequate infrastructure and funding support for health services. Besides, poor life expectancy in rural regions, fewer job opportunities, poor personal health, and environmental concerns call the need for the implementation of telepharmacy measures, with the aim of enhancing health and wellbeing of the population. To conclude, the role of this technological advancement that is directed towards enhancing communication between the medical staff and patients, with fidelity and at convenience of both establishes its importance in present times.
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Risk Factors in Rural Locations
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