Pivoting to virtual care - what we know now

Health care professionals across the country are demanding access to virtual care platforms and training so they can safely provide patient care, while maintaining physical distancing requirements. Pharmacists have not been spared from this new challenge, and as virtual care models rapidly begin to integrate into traditional workflows, we expect this will be a new normal within pharmacy practice. Since our opening in 2013, the Pharmacists Clinic has offered patients the option of in-person, telephone or telehealth appointments. This article describes our challenges, experience and learnings as we shifted entirely to virtual care in March 2020.

Different logistic aspects need to be considered for virtual care. These include:

1. Patient Consent: It is important to communicate the risk, limitations and benefits of a virtual appointment, then obtain and document consent before proceeding. This is especially important if another individual, like a student, is participating. Keep in mind that patients can be put-off by any surprises during a virtual appointment. Conversely, patients may invite a friend or family member to participate without letting you know beforehand. Decide in advance how you will handle these requests and what role this observer will play.
 

2. Confidentiality and Security: All of our devices are password protected and encrypted to safely store information. In addition, our electronic medical records are secured through a virtual private network (VPN). Appointments are offered through a secure telehealth platform and occur with the pharmacist, and ideally the patient, in a private room. 
 

3. Connectivity: Prior to a telehealth appointment, we send patients detailed instructions on technology requirements, set up, and a link to access our telehealth system. The instructions contain screenshots and practical tips. Our medical office assistant is available prior to these appointments to help patients troubleshoot.  
 

4. Contingency Planning: Technology is great when it works, however, unforeseen circumstances are also part of our reality. For example, patients in rural communities do not always have a reliable internet connection. When we suspect this issue, we avoid scheduling appointments during high-traffic times like lunchtime or late afternoon. If problems persist, we will either transition to a phone appointment or reschedule. 
 

5. Policies and Procedures: The College of Pharmacists of BC provides guidance for telepharmacy services – a helpful starting point for telehealth. We carefully follow the Pharmacist Code of Ethics, HPA Bylaws and FIPPA. Processes are also in place in the event of a privacy breach, which we review and update annually.

Additionally, we have found the following practical tips helpful in providing virtual care:
 

1. Preparation: We review a patient’s PharmaNet profile and any referral documents prior to appointments. Preparation is important in a virtual space so the pharmacist is ready to help direct a conversation if a patient has difficulty communicating their concerns.  
 

2. Pace: It is important to remember that the pace of a virtual appointment may need to be slower than in-person appointments. Technology can be a barrier that prevents clinicians from picking up on non-verbal cues. Throughout the appointment, we suggest taking a moment to check comprehension and ask how the patient is doing.
 

3. Disclosure: The patient’s willingness to disclose information may differ virtually. Patients may disclose more information if they feel conformable, while others will share less or none at all. Follow-up appointments are important for establishing rapport and trust, which usually makes patients more comfortable to disclose additional information.
 

4. Interpersonal skills: As with in-person care, developed interpersonal skills such as listening and empathy are vital for building trust. Ideally, we try to have at least one in-person or virtual face-to-face appointment early on to establish some connection before transitioning to telephone appointments. 
 

5. Sound: Using a headset and microphone optimizes your sound quality and frees up your hands to write notes. This also reduces the risk of others hearing personal information.    
 

We still have much to learn about virtual patient care, and will continue to share what we learn with our pharmacist colleagues so we can all contribute to the growing body of knowledge in this area.
 

The UBC Pharmacists Clinic acknowledges and gives thanks to all front-line workers who are tirelessly and selflessly working during the pandemic. We admire your commitment, compassion and professionalism.