How two NewYork-Presbyterian pharmacists tapped into telehealth to improve care for transplant patients

Medication adherence is an important aspect of any patient's care. But the stakes are just a little bit higher when that patient has just undergone an organ transplant.

For a transplant patient, missing an antirejection dose isn’t like forgetting your daily cholesterol pill. That’s one reason that two pharmacists at NewYork-Presbyterian Hospital decided to start seeing patients virtually—an approach that allows them to maintain continuity of care after discharge from the hospital while expanding the hospital's service to patients that would otherwise end up in the emergency department.

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Nicholas Jandovitz, PharmD, clinical pharmacy manager in the kidney and pancreas transplantation program and Demetra Tsapepas, PharmD, the program’s director of quality and research at the New York City-based hospital, recognized two problems facing all transplant patients: They often needed followup care and medication guidance after they were discharged, but the hospital lacked the clinic space to allow pharmacists to see patients in a designated outpatient setting.

“At our organization, we are limited to the hospital setting, currently,” Tsapepas told FierceHealthcare. “When this initiative came up it gave us an opportunity to expand pharmacy services beyond our traditional environment.”

Unlike most telehealth initiatives, this wasn’t a far-reaching, top-down program hatched in the hospital's C-suite—it was two pharmacists tinkering with ways that innovative technology could improve patient care.

Fortunately, the IT systems were already in place. NewYork-Presbyterian has a well-developed Innovation Center that was launched in 2015. In a recent article in NEJM Catalyst, executives explained how the innovation arm of the hospital has created a pathway for clinicians to bring interesting ideas to fruition, particularly when it comes to telehealth. In 2016, the hospital launched NYP OnDemand, an in-house telehealth app that aims to serve 20% of the provider’s patient population by 2018.

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For Tsapepas and Jandovitz, NYP OnDemand offered a ready-made solution to the patient care problems they were encountering. Partnering with the Innovation Center, the pharmacists have offered follow-up telehealth consultations to 21 transplant patients since January, ironing out their workflow as they went along. 

At first, Jandovitz was setting up the appointments on his own. Now, a member of the innovation team helps sign patients up for the service, create an account and show them how to download the app to their phone or tablet before leaving the hospital. Eventually, the pair said they want to start that process even before patients come in for the procedure since the vast majority of transplants are elective and planned well in advance.

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"One of the interesting things about transplant patients specifically is they are lifelong patients—they require medication to sustain their health and livelihood,” Tsapepas said. “This ability to have continuous interactions with them outside of the care environment is important.”

It's still too early in the program's life-cycle to generate any specific findings, but both pharmacists are tracking and analyzing metrics like virtual visit duration (about 15 minutes) and comparing that against the amount of time that patient would spend traveling to the hospital to receive care.

Jandovitz added that he was surprised at how eager patients have been to use the telehealth platform.
Although both he and Tsapepas have run into some issues regarding patient access to equipment or an internet connection, overall, patients have been impressed that the hospital offers a much more convenient service.

“I thought we’d have to convince patients,” he said. “But even just introducing [telehealth] as a topic they were like, 'Absolutely.' They were excited for it.”