Design and Evaluation of a Pharmacist-Led Telepharmacy Service Model

Thesis Abstract

The rapid expansion of digital health platforms has heightened the potential for telepharmacy to improve access to pharmaceutical care, particularly in underserved and remote communities, yet practical models that integrate pharmacist-led services with patient-centered outcomes remain under-explored. This study addresses the gap by designing, implementing, and evaluating a pharmacist-led telepharmacy service model that integrates medication therapy management (MTM), remote counseling, and pharmaceutical care follow-up within a primary care network. The aim is to assess feasibility, effectiveness, and user acceptance of the telepharmacy model, and to delineate an evidence-based framework for scalable deployment. Specific objectives include (1) to develop a standardized telepharmacy workflow incorporating MTM protocols, secure video consultation, e-prescribing, and patient education materials; (2) to evaluate clinical outcomes including blood pressure control in hypertensive patients, lipid management in dyslipidemia, optimal anticoagulant monitoring in atrial fibrillation, and adherence as measured by Medication Possession Ratio (MPR) over 12 months; (3) to assess patient and provider satisfaction and perceived quality of care using validated instruments; (4) to analyze economic implications through a cost-effectiveness assessment from the payer and societal perspectives; and (5) to identify barriers and facilitators to implementation guided by the Consolidated Framework for Implementation Research (CFIR). The study adopts a mixed-methods design in a controlled implementation within a network of five primary care clinics serving 7,500 adult patients. A pragmatic quasi-experimental approach will compare outcomes between an intervention cohort (n?1,200) receiving pharmacist-led telepharmacy services and a control cohort (n?1,200) receiving usual care over 12 months. Quantitative data will be collected from electronic health records, pharmacy dispensing systems, and patient-reported outcome measures, including validated scales for health literacy and satisfaction. Instrument validity and reliability will be established through pilot testing and 2-point inter-rater reliability checks for MTM adherence scoring. Quantitative analyses will include multivariate mixed-effects regression to evaluate changes in clinical endpoints, time-to-event analyses for adherence lapses, and cost-utility analyses using quality-adjusted life years (QALYs). Qualitative insights will be generated from semi-structured interviews with 40 patients and 20 clinicians, analyzed via thematic analysis to illuminate experiences, acceptance, and implementation dynamics. Theory-informed interpretation will invoke the Technology Acceptance Model (TAM) and CFIR to contextualize adoption and sustainability. The anticipated findings include statistically significant improvements in systolic and diastolic blood pressure, LDL cholesterol reduction, and higher MPR among the telepharmacy group, with enhanced patient satisfaction and perceived care quality. Economic evaluation is expected to demonstrate favorable incremental cost-effectiveness ratios (ICERs) within accepted willingness-to-pay thresholds, driven by reduced hospitalizations and improved medication safety. The study contributes to knowledge by presenting a rigorously evaluated, scalable telepharmacy model that bridges clinical efficacy, acceptability, and economic viability, underpinned by explicit implementation guidance and a replicable workflow. The anticipated implications include informing policy for reimbursement structures, guiding pharmacy education to integrate telepharmacy competencies, and providing a blueprint for health systems seeking to optimize pharmacotherapy management through remote delivery. The main conclusion is that a structured pharmacist-led telepharmacy service model can deliver clinically meaningful improvements in chronic disease management, patient satisfaction, and cost-effectiveness when embedded within robust workflow, governance, and training infrastructures. Recommendations emphasize standardizing MTM protocols, investing in user-centered telehealth interfaces, strengthening data interoperability, and pursuing broader implementation studies across diverse settings to validate generalizability and long-term sustainability.