Tele-pharmacies could spread through rural Iowa

ZEARING, Ia. — Other small towns are looking to this corner of Story County for an answer to a chronic challenge: How can rural areas provide crucial pharmacy services, especially for elderly people who have trouble traveling?

Zearing leaders say the key is tucked in the corner of a former beauty parlor that has been transformed into a small drugstore. Next to the counter, organizers set up a video screen through which customers can interact with pharmacists working in larger towns.

The pharmacists explain how patients should take medications and avoid interactions with other drugs. Customers can ask questions and raise concerns. The video conversations, which usually take a minute or two, could soon become more common around the state.

Iowa legislators are considering a bill that would let state pharmacy regulators routinely approve tele-pharmacies instead of handling them as limited pilot projects.

Supporters expect the idea to spread to other small towns, including places where drug

Zearing, which has about 550 residents, is one of five Iowa towns where the tele-pharmacy idea has been tested. Customers at the NuCara pharmacy said the three-year-old arrangement took some getting used to.

Dorothy Perisho stopped in the other day to pick up a prescription. She said she used to drive nearly 30 miles to Wal-Mart in Ames for medications. Now she can buy them in Zearing.

Perisho, 85, said she needed help at first to use the video screen, which is similar to an iPad. But she said she got the hang of using her finger to respond to a few prompts on the screen, then speaking to a pharmacist via a phone handset attached to the video system. “It’s pretty self-explanatory,” she said. “I think it’s great. Anyone will tell you that.”

The store is staffed by a pharmacy technician, who works with pharmacists in Ames and Nevada. The technician fills orders, and one of the pharmacists visits at least monthly.

Such video communication also is being used to bring other scarce medical services, such as psychiatry, to small towns. Supporters say pharmacy could become one of the most common health care uses of the technology.

On this day, pharmacist Ashley Loeffelholz in Ames was using the video system to help pharmacy technician Lindsey Thompson fill customers’ orders in Zearing. Loeffelholz noted that instead of standing at the counter and speaking out loud to a pharmacist, the tele-pharmacy customers step to the kiosk and use the phone handset and video screen.

“You actually get a little more privacy this way,” she said.

Loeffelholz said she originally was unsure how well the video approach would work, but she has heard few serious complaints from colleagues. “I think pharmacists are open to it," she said. "We feel bad when our patients can’t access care.”

Brett Barker, vice president of the NuCara chain, said Zearing residents’ nearest pharmacy used to be in Nevada, which is 20 miles to the southwest. That drive was especially daunting for many seniors, who tend to use the most prescription drugs, he said.

“Best-case scenario, they were looking at an hour to get a prescription filled,” he noted.

Barker said the Zearing store fills about 800 prescriptions a month, which is less than half the minimum needed to justify a pharmacist behind the counter. The store stocks most common medications, such as those for high blood pressure, cholesterol, heartburn and diabetes. It can order almost anything else and have it delivered within a day, he said.

Town leaders helped make the pharmacy possible. They bought the vacant beauty parlor, renovated the building and leased it to NuCara.

“We’ve got to have meds in this town,” City Clerk Shelley Soe said. “If you’re sick and there’s a blizzard, this place is absolutely a blessing.”

Soe can see the pharmacy from her desk at City Hall across the street. “People are coming and going all the time. It makes me happy to see this being used,” she said.

The pharmacy also has bolstered a neighboring clinic, run by nurse practitioner Mary O’Connor. The clinic is such an institution that some townspeople refer to it simply as “Mary’s place.” But O’Connor said some residents went instead to clinics in other towns, since they figured they’d have to travel for pharmacy services anyway.

“It’s all about access to care, and if you don’t have access to medications, you don’t have access to care,” O’Connor said. With the addition of the pharmacy next door, her practice has swelled enough that she hired a second nurse practitioner.

The legislative bill, Senate File 453, was passed last spring by the Iowa Senate and is before the House. Proposed amendments include steps to ensure that new tele-pharmacies will serve communities that lack pharmacy services instead of competing with existing drug

Andrew Funk, executive director of the Iowa Board of Pharmacy, said the pilot projects have shown tele-pharmacies can safely help rural residents. He said the board has heard little opposition to letting the approach spread to other towns, as long as safeguards are in place.

“I don’t expect them to pop up on every corner,” he said, but he thinks they’ll become more common in small towns.

The pilot projects’ software system was designed by TelePharm, a national company based in Iowa City. Marketing Director Greg Janes said such projects also are set up in four other Iowa towns — Brooklyn, State Center, Victor and West Liberty.

His company has provided software to about 70 rural pharmacies in five states. He said Telepharm has identified 86 other Iowa communities that might benefit. Each of those towns has at least 500 people and is at least 10 miles from the nearest pharmacy, he said.

Soe, the Zearing city clerk, has taken calls from other small-town officials seeking her opinion of tele-pharmacies.

“I tell them go for it,” she said. “If you can get something like this, it helps you keep your town.”

Potential tele-pharmacy locations

Here are Iowa towns that the company TelePharm says could be candidates for tele-pharmacies. The company, which sells software for the operations, identified towns with populations of more than 500 that lack pharmacies and are at least 10 miles from the nearest pharmacy.

Afton, Albert City, Allison, Armstrong, Bancroft, Baxter, Brighton, Buffalo Center, Charter Oak, Clarence, Donnellson, Dows, Dunkerton, Early, Eldon, Elma, Farmington, Fonda, Fredericksburg, Fremont, Garnavillo, George, Gilmore City, Gladbrook, Graettinger, Griswold, Hedrick, Holstein, Hopkinton, Hubbard, Ireton, Kanawha, Keota, Lake Park, Lansing, Larchwood, Lime Springs, Lone Tree, Lovilia, Lowden, Manly, Maxwell, Melbourne, Melcher-Dallas, Milo, Monroe, Montezuma, Morning Sun, Moulton, Nashua, New Albin, New Sharon, Newell, Odebolt, Olin, Ossian, Pleasantville, Pomeroy, Postville, Princeton, Radcliffe, Redfield, Richland, Rockford, Rolfe, Runnells, Ruthven, Schaller, Schleswig, Seymour, Sioux Rapids, Sully, Sutherland, Swea City, Thompson, Treynor, Tripoli, Underwood, Wayland, Wellsburg, West Bend, What Cheer, Wheatland, Whittemore, Winfield, Wyoming.