Questioning the cost of convenience: a mixed methods study of the impact of a telehealth service delivery on pharmacists' work.

objectivesTelehealth represents a fundamental change to the health care delivery process. Despite the burgeoning literature on the rapid expansion of telehealth services during the COVID-19 pandemic, the consequences of these changes for clinicians' workload are seldom examined. This study addresses that gap by describing the interactions between patient activity, work processes and pharmacists' experience of an Australian hospital outpatient telepharmacy service that was rapidly upscaled during the pandemic to ensure all patients continued to access pharmaceutical care.

methodsA three-phase explanatory mixed methods design was used: (1) a retrospective audit quantified changes to patient use of telepharmacy before (August 2019-March 2020) and during (March-September 2020) COVID-19 lockdowns; (2) process mapping to visualise and compare all the work steps involved in delivering telepharmacy and its face-to-face equivalent; (3) interviews with pharmacists (n = 10) to explain the patterns of patient use identified in the audit data and explore the impact of telepharmacy on their work.

resultsTelepharmacy occasions of service (N = 1442) increased 6-fold during COVID-19 lockdown, with a significant increase in metropolitan and express deliveries. Comparing the process maps reveals the inherent efficiencies of face-to-face care, as remote dispensing involved substantially more administrative steps than in-person encounters. Three themes emerged from the interviews that illuminate pharmacists' experience of delivering telepharmacy: increased and less satisfying work; shifting responsibility for medication management from patients to pharmacists; and questioning the cost of convenience.

conclusionsTelepharmacy successfully maintained access to pharmaceutical care for highly immunocompromised outpatients during, and long after the COVID-19 pandemic, but this came at the cost of increased administrative workload and reduced professional satisfaction for pharmacists. As telehealth becomes embedded in routine care, service models must account for these hidden workload consequences and ensure telehealth is targeted to settings where it delivers value rather than just convenience.