A demonstration project: Assessing the significance and impact of utilizing a novel telemedicine application in the delivery of community based palliative care in a rural seriously ill population.

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Project Abstract Community-based palliative care is an important specialty that is needed to help address the gaps in caring for people with serious illnesses. Geographic barriers and the shortage of palliative care providers result in patients lacking access to palliative care in rural areas. A potential solution to provide better care to these patients is through telemedicine. However, current telemedicine programs are unable to address all aspects related to caring for people with serious illness, multiple morbid conditions (multi-morbidity), and polypharmacy. Therefore, the objective of this study is to test the feasibility, acceptability, and usability of a novel telemedicine application which incorporates a virtual pharmacist, in the delivery of patient-centered palliative care in a rural population in Western North Carolina. This telemedicine application, Adapt, will include the following components: (1) virtual pharmacist; (2) remote patient monitoring (symptoms, medications, vital signs, photo uploads); (3) messaging between patients/caregivers and providers/pharmacists; (4) videoconferencing with patients, caregivers, family members, and/or providers/pharmacists; and (5) provider clinical dashboard monitoring. Using this application, the following three aims/hypothesis are proposed: Specific Aim #1 will evaluate the feasibility, usability, and acceptability, of a virtual pharmacist to providers and patients in a palliative care telemedicine model. Patient and provider acceptance and satisfaction with the application will be measured using validated surveys. Specific Aim #2 will identify the common drug-drug interactions by a virtual pharmacist in a palliative care population. Specific Aim #3 will then evaluate a virtual pharmacist’s recommendations for medication management. Lastly, exploratory Specific Aim #4 will examine the effects of virtual pharmacy consultations on patient-reported outcomes using validated surveys. This application has the potential to address the multifaceted problems involved in caring for an increasingly aging population with serious illness and multi-morbidity that is often associated with a high prevalence of polypharmacy. This study will provide critical information about the feasibility, acceptability, and usability of the application that will inform a future clinical effectiveness trial.