"Telehealth Interventions in Pharmacy Practice: A Systematic Review of Reviews and Recommendations" (Preprint)

Pharmaceutical care has expanded, with telehealth playing a key role, especially during the COVID-19 pandemic. Despite global growth, existing reviews focus on specific settings or conditions, highlighting the need for broader research on public health topics and comparative studies to evaluate the effectiveness, preferences, and cost of telehealth interventions in pharmacy practice. The aim of this study was to unify existing literature on the impact of telehealth on future pharmacy practice and to analyze those already implemented in current pharmacy practice, with the objective of providing recommendations. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was used to guide this review. In total, 4 databases were searched for relevant studies: PubMed, CINAHL, Web of Science, and Cochrane Library. Title, abstract, and full-text screening was performed, and 18 reviews met the selection criteria. The search period was from August 1, 2012, to December 22, 2024. The quality of the reviews was assessed using a 5-point Likert scale and a GRADE-CERQual scale. Based on the identified reviews, telehealth interventions were categorized into teleconsultation, telemonitoring, telecollaboration, and telesupport. Teleconsultation was the most frequently used. Telephones were most common in teleconsultations and telemonitoring, while mobile, web, or computer applications were most frequent in telesupport. A combination of methods was most used to facilitate telecollaboration, such as telephone, fax, electronic messaging, shared electronic records, and videoconferencing. The identified reviews were evaluated by health outcomes, hospital readmission rates, patient safety, adherence, satisfaction, pharmacist shortage, and quality and access to care. The use of telehealth in pharmacy has generally seen an improvement in overall outcomes compared to traditional pharmacy practice. Our results show a strong push to integrate telehealth into future pharmacy practice, with the United States leading the way in adoption, demonstrating increased care access, quality, and patient safety. In Singapore, telephone consultations have been commonly used in hospitals, though community settings lack widespread adoption. However, the growing digital literacy of older adults and innovations like chatbots and telemonitoring present opportunities to expand telehealth services. To align with this shift, pharmacy education should invest in enhancing formative training by incorporating telehealth training, ensuring future pharmacists are prepared for this evolving practice, applicable to regions with similar contexts. Telehealth has shown promise in improving overall outcomes in pharmacy practice. While many countries have made strides, particularly in hospital settings, there remains an opportunity for greater adoption in community health care, driven by innovations like telemonitoring and digital literacy among older adults. The findings from this study can be used to inform future implementation of telehealth interventions in pharmacy in Singapore and other regions or cities with similar contexts.