PRIMARYCAREFOCUS Development of a protocol for telehealth Residential Medication Management Reviews to enable collaboration of pharmacists and geriatricians Christopher R. Freeman, BPharm, GDipClinPharm, PhD, AACPA, AdvPracPharm, BCACP, MAICD, FPS 1 , Nancye M. Peel, PhD, MPH, BPhty 2,3 , Jacqueline N. Watts, MAppSc, BHlthSc 2,3 , Taralina A. Gaee- Atefi, MMedRes, MBBS, BSc Biochem 4 , Liam J. Caffery, PhD 3 , Ruth E. Hubbard, BSc, MBBS, MRCP, MSc, MD, FRACP 2 , Sarah N. Hilmer, PhD, MBBS, BScMed, FRACP 5 , Len C. Gray, PhD, MMed, BS, MB, FAHSE, FAAG, FANZSGM 2 1 The University of Queensland School of Pharmacy, Pharmacy Australia Centre of Excellence, Woolloongabba, Australia 2 The University of Queensland Centre for Research in Geriatric Medicine, Woolloongabba, Australia 3 The University of Queensland Centre for Online Health, Princess Alexandra Hospital, Woolloongabba, Australia 4 The University of Queensland Centre for Research Excellence in Telehealth, Princess Alexandra Hospital, Woolloongabba, Australia 5 Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia INTRODUCTION A significant and increasing number of Australians over the age of 70 are residents of long-term aged-care facili- ties. 1–3 Of these residents, over 50% have dementia. 4 Delivering health care that meets the complex needs of this population poses multiple challenges, in particular medication management. 5 Despite the development of the Residential Medication Management Review (RMMR) process, and a subsequent evaluation that was generally positive, 6,7 aged-care residents with dementia remain at risk of ‘potentially harmful medication use’, ‘potentially inappropriate prescribing’, and ‘adverse out- comes relating to medication use’. 8,9 MEDICATION REVIEWS Ideally, formal medication reviews undertaken by an accredited pharmacist should occur at the time of entry to long-term care for all residents, and at least every 2 years thereafter. 7,10 However, because of the travel ‘overhead’, reviews tend to be batched at 3- or 6-month intervals, leading to delays in review and potentially long periods of inappropriate prescribing. RMMR guiding principles underline the importance of a collaborative approach, and evaluation of the RMMR program indicates that collaboration is cost effective against both financial and health outcome criteria. 6,7 While the RMMR evaluation refers to collabo- ration between pharmacists and general practitioners (GPs), the collaborative principle remains the same for any specialists involved in the RMMR, including geria- tricians. 11 However, Residential Aged Care Facilities (RACFs) usually lack onsite expertise from specialists, including geriatricians and pharmacists. Further, when it is available it may not be timely. In theory, medication reviews produced from the syn- chronous, integrated input of health professionals should be available to RACFs in a timely fashion. If the expertise of GPs, RACF nursing staff, geriatricians and pharmacists is pooled simultaneously, optimal prescrib- ing is likely to be achieved. 6 However, these profes- sional groups tend to work separately, in different timeframes, with various payment systems to support assessment and medication reviews. The outcome is either that reviews are sub-optimal and/or that there is non-simultaneous duplication of effort and poor com- munication of findings among health professionals. 12 Persons with cognitive impairment are most exposed to risk when their care is fragmented by interacting with multiple specialists, as they are unable to ensure that their relevant information is provided consistently to each specialist. 13 Integrated assessment is likely to bene- fit people with cognitive impairment, perhaps more than any other group. TELEHEALTH Telehealth is the provision of health care using informa- tion communication technology (ICT) and may provide a mechanism to overcome the practical difficulties Address for correspondence: Christopher R. Freeman, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall St Wool- loongabba, 4102, Queensland, Australia E-mail: c.freeman4@uq.edu.au © 2017 The Society of Hospital Pharmacists of Australia Journal of Pharmacy Practice and Research (2017) 47, 153–157 doi: 10.1002/jppr.1335 Official Journal of the Society of Hospital Pharmacists of Australia