Four Seasons Launches Hospice Telehealth Pharmacy Program

North Carolina-based hospice and palliative care provider Four Seasons has launched a pilot telehealth-based pharmacy program that will include a virtual pharmacist system for patients who live in rural areas of their home state. Four Seasons will be collaborating with pharmacy benefit manager Delta Care Rx on the project.

Telehealth is becoming increasingly important for patients in rural areas who may live a considerable distance from their health care providers. Organizations are developing and investing in methods of reaching these patients in a more timely, effective and efficient manner.

Nationally, urban centers are far more likely to have a Medicare-certified hospice than rural counties, and rural patients have considerably less access to hospice and palliative care than those who live in more populated regions, a 2015 study found.


“Our programs are geared towards improving best practices in caring for a seriously ill population. The [pharmacy] program will involve a pharmacist who is available to consult with the palliative care provider and with the patient on a remote basis,” Tyler Bice, research and development team lead at Four Seasons, told Hospice News. “This provides an extra layer or support for our patients, and it provides an extra layer of support and network for our providers. If they need a consult around medications, that is available in real time.”

Four Seasons is financing the project through a two-year grant the hospice received from the U.S. Agency for Healthcare Research and Quality (AHRQ). The program will build on previous work done by Four Seasons as part of the U.S. Centers for Medicare & Medicaid Services Health Care Innovation award program.

As part of the AHRQ grant, Four Seasons will study the outcomes of this work to evaluate the impact of these systems on patients as well as their staff.


The project makes use of a new technology application from Delta Care Rx called ADAPT Health. The application is capable of interfacing with the organization’s electronic medical record systems, allowing pharmacists to review potential drug interactions, make prescription recommendations, provide education about new medications and track the incidence of side effects among their patients.

Clinicians who access the application, which is secure and encrypted according to Delta Care Rx, will be able to review pharmacy recommendations and will use e-prescribing as indicated for any medication changes.

The systems will include remote patient monitoring software that will allow patients to enter comments about their condition and symptoms using a word cloud. Clinicians and pharmacists will have access to these comments and can change or recommend medication adjustments in response to the patients’ needs. Patients will also be able to send secure messages or video-conference with pharmacists.

“Collaboration, collaboration, collaboration … the impact of many is greater than the impact of one,” said Reginald Nichols, regional director of palliative care for Four Seasons. “Having a natural flow of care for patients through which medications are reviewed and changes recommended by a pharmacist has the potential of transforming a patient’s entire well-being. Many times, medications have interactions that cancel out the impact of the other. A simple separation of two-to-three hours between two medications has the capacity to dramatically impact the effectiveness of those medications.”

Four Seasons currently serves 11 counties across western North Carolina, providing hospice and palliative care, care navigation, home care, bereavement support and conducting clinical research.

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