Telepharmacy Kept Care Flowing in a Pandemic, But Pharmacists Paid the Price

When COVID-19 lockdowns swept across Australia in early 2020, hospitals faced an urgent dilemma: how to keep vulnerable patients connected to essential care without exposing them to infection. For outpatient pharmacy services, the answer seemed obvious. Move consultations online, dispense medications remotely, and deliver prescriptions to patients’ doors. What followed was one of the fastest transformations in modern health care delivery, and it worked, in the sense that patients kept receiving their medicines. But a new study from St Vincent’s Hospital in Sydney suggests that the convenience patients gained came at a hidden cost, one paid not in dollars but in the workload and professional satisfaction of the pharmacists who made the system function.

The research, published in BMC Health Services Research, examined a hospital outpatient telepharmacy service that was rapidly upscaled during the pandemic to ensure that all patients, particularly those who were highly immunocompromised, continued to access pharmaceutical care. Led by Jane E. Carland and Christine T. Shiner as joint first authors, with Sarah Wise as corresponding author, the team used a three-phase explanatory mixed methods design to capture what actually happened when face-to-face pharmacy went remote. The approach combined hard usage data with detailed analysis of work processes and in-depth interviews, offering one of the most complete pictures to date of how telehealth reshapes the daily labour of clinicians.

The first phase was a retrospective audit quantifying changes in patient use of the telepharmacy service across two periods: before the pandemic, from August 2019 to March 2020, and during the COVID-19 lockdowns, from March to September 2020. The numbers were striking. Telepharmacy occasions of service, totalling 1,442 during the lockdown period, increased six-fold, with significant growth in metropolitan and express deliveries. Patients who once travelled to the hospital for medication reviews and dispensing now received the same pharmaceutical care without leaving home. On the surface, the service had achieved exactly what it set out to do: continuity of care under crisis conditions.

But the second phase of the study, process mapping, revealed what the usage statistics could not. By visualising and comparing every work step involved in delivering telepharmacy against its face-to-face equivalent, the researchers exposed the inherent efficiencies of in-person care. Remote dispensing, it turned out, involved substantially more administrative steps than in-person encounters. What appears to patients as a simple, streamlined transaction is, behind the scenes, a longer chain of tasks: coordinating deliveries, verifying prescriptions at a distance, managing logistics that would previously have been resolved in a single conversation across a pharmacy counter. Each removed step in the patient’s journey had, in effect, been added back somewhere else in the pharmacist’s day.

The third phase, interviews with ten pharmacists, explained these patterns from the inside. Three themes emerged from the conversations. The first was increased and less satisfying work. Pharmacists described how the telepharmacy model multiplied administrative burdens while stripping away the parts of the job that gave it meaning, such as direct interaction with patients and the immediate professional judgement that face-to-face encounters allow. The second theme was a shifting of responsibility for medication management from patients to pharmacists. When care moves online and medicines arrive by courier, the informal checks and patient engagement that happen naturally in a pharmacy visit disappear, and pharmacists must compensate by taking on more of the monitoring and follow-up themselves.

The third theme gave the study its title: questioning the cost of convenience. Convenience, the pharmacists suggested, is not a free good. It is redistributed. Patients gained time and safety, especially those whose compromised immune systems made hospital visits genuinely dangerous. But the workload consequences of that convenience fell on a workforce that had little say in the redesign of its own processes and received no corresponding relief elsewhere. The study’s authors argue that these hidden costs are seldom examined in the burgeoning literature on telehealth expansion, which has tended to focus on patient outcomes and access rather than on what happens to clinicians’ work.

The findings arrive at a critical moment. Telehealth was already growing before 2020, but the pandemic compressed a decade of likely adoption into a matter of months, and much of that change has proved permanent. Health systems around the world are now deciding which telehealth services to embed in routine care and which to roll back. Those decisions are usually framed around patient demand, clinical effectiveness and cost. The Sydney study adds a dimension that is easy to overlook: whether a telehealth model actually delivers value, or merely relocates effort from patients to staff. A service that looks efficient on a spreadsheet may be quietly generating overtime, frustration and attrition among the professionals who operate it.

The methodological rigour of the study strengthens its message. By triangulating three independent forms of evidence, the researchers could connect what happened, how it happened and why it mattered. The audit established the scale of the shift. The process maps identified precisely where the additional work was created, step by step. The interviews supplied the experiential texture, explaining why pharmacists found the new model less satisfying and how responsibility had migrated from patients to staff. This combination is rare in telehealth research, which often relies on satisfaction surveys or utilisation data alone, and it demonstrates the value of mixed methods designs for evaluating service transformation honestly.

There are important caveats and context to keep in mind. The study was conducted at a single Australian hospital with a specific patient population, many of them highly immunocompromised, for whom remote care during a pandemic was arguably not a convenience but a necessity. The authors themselves note that telepharmacy successfully maintained access to pharmaceutical care for these patients during, and long after, the COVID-19 pandemic. The point is not that telepharmacy failed; it is that its success had a price, and that price was invisible in the metrics that health services typically track. Four of the authors are employed at the hospital where the study was conducted, though the two pharmacy department employees were not involved in data collection or analysis beyond process mapping, and the study received no specific external funding.

The implications reach well beyond pharmacy. As telehealth becomes embedded in routine care across medicine, nursing and allied health, service models must account for these hidden workload consequences, the researchers conclude, and ensure that telehealth is targeted to settings where it delivers genuine value rather than just convenience. That requires measuring clinician workload with the same seriousness that patient satisfaction is measured, mapping processes before and after digital transformation, and involving frontline staff in the design of the services they will have to run. The pandemic proved that remote care can be built in weeks. The harder lesson from Sydney is that building it well, in a way that sustains both patients and the professionals who serve them, takes far more than a video call and a delivery van.

Subject of Research: The impact of telehealth service delivery on pharmacists' workload and work experience in an Australian hospital outpatient telepharmacy service

Article Title: Questioning the cost of convenience: a mixed methods study of the impact of a telehealth service delivery on pharmacists’ work

Article References: Carland, J. E., Shiner, C. T., Suresh, V., Melocco, T., Le, M., & Wise, S. (2026). Questioning the cost of convenience: a mixed methods study of the impact of a telehealth service delivery on pharmacists’ work. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15469-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15469-z

Keywords: telehealth, telepharmacy, pharmacists, workload, workflow, task shifting, process mapping, COVID-19, health services research, medication management, hospital pharmacy, professional satisfaction