Thundermist began to implement the satellite distribution system by seeking the state’s approval for remote dispensing of pharmaceuticals. One major challenge was the licensure of the remote dispensing system through the Department of Health’s Board of Pharmacy. The Board members were concerned about the newness of the technology and the security of the system, wondering who would be releasing the medication at the remote facility. Because of a lack of experience withthis technology, few statutes and regulations applied to remote dispensing. This impediment resulted in a five-month delay. The Board of Pharmacy eventually granted approval with a one-year probationary period.

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In early 2003, during the planning for the initial in-house pharmacy, Thundermist began formulating plans to expand the availability and access of integrated pharmaceutical care to other underserved sectors in the state. To keep costs as low as possible, the organization began to seek nontraditional ways to accomplish this goal. While attending several health care conferences throughout the country, the CEO became familiar with remote dispensing technology, which was being tried at other health centers nationwide.

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Thundermist has identified several significant health needs and concerns of the medically underserved and has responded with a variety of service options, including:

• increased health services for its targeted patients. To address the lack of these services in the community, Thundermist implemented a mental health program, including psychotherapy, evaluations, crisis intervention, and psycho-pharmacological medication management.
• chronic disease-prevention efforts among targeted patients. Roughly 25% of all pediatric patients at Thundermist have asthma; this is a much higher rate than the statewide average. As a result, Thundermist is participating in the Asthma, Diabetes, and Diabetes Prevention Collaborative.
• adult medicine. More than 10% of the center’s adult patients have diabetes. Thundermist has reshaped its care and treatment of diabetic patients, extending lessons learned from the work of the collaborative to the management of other chronic disorders (e.g., substance abuse), which is also a major health problem among these patients.

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Introduction

The development and application of new and improved technology have had a dramatic impact in the health care field. Advances in diagnostic procedures and devices, medical implants, and surgical techniques are revolutionizing medical care. However, technology has been slow to assist patients living in remote service areas and segments of the population who have historically had difficulty gaining access to quality health care.

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