Telepharmacy Services for Improving Medical Care Quality on Board Ships

Travelling at sea for any reason poses travelers at risk of accidents or diseases. Treatment of these problems requires the availability of drugs and medical devices to cope with these situations. Another problematic factor in case of pathologies onboard is the fact that with the only exception of passenger on cruise ships, merchant ships do not carry doctor or adequately trained paramedic personnel. With the discovery and dissemination of the radio, the isolation conditions at the sea were interrupted and Radio Medical Centers were established to ensure reasonable levels of medical care on board. When accidents occur on board or if a crew member suffers grave a disease of some complexity, the master may request the intervention of a physician on a nearby ship with medical facilities on board, or may ask medical advice to a maritime telemedicine assistance service (T.M.A.S.). In this respect it should be mentioned that the Italian T.M.A.S., Centro Internazionale Radio Medico (C.I.R.M.), is the organization with the largest experience in the field worldwide. The disparity between national and international regulations relatively to medicines that ships must have on board, can make healthcare complicated, especially in ships involved in long distance routes and far long times Recent Information and Communication Technologies (ICT) technology advancements have led to health care improvement and increased the scope of technology in the medical fields. What was impossible in the past due to technological limitations is now possible, improving health outcomes of vulnerable populations, such as seafarers. The discipline that governs the application of modern medical technologies is called e-health or commonly referred to as “electronic health”. This thesis describes in detail all the services that include electronic health with the advantages and limitations associated with them by analyzing in depth what these technologies are most widely used for applications are also presented according their use. The rest of the document consist of some publications in specific e-health services published during my PhD program in telemedicine and telepharmacy by myself and all the team in the department I worked with. In order to further improve the quality of assistance provided to seafarers (but, by extension, to all remote patients) a questionnaire on "Customer Satisfaction" was developed, submitted to both seafarers and their TMAS assistants. This allowed us to assess in first person the degree of appreciation of the services offered and experienced, overall. Development of a system for handling the ship’s pharmacy requires knowledge of compliance, understanding of the life at sea and an analytical approach to managing the medical chest. The aim of the system is to manage the ship’s medical chest reducing as much as possible the human interaction avoiding misunderstanding and issues. The system developed has proved to be an effective tool which serves to guarantee the compliance of the ship pharmacy with regulations of the flag state in terms of medicinal products and medications. Sharing the system with the Telemedical Maritime Assistance Service may result in avoiding mistakes in drug administration. Last but not least the availability of that software could help reduce/avoid problems with maritime health authorities in case any of the required medicinal products are missing.