Feasibility and Acceptability of an Overdose Prevention Intervention Delivered by Community Pharmacists for Patients Prescribed Opioids for Chronic Non-Cancer Pain.

There have been increases in prescriptions of high strength opioids for chronic non-cancer pain (CNCP), but CNCP patients perceive themselves as being at low risk of opioid overdose and generally have limited overdose awareness. This study examined how an overdose prevention intervention (opioid safety education, naloxone training, and take-home naloxone (THN)) delivered by community pharmacists for patients prescribed high-strength opioids for CNCP would work in practice in Scotland. Twelve patients received the intervention. CNCP patients and Community Pharmacists were interviewed about their experiences of the intervention and perceptions of its acceptability and feasibility. CNCP patients did not initially perceive themselves as being at risk of overdose but, through the intervention, developed insight into opioid-related risk and the value of naloxone. Pharmacists also identified patients' low risk perceptions and low overdose awareness. While pharmacists had positive attitudes towards the intervention, they outlined challenges in delivering it under time and resource pressures and during the COVID-19 pandemic. Overdose prevention interventions are required in the CNCP population as this group has elevated risk factors for overdose but are commonly overlooked. Customised overdose prevention interventions for CNCP patients attend to gaps in overdose awareness and risk perceptions in this population.

A systematic review on pharmacist-led pharmaceutical care optimization through virtual platforms

Objectives To display virtual pharmaceutical care programs implemented by pharmacists across the world. Accordingly, a search in PubMed, Scopus and Embase with keywords such as ''Pharmacist', 'Pharmaceutical care', 'Virtual platform' and its associated medical subject headings retrieved appropriate articles. The quality of each filtered article were assessed with the Critical Appraisal Skills Program checklist. Key findings A total of 2 14 841 articles were identified through database screening and 16 articles were extracted and finalized. Twelve papers presented different forms of electronic medical record-based virtual pharmacy systems that had significantly contributed to patient care;minimizing medication errors, rectifying adverse events, modifying drug administration patterns to reduce the fatality of drug-drug interaction and further promoting medication counselling. Nevertheless, few studies had social media platforms for providing clinical pharmacy services that depicted good patient satisfaction. Additionally, we were also able to portray community pharmacies that transformed themselves to provide better and easily accessible pharmaceutical care to their society. There are limited numbers of peer-reviewed articles on pharmacist-operated virtual systems. However, owing to the benefits imparted to patient safety and care by the virtual pharmacy in the era of pandemic, it is highly recommended that more pharmacy professionals contribute and implement such programs in their settings. Prospero Registration ID CRD42022307175.

Community Pharmacist's Background, Barriers and Competence towards Counselling and Administering COVID-19 Vaccines and Policymaker's Responsibilities

Community pharmacists have an important role in administering vaccines and educating the public about them. Vaccines are one of the most important means to prevent the spread of infections. This study was designed to assess the knowledge, attitudes, and practice of community pharmacists towards providing counseling and administering vaccines in Saudi Arabia during the COVID-19 pandemic. A cross-sectional study was conducted using a sample of 500 pharmacists of Saudi and non-Saudi origins, sampled from various community pharmacies in the Kingdom of Saudi Arabia. The age bracket of the participants was between 23-60 years. The entire duration of the study for was a period of 3 to 6 months. The researchers used the Statistical Package for Social Sciences (SPSS) software to carry out the data analysis. A total of 730 community pharmacists participated in this study, and the response rate was 83.24% of the 877 potential participants to whom the online questionnaires for data collection were emailed upon their informed consent to participant in the study. Most of them (86.58%, n = 632) were males. Their ages ranged between 20 and 59 years, with the age bracket 30-39 years being the modal class with a representation of 54.79% of all the participants. Few of them, 16.99% (n = 124) had Pharmacy diploma as their highest educational qualification, 1.23% (n = 9) had a master's degree, 0.41% (n =3) had a diploma, but the majority, 81.37% (n = 594) had a bachelor's degree in pharmacy. With an exception of 6 respondents (<1%), the participants had good knowledge regarding vaccination and more than half of them had extensive knowledge of doses, indications, side effects of interaction and contraindications to vaccines. Most respondents reported the pivotal role of the vaccine in preventing and controlling the spread of infectious diseases, especially in light of the COVID-19 pandemic. Vaccination continues to gain great importance. Among the participants, 46.16% (n = 337) of them believe that the current situation and the mechanism of adult vaccination is sufficient and (61.10%, n = 446) believe that increasing vaccination coverage among adults is important. A proportion of 40.82% ( n = 298) of respondents highly recommend the importance of having an official certificate in the field of vaccination for pharmacists. Female community pharmacists showed limited experience and average knowledge about vaccination but higher willingness to provide such service. The contribution of female pharmacists in the vaccination against COVID-19 is highly needed and by offering proper training to them they will be ready to succeed in the provision of service.

Global overview of pharmacist and community pharmacy actions to address COVID-19: A scoping review.

Introduction: Pharmacists and community pharmacies play an important role in managing, identifying and preventing the spread of the COVID-19 outbreak. Objectives: To characterize the global panorama of action by pharmacists and community pharmacies in facing the COVID-19 pandemic. Methods: The scoping review was based on the search for scientific articles in the databases: PubMed; Scopus; ScienceDirect and Web of Science. The search was carried out on August 31, 2021. The selection process was divided into 3 phases: i) title analysis; ii) analysis of study abstracts; iii) analysis of the full texts of the studies selected in the previous step. Studies were independently selected by two investigators and discrepancies resolved by consensus during focus group discussions led by a third reviewer. Results: The final search yielded 36 articles for the review. The main strategies for coping with COVID-19 were grouped into 4 categories defined by consensus between the authors: (1) services for providing care to the patient; (2) product management; (3) infection prevention and control practices in community pharmacy; (4) preparation, sources of information used and training offered/received. Through these, the aim was to involve technical managerial, technical assistance and pedagogical technical actions adopted, as well as structure and process indicators that allowed the continuity of the offer of services. Conclusion: During the pandemic, pharmacists and community pharmacies have been providing essential health services to communities. The results of this review may help to identify the changes adopted to face the COVID-19 pandemic and may contribute to improving the quality of practices in these establishments during the pandemic and after it, in similar situations.

Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists.

Background: Community pharmacists played an essential role in the control and management of the COVID-19 pandemic; both pharmaceutical care and community pharmacists were affected, given that, patients' needs and demands increased due to the fear of lockdowns and shortage of medication throughout the pandemic. Objectives: This study was based in Lebanon and aimed to assess the impact of the COVID-19 pandemic on (1) pharmacists, including infection rates, pay, and working hours, and (2) pharmacy practice, including medicine and personal protective equipment (PPE) shortages. Design: A cross-sectional study involving 120 community pharmacists was carried out between August and November 2021. Methods: Data were collected using an online survey filled out by pharmacists working in Lebanon. Results: Most participants (71.7%) reported an increase in their income during the pandemic, and 60% reduced their working hours. A significant association was noted between being previously infected and marital status, level of education, work position, and salary of the participants. Most participants (95.8%) encountered a shortage of medications during the pandemic leading to high home storage of medication, searching for other sources of medicines, and decreased patient/pharmacist interactions. Conclusion: The COVID-19 pandemic imposed new challenges on pharmacists and the provision of pharmaceutical care. It affected pharmacists' daily routines, putting them at risk of infection with limited availability of medicines and PPE. This study suggests that establishing effective crisis management plans to increase community pharmacists' resilience during similar outbreaks.

A photovoice study on community pharmacists' roles and lived experiences during the COVID-19 pandemic.

BACKGROUND: Community pharmacists were the face of the health response to the unprecedented COVID-19 pandemic. Their pivotal role during the pandemic has been widely recognized, as they adapted to continue to provide a higher level of care to their patients. OBJECTIVE: The objective of this study was to gain a deeper understanding of frontline pharmacists' lived experiences of the COVID-19 pandemic and its impact on their roles. METHODS: Photovoice, a visual research method that uses participant-generated photographs to articulate their experiences, was used with semi-structured interviews to explore pharmacists' lived experiences. Frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada were recruited. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. A published conceptual framework model was used as the foundation of the analysis with care taken to include new concepts. Ethics approval was obtained from the University of Alberta health research ethics board. RESULTS: Interviews were conducted with 21 participants and they 71 photos. This study advanced the conceptual framework model presented in a scoping review, of what was made visible (pharmacists' information, public health, and medication management roles) and what was invisible but made visible by the pandemic (pharmacists' leadership roles). It was revealed through the reflective nature of this study the important leadership role pharmacists have in their communities. CONCLUSIONS: This study highlighted the work of community pharmacists responding to the COVID-19 pandemic through their information, public health, medication management, and leadership roles. Their experiences also made visible the cost their work had on them as they did more to adapt and continually respond as the pandemic evolved. Pharmacists recognized their role as leaders in their practice and communities.

Readiness and willingness of Malaysian community pharmacists in providing vaccination services.

BACKGROUND: Vaccination is an effective public health intervention in reducing morbidity and mortality of infectious diseases. Compared to other countries where community pharmacists (CPs) administer vaccines, CPs in Malaysia are not authorised. This study aimed to assess CPs' readiness and willingness to provide vaccination in Malaysia, identify potential barriers to and factors supporting the provision of this service. METHODS: A cross-sectional study was conducted among Malaysian CPs from April to June 2021. A validated online questionnaire was distributed through social media, instant messaging, email, and pharmacy societies. RESULTS: Of 492 CPs recruited throughout Malaysia, 439 (89.2%) expressed willingness to provide vaccination services to the public, 403 (81.9%) agreed with the accessibility of community pharmacies to the public, and 73.4% agreed that their role in vaccination could help to improve the overall vaccination coverage rate. The lack of pharmacist training in vaccination and concerns on maintaining patient safety were identified as barriers to CPs' implementation of vaccination services, with 52.8% and 47.8% of them agreeing, respectively. Training sessions and operational guidelines on providing vaccination services are required to overcome the barriers. CONCLUSION: CPs in Malaysia were ready and willing to provide vaccination services to the public. However, the implementation demands training workshops and re-evaluation of CPs in public vaccination programmes by Malaysian healthcare policymakers.

A typology of vaccine hesitancies: Results from a study of community pharmacists administering COVID-19 vaccinations during the pandemic.

Pharmacists were integral to the vaccine administration process during the first two years of the COVID-19 pandemic. As such, they encountered a variety of different forms of vaccine resistance. This qualitative study explored 33 community pharmacists (from varying geographical and practice types) responses to vaccine resistance and tactics utilized to support vaccination amongst diverse community members. A typology of 8 different variants of vaccine hesitancy emerged, each with its own root cause and potential opportunities for intervention. Pharmacists in this study described techniques to support adherence to public health guidance based on their assessment of root causes for resistance demonstrated by patients. Importantly, all pharmacists in this study described feelings of anger towards truly anti-vax patients and unwillingness to actually engage or even try to address this group in their practice.

Community pharmacists' perceptions and experiences of stress during COVID-19.

BACKGROUND: Pharmacists play a crucial role in the COVID-19 pandemic scenario, performing frontline roles for the community, and supporting the healthcare system. This study aimed at investigating stress and its correlates among this category of workers at a high risk of SARS-CoV-2 infection. METHODS: The participants for this study were employees of the "Municipal Pharmaceutical Company" of L'Aquila (Italy). Data were collected using an anonymous, web-based, self-administered questionnaire. Two independent surveys were conducted, from June to July 2020, and in January 2021. RESULTS: Two separate groups of respondents were involved: a total of 37 workers participated in the first survey (mean age 44.9 ± 10.7, 75.7% women) and 18 in the second survey (mean age 45.9 ± 9.2, 94.4% women). The average total scores of the perceived stress (GHQ-12 score) increased significantly from 15.5 to 18.2 (p = 0.0438), showing a moderate level of stress in the category investigated. CONCLUSIONS: We observed a strong emotional exhaustion in the study sample of pharmacists, who reported high-risk perceptions and fear. A comprehensive assistance should be granted to support the well-being of healthcare workers who provide an essential service, despite the high risk of infection.

A Community Pharmacist's Guide to Oral COVID-19 Antivirals.

The recent approval of novel, oral antivirals for the treatment of COVID-19 has significantly altered the outpatient management of patients diagnosed with COVID-19. From a community pharmacy perspective, the two treatment options for mild to moderate COVID-19 are Paxlovid™ (nirmatrelvir/ritonavir) and Lagevrio™ (molnupiravir). While the availability of these antivirals has expanded community pharmacists' capability to provide care for patients diagnosed with COVID-19, many community pharmacists may struggle to effectively operationalize these agents in practice. This commentary provides a review of Paxlovid™ and Lagevrio™ clarifying the differences between each medication and their respective places in therapy, as well as suggestions and best-practices to operationalize the provision of these services in community pharmacies. These considerations are necessary to support and inform community pharmacy practice when providing oral COVID-19 antiviral therapy.

Home Drug Delivery Service from the Perspective of Community Pharmacy Staff in Saudi Arabia.

Background: In response to COVID-19, many big pharmacy chains in Saudi Arabia have started to provide home drug delivery services. This study aims to understand home drug delivery service from the perspective of community pharmacists in Saudi Arabia. Also, the study investigates the obstacles that may limit the use of home drug delivery service. Methods: A cross-sectional self-reported survey was distributed from February 2021 to May 2021. Descriptive analysis of sociodemographic characteristics was conducted and presented. Frequencies and percentages were calculated for all variables. Results: A total of 965 community pharmacists were surveyed. Most of the pharmacists, (73.5%) were young, aged 23 to 34 years old. The vast majority of the participants, (93.6%), said that the service will improve drug adherence. The lack of required knowledge and skills among pharmacists could be the main obstacle to implement home drug delivery service (34%). A shortage in the number of community pharmacists was the second main obstacle (24%). Conclusion: Home delivery services in the future may largely replace the tradition of going in person to the pharmacy. There are obstacles that may limit the full use of the service like shortage in number of pharmacists and the lack of required training.

Assessing Community Pharmacists' Perception on Readiness to Initiate Point-of-Care Testing for SARS-CoV-2 in New York State During the Pandemic.

Introduction: Pursuant to the COVID-19 pandemic, an executive order issued by the New York State (NYS) governor allowed pharmacists to act as laboratory directors for a limited-service laboratory (LSL) to order and perform Food and Drug Administration (FDA) and Emergency Use Authorization (EUA) Clinical Laboratory Improvement Amendment (CLIA)-waived COVID-19 point-of-care testing (POCT). Objectives: To (i) assess the status of NYS community pharmacists with POCT in the early stages of the COVID-19 pandemic, (ii) assess the readiness and willingness of community pharmacists to incorporate COVID-19 POCT into their workflow during a pandemic, and (iii) assess community pharmacists' perception of the barrier to initiating COVID-19 POCT. Methods: This is a prospective cross-sectional study conducted from February 4 to February 21, 2021. An electronic survey consisting of 66 Likert-type questions, select all that apply, and fill-in-style questions were emailed to 250 Community Pharmacy Enhanced Service Network (CPESN) NY pharmacies, with a follow-up email sent halfway into the data collection period. The data were analyzed using descriptive statistics. Results: The result indicated that most participants (median = 5) demonstrated readiness and willingness to offer COVID-19 testing. Barriers to COVID-19 POCT were identified: impact on pharmacy workflow (59%), lack of payment mechanism (55%) and lack of sufficient training (21%). Most participants expressed interest in continuing POCT beyond the pandemic (86.1%). Conclusion: Community pharmacists in NYS reported willingness to initiate COVID-19 POCT. Addressing the identified barriers, such as workflow disruption and reimbursement challenges, will enable pharmacies to be better prepared to provide patient care, including POCT.

Development and evaluation of an online training program based on the O-AMAS teaching model for community pharmacists in the post-COVID-19 era.

Background: Formerly, the community pharmacists' work was mainly focused on drug supply. However, during the COVID-19 epidemic outbreak, community pharmacists in Wuhan played an important role in control and prevention of SARS-CoV-2 and in providing pharmaceutical care. Due to a lack of adequate knowledge and skills, many community pharmacists were not able to cope with healthcare work timely and efficiently. To improve community pharmacists' specialized knowledge and enhance their professional competence through systemic training in the post-COVID-19 era. Methods: Based on the O-AMAS (Objective, Activation, Multi-learning, Assessment and Summary) teaching model and flipped classroom, an online continuing training program containing four sections was developed. It was a semi-experimental study with no control group. Quantitative tests before and after training as well as questionnaire were used to evaluate the outcome of this training program for community pharmacists. Results: A total of twenty-six community pharmacists were invited to participate in continuing education, and twenty-five trainees finished this training program with a completion rate of 96.2 %. Quantitative tests before and after training and anonymous questionnaires were carried out to comprehensively evaluate the outcomes of this training program. Compared with the test scores before training (61.6 ± 6.6), the score after training was statistically higher, reaching 80.9 ± 7.5 (P < 0.001). Twenty-three questionnaires were received (returns ratio, 92.0%). Notably, most of the pharmacists were satisfied with the training program. The percentage of positive responses for each item in this anonymous questionnaire was more than 85 %. Conclusion: It was suggested that the O-AMAS model and the flipped classroom-based continuing educational program achieved the expected training effects. It is a promising on-the-job training approach for pharmacy continuing education. Moreover, our study also demonstrated that online learning had advantages of no geographic constraints, flexible learning beyond time and easy interaction, over traditional face-to-face training style, especially in the post-pandemic era.

Anxiety levels of community pharmacists during the COVID-19 pandemic: a cross-sectional study in Istanbul

Community pharmacists have been on the frontlines during the 2019 Coronavirus Disease (COVID-19) pandemic. Although the mental health and anxiety levels of many other health workers are studied in this period, literature is very limited to understand the experience of pharmacists. This study aims to define the anxiety level of community pharmacists in Istanbul during the COVID-19 pandemic and identify possible influencing factors. The population of the study is community pharmacists from pharmacies in Istanbul. In this cross-sectional study, 348 pharmacies are selected by simple random sampling. Participants are approached via telephone and inquired with questions about sociodemographic information, work conditions, COVID-19 specific concerns, and the Beck Anxiety Inven-tory. 239 (68.7%) pharmacists responded. This study identifies that, by the 6th month of the pandemic, the mean anxiety score of the pharmacists in Istanbul is 9.4±10.6, and 54.8% (n=134) of the participants is experiencing “minimal” anxi-ety. However, they have some COVID-19 specific concerns (becoming infected and transmitting the disease to family or environment) at high and extreme lev-els. Those concerns significantly increase the anxiety score. The findings of this study are promising for public health, as they show that community pharmacists could cope with the psychological effects of the pandemic. © 2021, Hacettepe University, Faculty of Pharmacy. All rights reserved.

Opportunistic Risk Screening of Depression by Community Pharmacists: Noble Intervention to Mend the Mind during COVID-19.

Depression is the most common condition affecting the mental health of individuals. During the whole lifetime, at least one in four individuals go through an episode of this disorder. Recently, the Malaysian number of cases has increased to around 500,000 with more adding due to COVID-19 pandemic. The first professionals to detect depression by analysing the rather emotional, presenting symptoms of the patient are the family physicians. In such circumstances, how is it possible for a community pharmacist to identify undiagnosed depression? Depression is real, sadly, the silent nature of the disorder results in an increase in its unreported cases. On the bright side we believe the new screening guidelines and intervention of community pharmacists might be one noble way to aid in the opportunistic risk screening of depression and heal the hidden emotions during COVID-19.

Healthcare concerns of older adults during the COVID-19 outbreak in low- and middle- income countries: Lessons for health policy and social work

This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 717-723. (The following of the original article appeared in record 2021-00510-034.) Older people have been identified to be one of the most vulnerable population groups to the 2019 novel coronavirus (COVID-19). At the same time, more health workers in low-and middle-income countries (LMICs) including Ghana are contracting COVID-19. This poses healthcare utilization concerns for older adults. As a result, many older adults are changing their health-seeking behavior by staying at home and resorting to informal healthcare such as the use of traditional therapies and over-the-counter medicines for self-treatment or to boost their immune system. This commentary calls for social workers to collaborate with health authorities and community pharmacists to develop social and health programs to increase older adults' access to healthcare during the COVID-19 crisis. Policies are also required to deal with the pandemic and its impact on health systems in LMICs for both short and long term. We have suggested in this commentary how governments, health institutions, and local authorities in LMICs can address the healthcare concerns of older adults during this and any future pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Pharmaceutical Care Services During the COVID-19 Pandemic in Turkey: Proposal of a Holistic Approach

Community pharmacists, who are among the primary healthcare service providers, are regarded as the closest and most accessible healthcare professionals. Unfortunately, patient counseling, one of the most important pharmacy profession tasks, cannot he performed in exceptional cases, which can endanger patient safety. The coronavirus disease-19 (COVID-19) pandemic process we are facing today is an example of these particular situations in Turkey. Partial curfews imposed within the scope of COVID-19 pandemic measures have also increased problems. Therefore, there is a need for a pharmaceutical care service network that will enable individuals who do nor have aces to pharmacies, who arc in risk groups, or whose mobility is restricted due to pandemic or disaster, to reach their prescribed medicines safely under pharmacist consultancy. In this regard, establishing a pharmaceutical care service network on a scientific and systematic basis may solve the current problems, mostly encountered during the COVID-19 pandemic in Turkey. Designing a network within the framework of vehicle routing and assignment problems is important in ensuring patients' rapid access to prescribed medications and preventing unfair competition among pharmacies.

Role of community pharmacists in the prevention and control of Covid-19 in Catalonia

Background: In the last decades, both pharmacy and pharmacist have been in a constant evolution, being fundamental in the control of infectious diseases. The aim of this research is to show the role of community pharmacists in disease prevention and monitoring programs, specifically in the control of COVID-19. Besides, we want to know the perception of pharmacists about their role in the control of the COVID-19 pandemic. Methods: An online survey was sent to 8556 community pharmacists registered in Catalonia, in which they were asked about their opinion and perception of their role in different COVID-19 control activities. A bivariant and descriptive analysis of the different variables was done globally, age stratified (<40 years, 40-60 years, >60 years) and according to the type of pharmacy (urban vs others). Results: The response rate was 14.63% (1253). However, despite the positive perception that pharmacists have about their role in the pandemic, 90,9% of the respondents consider that the Health Administration didn't count much on them. Statistic significative differences were found in some aspects, for example, in the pharmacists' perception of the knowledge level of the pharmacy users, or in the frequency of encounters with COVID negationists, both aspects related with the pharmacist age (p=0,047 and p=0,0001 respectively). Conclusions: Pharmacies are sanitary establishments strategically located to perform public health activities and to control pandemics. Therefore, the pharmacist, as a health professional, should be considered one more piece of the gear to improve the efficiency of the health system.

Feeling the burn in the era of COVID-19: cross-cultural adaptation and validation of the Arabic version of the Copenhagen Burnout Inventory among community pharmacists.

BACKGROUND: Community pharmacists (CPs) are one of the frontline healthcare workers (HCWs) working diligently to provide much-needed services during the COVID-19 pandemic. Burnout was one of the detrimental outcomes of the pandemic on the mental health of Lebanese CPs. To assess the extent of this syndrome among Lebanese CPs, a psychometrically reliable and valid tool is needed. OBJECTIVES: This study aimed to validate the Arabic version of the Copenhagen Burnout Inventory (CBI-A) for use in the assessment of burnout among CPs. METHODS: A web-based cross-sectional study was conducted among Lebanese CPs over February 2021. Data were collected using an anonymous Arabic self-administered questionnaire that includes information on socio-demographic characteristics, work-related variables, in addition to the measurements: the CBI which includes personal, work-related, and patient-related dimensions of burnout, and the hospital anxiety and depression scale. Data were analyzed using SPSS and Amos software. Exploratory factor analysis and confirmatory factor analysis were performed to explore the factorial structure and to measure model fit. Cronbach's alpha was used to assess internal consistency. The criterion validity of the CBI was assessed. Multivariable linear regression analyses were used to explore the association between different aspects of burnout and mental health outcomes such as depression and anxiety. RESULTS: The CBI-A showed high internal consistency with Cronbach's alphas varied from 0.774 to 0.902 and a low floor and ceiling effect (1-9%). As for the CBI-A construct validity, the exploratory factor analysis showed three factors with good factor loadings and explained 72.17% of the variance. The confirmatory analysis supported the three-factorial structure of the CBI that presented a good overall fit based on the goodness-of-fit indices. Ad hoc modifications to the model were introduced based on the modification indices to achieve a satisfactory fit by allowing one covariate error between one pair of items within the personal burnout domain. All of the 19 items were kept in the construct since they showed a good factorial weight. The CBI-A is associated with burnout-related factors in expected directions, including extensive working hours, sleeping hours, and job satisfaction, indicating, therefore, the criterion validity of the tool. CBI subscales were also found positively associated with mental health outcomes such as depression and anxiety demonstrating, in turn, a predictive validity. CONCLUSION: This study provides evidence for the validity and reliability of the Arabic version of CBI as an adequate tool for assessing burnout among CPs. Such an instrument could be useful for assessing such syndrome among other healthcare workers.

Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19.

In Italy, following the start of the SARS-CoV-2 vaccination campaign, community pharmacies (CPs) were recruited on a voluntary basis in order to administer COVID-19 vaccines as part of their activities. The aim of the present study was to investigate the knowledge, attitudes, and practices regarding SARS-CoV-2 infection prevention, and vaccine acceptance/hesitancy towards COVID-19 and influenza vaccinations among the community pharmacists operating in the Palermo Province. A cross-sectional study was conducted, with two different questionnaires administered before and after the conduction of the vaccination campaign against SARS-CoV-2 at the COVID-19 vaccination center of the Palermo University Hospital (PUH). The baseline survey showed that 64% of community pharmacists (CPs) declared that they planned to vaccinate against SARS-CoV-2, and 58% were vaccinated against influenza during the 2020/2021 season. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines (adjOR 1.76; CI 1.11-2.80), fear of contracting SARS-CoV-2 infection (adjOR 1.50; CI 1.06-2.11), considering COVID-19 vaccination to be the best strategy to counteract SARS-CoV-2 (adjOR 1.79; CI 1.39-2.29), and adherence to influenza vaccination during the 2020/2021 season (adjOR 3.25; CI 2.23-4.25). The adherence among CPs of the Palermo Province to COVID-19 vaccination was 96.5%. From the post-vaccination survey, the main reasons for changing opinions on vaccination adherence were the introduction of mandatory vaccinations, fear of contracting COVID-19, and limitations on work activities in the case of vaccine refusal. The achievement of very high COVID-19 vaccination coverage rates among healthcare professionals (HCPs) in the present study was mainly due to the mandatory vaccination policies; nevertheless, a willingness for COVID-19 vaccination was relatively high among pharmacists before the beginning of the vaccination campaign. HCPs and CPs should receive training on vaccination, which is recommended in the national immunization plan and is also suggested by the respondents in our study, in order to routinely re-evaluate their own vaccination profiles, as well as those of their patients.