Pharmaceutical consultations associated with dematerialized drug dispensation in exceptional health context: Proof of concept and perspectives

During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.Copyright © 2022 Elsevier Masson SAS

On the Frontline Against COVID-19: Provision of Community Pharmacy Services during a Public Health Crises

Objectives: During the current pandemic, it is recognised that pharmacies will often be the first point of contact with the health system for individuals with COVID-19 related health concerns or who require reliable information and advice. It is also important in the midst of the current public health crisis to reduce general practitioners' (GP) minor ailment-related workload. The aim of our study is to examine the problems in the midst of public health crisis of the current magnitude with the roles and activities of pharmacists. This information could help to inform future decisions about the restructuring of existing health services by governments, public health bodies and policy makers in response to public health crises such as COVID-19. Method(s): The study was carried out among 384 consumers using pharmacy in the regions of Armenia and Yerevan. Research instrument was questionnaire. Number of questionnaires distribution was determined by The Survey System Version 11.0. Analyses were performed using Statistical Package for the Social Sciences (SPSS) software (version 12.0). Result(s): During the study it becomes clear that very few percentage of consumers (17%) consulted by a pharmacy employees. Most of them don't get the necessary information from the pharmacy employee about medicine. Only 29 % of consumers are clearly satisfied with the answers of a pharmacy employee and 26% fully trust them. Conclusion(s): Steps should be taken for improving the professional knowledge of pharmacists about medicines and pharmaceutical care, which, in turn, can restore consumer trust in them, will help avoid self-medication errors by providing advice on medicines in response to public health crises such as COVID-19. There is a need to develop pharmaceutical care algorithms for minor ailments, national emergency drug formularies for COVID-19.Copyright © 2023

Response to COVID-19 Pandemic: Managing Inpatient Pharmacy Services at King Abdulaziz Medical City - Jeddah.

Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

Covid19 Impact OnTwelve Sectors Of The Indian Economy

This study aims to investigate the reaction of COVID-19 cases (confirmed, deaths, recovered, & active) on twelve sectors of Indian economy by using sectoral indices of national stock exchange. Daily frequency of COVID-19 case categories was obtained from Worldometer from January 30, 2020 to June 30, 2020 and dataset of daily closing prices of twelve sectoral indices (auto, banks, financial services, fast moving consumer goods, information technology, media, metal, oil & gas, pharmaceutical, public sector banks, private banks, realty sector) was obtained from national stock exchange web portal for the same period as of COVID-19. In this study, the ordinary least square regression was used to study the significance of COVID-19 cases (confirmed, deaths, recovered, & active) on twelve sectoral indices. Empirical evidence suggested no significant impact of COVID-19 cases on daily returns of twelve major sectors represented by sectoral indices except in the case of pharmaceutical sector, where daily growth in number of deaths is impacting daily returns on pharmaceutical sectoral index in a positive way. The twelve sectoral indices went into a downward spiral at the beginning of COVID-19 pandemic, but as government and central bank introduced various policy measures, the impact of COVID-19 pandemic on sectoral indices faded away.Copyright © 2020 Ubiquity Press. All rights reserved.

Role of pharmaceutical care in therapeutic regimens within the community pharmacy.

The concept of pharmaceutical care (PC) has existed as a professional philosophy for more than 30 years. However, for a long period of time, little had been done for its integration into the regular practice of healthcare provision. The COVID-19 pandemic and the resulting increase in patient influx in the community pharmacies (CP) encouraged the exploration and establishment of new healthcare services provided within the CP. Nevertheless, these services of PC are still novel, and more can be done to expand the community pharmacists' current role in primary healthcare. This can be achieved by improving and expanding the newly established services, all while incorporating new ones, for the benefit of public health and the reduction of avoidable healthcare expenditures. This article reviews information about the benefits of this service regarding patient health and the reduction of financial expenses pertinent to adverse drug events within the setting of the CP. Adverse drug events account for significant healthcare expenses and patient distress due to relevant symptoms, emergency doctor visits, and increased hospitalization rates. Several studies conducted internationally have investigated the positive impact of PC practiced by community pharmacists. In spite of results sometimes presenting a non-continuous pattern, PC applied under specific conditions has tangible positive outcomes. Congestive heart failure and type 2 diabetes mellitus patients presented fewer hospital admissions, better symptom control, and higher adherence in comparison to control groups, while a study on asthma patients revealed improved inhalation techniques. All intervention groups reported psychological improvement and a better understanding of their treatment. Special reference is made to the importance of this service for patients receiving anti-cancer treatment and how community pharmacists can have a crucial role in designing, monitoring, and re-designing these therapeutic schemes whose complexity and related adverse drug events negatively affect patient adherence. The role of community pharmacists was very important, especially for primary care, for both patients and healthcare systems during the pandemic, and it seems that it will remain decisive in the post-COVID era as well. The increased complexity of therapy and polypharmacy creates the need for organized, active participation of pharmacists in healthcare provision so that they can use their knowledge and skills under continuous cooperation with other healthcare professionals, thus providing coordinated services for the benefit of the patient.

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic.

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

A qualitative study into the barriers and facilitators to effective communication with people with age-related hearing loss in community pharmacy settings

Introduction: One in six adults are affected by hearing loss, and this number increases with age.(1) Inadequate communication is a barrier to the delivery of effective care for people with hearing loss.(2) Communication regarding medicines is particularly relevant to the pharmaceutical care of older people who are more likely to be living with hearing loss, have multiple comorbidities and experience polypharmacy, a risk factor for adverse drug events. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, to provide a base upon which to identify solutions/ interventions to improve these interactions. Aim(s): To explore the barriers and facilitators to effective communication with people with age-related hearing loss in the community pharmacy setting. Method(s): This qualitative study consisted of semistructured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and focus groups and interviews with community pharmacists, conducted between March - June 2022. Participants were recruited purposively via advert and snowballing. Interviews and focus groups were conducted using Microsoft Teams or Zoom;two interviews were held by telephone. Data was analysed using the framework method. Result(s): Sixteen people with age-related hearing loss and three older people without hearing loss took part. Eight community pharmacists took part across two focus groups and one interview. Four main themes were identified. The first was 'grappling with the environment'. This theme reflects the multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, time constraints, lack of privacy, noise levels and Covid-19 safety measures on communication. The second was 'promoting acknowledgment and inclusion of hearing loss in the pharmacy'. This theme captures the perception among patients that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss. Third, 'patient perceptions and use of community pharmacy services'. This theme highlights the awareness and perceptions of the role of the pharmacy that is, primarily or exclusively as a place to collect prescriptions and the limited interaction with pharmacy personnel. The final theme was 'differing perceptions of patients and pharmacists about communication'. This theme articulates the varying patient-provider perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Conclusion(s): This study garnered rich insights about the experiences of accessing and providing pharmaceutical care for people with age-related hearing loss within the community pharmacy setting. However, due to the Covid- 19 pandemic, data collection was chiefly conducted online and the findings cannot be considered reflective of the experiences of older people facing digital exclusion. There is clearly a need to improve pharmacists' awareness of, access to and implementation of strategies, adaptations, and assistive technologies to facilitate communication with people with hearing loss. Future research should identify interventions to support the implementation of strategies/adaptations that are tailored to the needs of people with hearing loss and pharmacists in order to engender hearing-friendly community pharmacies.

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.

Telemonitoring of older anticoagulant users during the COVID-19 pandemic

The COVID-19 pandemic brought challenges to the monitoring of anticoagulant users, especially older adults, making telemonitoring an alternative to provide continuity of care for these patients. The present study aimed to describe the experience of telemonitoring of older anticoagulant users during the COVID-19 pandemic. This is a descriptive study concerning the telemonitoring pharmaceutical service for older adults (>= 60 years old) using oral anticoagulants in a private geriatric outpatient clinic (Belo Horizonte). Older people had parameters of effectiveness and safety of anticoagulants monitored monthly by telephone (Apr-Dec/2021). Identified problems generated interventions for the patient or the multidisciplinary team. A total of 425 older adults were included in the service. Most used apixaban (189;41.9%), rivaroxaban (146;34.4%) and warfarin (47;11.1%). There was a mean age of 82.1 years, mostly female (65.2%), most at high risk of vulnerability (69%), and an incidence of 9.9% of COVID-19. There were 219 interventions related to warfarin (average of 4.6 interventions/patient);including requests for an INR test (57.5%), health guidelines (19.6%), dosage change (reduction -10.5%;increase -5.9%;suspension -0.6%), or referral (5.9%). Users of other anticoagulants did not show alterations in the monitored parameters. Eleven older adults suffered falls and 10 required hospitalizations due to thromboembolic or hemorrhagic events. There was no statistically significant difference in hospitalization rates between users of warfarin or other anticoagulants (p=0.314). Monitoring older anticoagulant users is important, especially considering the high level of frailty identified and the thromboembolic and non-thromboembolic risks that COVID-19 brings. Telemonitoring was important, allowing for multiple interventions to be performed.

A systematic scoping review of implementation of telepharmacy during COVID-19

This systematic scoping review aimed to examine the literature on expanding role of telepharmacy services during the ongoing COVID-19 pandemic. Four electronic databases, PubMed, Scopus, ProQuest, and Cochrane, were searched to identify published studies that reported implementation of telepharmacy services since the start of pandemic (31st December 2019 to 31st May 2022). Twenty-eight studies met the inclusion criteria comprising 15 cross-sectional studies, 12 studies sharing experience and practice related to telepharmacy services, and one pre-post intervention study. Studies reported establishment and implementation of various novel telepharmacy models in different settings;primary, secondary, tertiary, and quaternary care hospitals, hospital and community pharmacies, and specialized care centers. Telepharmacy provided pharmaceutical care to patients with COVID-19, chronic diseases, HIV infection, cancer, cystic fibrosis, and patients on anticoagulants. Pharmaceutical care services like patient counseling services (19 studies), medication order review and medication reconciliation (15 studies), drug therapy optimization (11 studies), adverse drug reaction monitoring and management (7 studies), medication adherence assessment (5 studies), and drug-related problem monitoring (4 studies) were delivered using telepharmacy. Based on the identified evidence, telepharmacy proved beneficial in delivering a range of pharmaceutical care services to the patients during the current pandemic. However, there is a need for more rigorous evidence on the reliability, safety, and effectiveness of telepharmacy in comparison to the traditional face-to-face healthcare delivery model © 2023 Syed Arman Rabbani et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/)

An Integrated Multidisciplinary Circuit Led by Hospital and Community Pharmacists to Implement Clopidogrel Pharmacogenetics in Clinical Practice.

The use of pharmacogenetics to optimize pharmacotherapy is growing rapidly. This study evaluates the feasibility and operability of a collaborative circuit involving hospital and community pharmacists to implement clopidogrel pharmacogenetics in Barcelona, Catalonia, Spain. We aimed to enroll patients with a clopidogrel prescription from cardiologists at the collaborating hospital. Community pharmacists collected patients' pharmacotherapeutic profiles and saliva samples, which were then sent to the hospital for CYP2C19 genotyping. Hospital pharmacists collated the obtained data with patients' clinical records. Data were analyzed jointly with a cardiologist to assess the suitability of clopidogrel. The provincial pharmacists' association coordinated the project and provided IT and logistic support. The study began in January 2020. However, it was suspended in March 2020 due to the COVID-19 pandemic. At that moment, 120 patients had been assessed, 16 of whom met the inclusion criteria and were enrolled in the study. The processing of samples obtained before the pandemic had an average delay of 13.8 ± 5.4 days. A total of 37.5% patients were intermediate metabolizers and 18.8% were ultrarapid metabolizers. No poor metabolizers were detected. Pharmacists rated their experience with a 7.3 ± 2.7 likelihood of recommending that fellow pharmacists participate. The net promoter score among participating pharmacists was +10%. Our results show that the circuit is feasible and operable for further initiatives.

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.

Providing Oncology Pharmacy Services during the Coronavirus Pandemic. French Society for Oncology Pharmacy (Societe Francaise De Pharmacie Oncologique-Sfpo) Guidelines Writing and Evaluation

Introduction: In 2020, SARS-COV-2 appeared and the most dramatic pandemic since decades spread over the world. Waiting for vaccines development, cancer patients were at a higher risk of the COVID-19 infection and more likely to be subjects of a higher morbidity and mortality. This was a big challenge for oncology teams that have to treat patients avoiding contamination by SARS-Cov-2. The aim of the current work is to present oncology pharmacy practice guidelines during the COVID-19 pandemic to secure pharmaceutical care of the cancer patients and their evaluation, 6 months later. Material(s) and Method(s): In April 2020, the bureau of the French Society for Oncology Pharmacy proposed these recommendations according to the French High Authority of Health regarding the guidelines for Good Practice, slightly modified according to pandemic crisis situation. These guidelines were elaborated by a working group of 7 experts in oncology pharmacy practice. Furthermore, the guidelines were assessed by 31 independent reviewers. In January 2021, guidelines were then evaluated by 47 independent reviewers through a specific survey. Results and discussion: About guidelines elaboration, 100% of reviewers approved the guidelines and 90% of them suggested some improvements. The final version incorporates the best compromises and consists of 26 recommendations organized in 8 different sections. Six months later, 47 pharmacists, mainly from Cancer Centers (17%), University Teaching Hospitals (19%) and general hospitals (49%) evaluated guidelines. Eighty one percent of them have used them and 77% judged them useful or partially useful. 22 recommendations were applied by at least 60% of pharmacists [62-93] and only 4 were applied by around40%of reviewers. Conclusion(s): These guidelines allowed to secure the pharmaceutical management of cancer patients during the COVID-19 pandemic. The most challenged recommendations were linked to external services (i.e. teleworking) or procedure in severe conditions implementation.