Community Pharmacy Practice During COVID-19 Pandemic: A Perspective From the Middle East.

The coronavirus disease 2019 (COVID-19) pandemic poses serious challenges to pharmaceutical care services, and innovative responses by community pharmacists and regulatory bodies are needed. The experience in Jordan, located in the Middle East, is shared in this article in light of available international guidelines to provide insight into the efforts made by the pharmacists to safely maintain pharmaceutical services during the current pandemic. In addition, unique roles played by community pharmacists in other countries are discussed to shed light on the important role of community pharmacists in this outbreak.

A qualitative evaluation of pharmacy technician opinions about administering immunizations.

Introduction: Pharmacy technicians began administering immunizations in Idaho State as part of a new administrative rule in 2017. Rapid expansion of pharmacy technicians as immunizers occurred during the COVID-19 pandemic. Previous studies demonstrate the success of having technicians as immunizers but, the opinions of technicians themselves about immunizing have not been explored. Methods: Key informant interviews were conducted to evaluate the opinions of certified and immunization-trained pharmacy technicians in the State of Idaho. A key informant interview script was utilized and included questions regarding satisfaction with current position, feelings about responsibility in the pharmacy, confidence administering immunizations to patients, changes patient interactions after becoming immunization-trained, support in the pharmacy, and opinion about expansion of immunization training for technicians to other states. The aim of this research was to gather the opinions of pharmacy technicians regarding the impact of administering immunizations on job satisfaction and career outlook. Results: Fifteen pharmacy technicians were interviewed. All participants believed their role as immunizers improved job satisfaction and feelings of being a valuable part of the pharmacy team. Technicians also believed being able to immunize aided in pharmacy workflow, decreased wait time for immunizations at their respective pharmacies, and increased the number of immunizations being administered. Respondents also believed technicians should be allowed to administer immunizations nation-wide but also felt strongly that the decision to immunize should be up to each individual pharmacy technician. Conclusion: Immunizing technicians in this study believe that this advanced role has had a positive impact on their job satisfaction, feeling valued in the workplace, and likelihood of staying in their current position. Immunizing has also led to positive engagement with patients and beliefs that they are providing an impactful service to their communities.

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.

Human Papillomaviruses in Adolescents: Knowledge, Attitudes, and Practices of Pharmacists Regarding Virus and Vaccination in France.

Human papillomaviruses (HPVs) are responsible for one of the most common sexually transmitted diseases in the world, and their oncogenic role has been well demonstrated in genital, anal, and oropharyngeal areas. However, a certain distrust and a lack of knowledge about this vaccine are perceptible among French adolescents and their parents. Thus, health professionals and, more particularly, pharmacists appear to be key persons to promote HPV vaccination and restore confidence in the target population. The present study aims to assess the knowledge, attitudes, and practices regarding HPV vaccination among pharmacists, particularly in boys, following the 2019 recommendation to vaccinate them. The present study was designed as a cross-sectional, quantitative, and descriptive survey that was conducted from March to September 2021 among pharmacists in France. 215 complete questionnaires were collected. Gaps in knowledge were found, only 21.4% and 8.4% obtained a high level of knowledge related to, respectively, HPV and vaccination. Pharmacists were confident in the HPV vaccine (94.4%), found it safe and useful, and felt that the promotion of the vaccine was part of their role (94.0%). However, only a few have already advised it, which they justify due to a lack of opportunity and forgetfulness. Faced with this, training, computerized reminders, or supportive materials could be implemented to improve the advice and thus the vaccination coverage. Finally, 64.2% were in favor of a pharmacy-based vaccination program. In conclusion, pharmacists are interested in this vaccination and the role of promoter. However, they need the means to facilitate this mission: training, computer alerts, supportive materials such as flyers, and the implementation of vaccination in pharmacies.

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.

Qualitative analysis of a community pharmacy practice transformation initiative

Objective: To evaluate practice transformation team (PTT) members' perceptions of the Flip the Pharmacy (FtP) initiative as a strategy for implementing and improving community pharmacy-based patient care. Method(s): FtP is a national 2-year practice transformation initiative for implementing enhanced patient care and medication optimization services at community pharmacies, launched in 2019 with 28 PTTs including over 500 pharmacy locations. Key informant interviews were conducted with team leads, coaches, and pharmacy champions from four PTTs that participated in the first FtP cohort. The interviews were conducted using semistructured interview guides based on the RE-AIM framework and focused on participants' experiences in the first year of FtP. Interviews were audio-recorded, transcribed, and analyzed using a rapid content analysis approach. Result(s): Four leads, 8 coaches, and 8 pharmacy champions were interviewed from 4 PTTs from May to October 2021 and resulted in 10 themes: (1) community pharmacy practice experience is important when selecting coaches;(2) team readiness supports successful pharmacy practice transformation;(3) measures of patient care quality are needed;(4) payment and practice transformation opportunities happen in parallel;(5) successful practice transformation requires strategic involvement of the entire pharmacy team;(6) FtP practice transformation domains are synergistic;(7) change packages, coaching, and performance monitoring are core practice transformation supports;(8) pharmacy teams value opportunities to share and learn from each other;(9) sustaining patient care services is continuous;and (10) COVID-19 accelerated practice transformation while creating new stress points. Conclusion(s): Participants in this study perceived the FtP initiative as a helpful strategy implementing and improving community pharmacy-based patient care. Future research should explore the sustainability of the FtP initiative and similar community pharmacy practice transformation efforts.Copyright © 2022 Pharmacotherapy Publications, Inc.

Pharmacists' Roles and Practices in Pharmaceutical Services During Covid-19 Pandemic: A Qualitative Study

The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020. Pharmacists as health workers also play an important role in this pandemic. This study aims to dig deeper into how pharmacists perceive their role and pharmaceutical services during this pandemic through a qualitative study with Focus Group Discussions (FGDs). Fifteen pharmacists from The Riau Islands Province were involved in the study based on a purposive sampling technique. They were purposively selected to include a wide range of pharmacists from the community pharmacies, hospitals, and community health centers. The FGDs were conducted via recorded Zoom meetings. The collected data were then transcribed and analyzed with inductive content analysis. This study found five themes with 18 sub-themes. The five themes were the roles and efforts of pharmacists in managing medicines, medical devices, and disposable medical materials (personal protective equipment);the roles of pharmacists in providing pharmaceutical care;community behaviors during the pandemic;development of pharmacists' roles and capacity during the pandemic;and external factors influencing the roles and practice of pharmacists during the pandemic. During the pandemic, pharmacists continued to work according to their previous roles and adjusted their roles and practice in pharmaceutical services to follow changes in community behaviors. This condition also encouraged pharmacists to develop their roles and capacities. The healthcare management team, the government, and the professional organizations influenced their roles, both positively and negatively. The results of this study provide a deeper understanding of pharmacist roles and practices during the pandemic. This understanding will be useful for the pharmacist in developing their potential and capability to be involved as healthcare professionals, specifically during the pandemic situation and generally in disaster management.Copyright © 2022 by Indonesian Journal of Pharmacy (IJP).

Pharmacogenetics in pharmacy practice: Collaboration between community and hospital pharmacists

Background: Clopidogrel is a CYP2C19-activated pro-drug, used to prevent cardiovascular events. Up to 27% of Caucasians has at least one CYP2C19*2 allele (impaired enzymatic activity), whereas 38% have at least one CYP2C19*17 allele (higher enzymatic activity). However, CYP2C19 pharmacogenetic analysis before prescribing clopidogrel is not widely implemented in clinical practice. Purpose(s): To evaluate feasibility and operability of a collaborative pilot circuit to determine pharmacogenetic markers to optimise clopidogrel prescription. Method(s): The authors expect 150 patients with a clopidogrel prescription by a cardiologist of Hospital de Sant Pau to enrol. They can enrol when filling their prescriptions in one of the 24 collaborating community pharmacies in the Hospital's area. Community pharmacists collect from each participant's pharmacotherapeutic profile and a saliva sample to be sent to the hospital for CYP2C19 genotyping. Hospital pharmacists collate all obtained data with their clinical records. Data are analysed jointly with a cardiologist to assess clopidogrel prescription adequacy. Barcelona Pharmacists' Association (COFB) coordinates the whole project and provides IT and logistic support. Result(s): This project started in January 2020 and it was temporarily suspended due to the COVID19 pandemic. On 13th March 2020, 114 patients with clopidogrel prescriptions were registered, 21 met the inclusion criteria and 15 were enrolled. Five out of the eight already genotyped patients were intermediate or poor metabolisers. Conclusion(s): This circuit seems to be feasible, but further research is needed once the study is resumed. Pharmacogenetics increasing clinical relevance needs more clinical implication of pharmacists.

COVID-19-seen through the eyes of the pharmacy interns

Background: One hundred and thirty (130) pharmacy students from the University of Copenhagen were doing their pharmacy internship in community pharmacy. Here they are to acquire knowledge of, as well as skills and competencies in, areas such as organisation, leadership, ethics, economy, patient counselling, patient safety, cooperation etc. The COVID-19 pandemic hit the entire world and created an extra steep learning curve for the interns. And why not try and combine the two: the pharmacy internship learning and the COVID-19 crisis? It is important to explore how pharmacies manage their customary and newly emerging roles during the COVID-19 outbreak. Purpose(s): The purpose of the study is to reveal how the COVID-19 pandemic influences pharmacy organisation, leadership, ethics, economy, patient counselling, patient safety, and cooperation seen through the eyes of the pharmacy interns. Method(s): A two-page long questionnaire on how COVID-19 influences the above mentioned areas was uploaded to the internship webpage, hopefully inspiring the interns, who were tasked with handing in a nine-page long report as part of their exam. A content analysis of the reports will be done. Result(s): Since the interns hand in their reports by June 19 2020, no results are available yet. If all interns write about COVID-19 in their report, though, more than 1,000 pages on their COVID-19 experiences will exist. Answers with the most insightful learning potential for pharmacy practice globally will be presented and discussed. Conclusion(s): Having successfully carried out pharmacy internship-based research for more than 20 years in Denmark, we are convinced that the study will reveal useful results.

Impact of COVID-19 pandemic on higher education in Japan: Transition to online education and challenges in experiential pharmacy practice

The COVID-19 pandemic has impacted all aspects of human life, including pharmacy education worldwide. This article depicts how the COVID-19 pandemic has impacted higher education in Japan with a focus on two topics: the transition to online education and the challenges faced in experiential pharmacy practice. In both topics, the sharing of information among educators and stakeholders, from students to governmental ministries, played vital roles in keeping the programme delivery as normal as possible during the pandemic. Insights gained from experience during the pandemic should offer a basis for the robust and versatile framework of tomorrow's pharmacy education. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

COVID-19 related Pharmacy education and workforce challenges in Zimbabwe

While the national lockdown has presented many challenges for both pharmacy education and pharmacy practice in Zimbabwe, pharmacy educators and policymakers have risen to the occasion, and their response has advanced the profession. This editorial describes the impact of the COVID-19 lockdown on pharmacy education and the pharmacy workforce and highlights some of the pragmatic responses and an outlook for the future of pharmacy in Zimbabwe. Copyright © 2020 FIP.

Pivoting an international experience preparation course during the COVID-19 pandemic

This case study describes the adaptation of a small group interactive course, originally designed to prepare student pharmacists for an international Advanced Pharmacy Practice Experience (APPE), to a hybrid virtual course designed to prepare students to work across cultures and in many different professional environments. As the uncertainty of the COVID-19 pandemic impacted planned international experiences, a strategic pivot in delivery and content was necessary. The course content was changed to enhance student skills in cross cultural communication and humility, working through conflict, personal emotion regulation, and appropriately engaging with other cultures. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

CASE STUDY: Innovation in experiential learning or assessment Pharmacotherapy virtual attachment during COVID-19 pandemic: Use of online experiential assessment in a Malaysian pharmacy school

This case study aims to report the efforts made by International Islamic University Malaysia to pursue the experiential pharmacotherapy attachment for the final-year of pharmacy students via online mediums in the light of the COVID-19 restrictions on face-to-face clinical experiential learning. A four-week virtual pharmacotherapy experiential attachments were redesigned and conducted via an online platform (Google Meet). Students were required to have a two-hour virtual discussion and consultation session with their preceptors twice a week throughout the attachment period. In each week, students were provided with real-life clinical cases that were chosen by their preceptors from the Department of Pharmacy Practice's clinical case repository. Students were assessed via clinical case reports, virtual seminar presentations, weekly virtual discussions with preceptors, and virtual objective structured clinical examinations. All the virtual sessions were conducted on a synchronous basis to assure students' active participation. Alongside this, a revised online final assessment was also designed. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Health-System Introductory Pharmacy Practice Experience as an online course in the United States

Introductory Pharmacy Practice Experiences (IPPEs) provide early experiential education in the Doctor of Pharmacy (Pharm.D.) curriculum in the United States (US). In response to Oregon's 'Stay Home, Save Lives' executive order issued during the COVID-19 pandemic, an online health-system IPPE course was developed to simulate the practice experiences that have historically been conducted in person. This case study describes experience from the online health-system IPPE course offered for incoming second-year student pharmacists enrolled in a three-year Pharm.D. programme at Pacific University in Oregon, US. The goals of the course were: 1) to expose students to pharmacy practice common in health-system settings in the US;and 2) for students to earn 50 experiential clock hours through simulation activities. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Adaptations in the role of pharmacists under the conditions of the COVID-19 pandemic: a systematic review and meta-analysis.

BACKGROUND: Community pharmacists actively engage in managing the health of local residents, but the COVID-19 pandemic has necessitated rapid adaptations in practice activities. OBJECTIVES: We sought to identify the specific adaptations in practice and the expanded roles of community pharmacists in response to the COVID-19 pandemic. METHODS: We conducted a systematic review of published studies reporting the tasks of pharmacists in community pharmacies or who were involved in pharmacy practices addressing the pandemic. Two investigators independently searched PubMed (December 2019-January 2022) for eligible articles. We conducted a meta-analysis to measure the frequencies of practical activities by pharmacists in response to COVID-19. RESULTS: We identified 30 eligible studies. Meta-analysis of these studies found that the most commonly reported adaptation in pharmacist practice activities was modifying hygiene behaviors, including regular cleaning and disinfection (81.89%), followed by maintaining social distance from staff and clients (76.37%). Educating clients on COVID-19 was reported by 22 studies (72.54%). Telemedicine and home delivery services were provided to clients by 49.03 and 41.98% of pharmacists, respectively. CONCLUSIONS: The roles of community pharmacists in public health activities have adapted and expanded in response to COVID-19, notably by incorporating public health education activities.

The Role of the Pharmacist in Combating the Opioid Crisis: An Update.

Introduction: The opioid overdose crisis has claimed hundreds of thousands of lives in the United States in the last decade, with overdose numbers continuing to climb. At the same time, the role of the pharmacist in combating the opioid crisis continues to evolve. Methods: A literature search was conducted in Ovid MEDLINE that incorporated both MeSH terms and keywords to describe two concepts: the opioid epidemic and pharmacists/pharmacies. The search was limited to articles published after 2010 through the end of 2021 and returned 196 articles that were analyzed thematically. Results: Thematic analysis revealed the following themes: prevention, interventions, public health role of the pharmacist, pharmacists in multiple roles, barriers, pharmacist and healthcare provider attitudes, educational initiatives for pharmacists and student pharmacists, and future research. Discussion: While a great deal of progress has been made in the role of the pharmacist in supporting individuals with opioid use disorder (OUD) in the last two decades, pharmacists must seek to invest time and resources into practices with a strong evidence base to better mitigate the growing, devastating impact of the opioid crisis. Pharmacists must be willing to embrace new and non-traditional roles in patient care, service and research, and seek to advance evidence-based knowledge and practice. Conclusion: Pharmacy practice has expanded greatly in the past decade with pharmacists taking on new and creative approaches to addressing the opioid crisis. Collaborative and interdisciplinary approaches to addressing the root causes of opioid misuse and opioid overdose are still desperately needed. These include attention to the critical roles of social determinants of health, stigma elimination, legislative advocacy for patients with OUD, and focused education for providers, pharmacists, and the community. Recognition and support of the value of collaboration to both improve public health and individual patient care, continued investments in pharmacy practice advancement in OUD treatment and harm reduction, and the creation of workflows and prescribing algorithms to assist in dosing medications to prevent withdrawal symptoms and achieve improved pain control are desperately needed.

Computer-Based Simulators in Pharmacy Practice Education: A Systematic Narrative Review.

Computer-based simulations may represent an innovative, flexible, and cost-efficient training approach that has been underutilised in pharmacy practice education. This may need to change, with increasing pressure on clinical placement availability, COVID-19 restrictions, and economic pressures to improve teaching efficiency. This systematic narrative review summarises various computer-based simulations described in the pharmacy practice education literature, identifies the currently available products, and highlights key characteristics. Five major databases were searched (Medline, CINAHL, ERIC, Education Source and Embase). Authors also manually reviewed the publication section of major pharmacy simulator websites and performed a citation analysis. We identified 49 studies describing 29 unique simulators, which met the inclusion criteria. Only eight of these simulators were found to be currently available. The characteristics of these eight simulators were examined through the lens of eight main criteria (feedback type, grading, user play mode, cost, operational requirement, community/hospital setting, scenario sharing option, and interaction elements). Although a number of systems have been developed and trialled, relatively few are available on the market, and each comes with benefits and drawbacks. Educators are encouraged to consider their own institutional, professional and curriculum needs, and determine which product best aligns with their teaching goals.

A grounded theory approach to exploring the experiences of community pharmacists in Lebanon to a triple whammy of crises: The Lebanese financial crisis, COVID-19 pandemic, and the Beirut port explosion.

Background: Community pharmacists like other health care professionals in Lebanon have been grappling with a series of multifaceted, country-wide and ongoing challenges that have formed the impetus for this research. We aimed to explore experiences of community pharmacists in Beirut, Lebanon, during three concurrent crises in 2020: the Lebanese financial crisis, COVID-19 pandemic and the Beirut Port explosion. Methods: A qualitative approach using a constructivist grounded theory methodology was employed. Between October 2020 and February 2021, semi-structured interviews were conducted with purposefully recruited community pharmacists working in Beirut. All interviews were conducted virtually, and data collected were analysed using inductive reasoning, with open coding and concept development. Results: Thirty-five participants (63% female, mean age 30) were interviewed online. Emergent categories and theoretical concepts included 1. painting the picture - pharmacists describing the context/setting; 2. impact of the crises - on community pharmacists, the profession, patients and the system; 3. response to the crises - of community pharmacists, the profession (+ practice), patients and the system; and 4. need for advocacy and leadership. A theory was developed about "unsustainable resilience" in the scheme of ongoing crises. Conclusions: The findings revealed a shared sense of futility and despair among pharmacists collectively as a profession, as well as a sense of unsustainable healthcare systems in Lebanon, and environments impacting on the resilience of pharmacists at an individual level. A call for action is needed for urgent sustainable structural and financial reforms, advocacy and planning for future resilient systems, as well as a resilient pharmacy profession and protection of pharmacists' wellbeing and livelihood.