Community pharmacy services and preparedness during COVID-19 outbreak in Madinah, Saudi Arabia

A survey of pharmacists' perception of the work environment and patient safety in community pharmacies during the COVID-19 pandemic

Background

Community pharmacies have changed during the COVID-19 pandemic, and new routines have been introduced to address the needs of customers and staff and to reduce the risk of spreading infection. Burnout has been described among staff possibly due to a changed working climate. However, little research has focused on the pandemic's effect on patient safety in community pharmacies.

Objective

To examine pharmacists' perceptions of the impact of the COVID-19 pandemic on workload, working environment, and patient safety in community pharmacies.

Methods

A survey was distributed to all Swedish community pharmacists, constituting a census study. Questions regarding the pharmacists' perception of the impact of the pandemic on workload, working environment, and patient safety were included. Respondents were asked to provide comments on their working situation. Quantitative results were analysed using descriptive statistics, and comments were analysed using qualitative content analysis.

Results

The response rate was 41% (2034 responses). Most pharmacists (62%) considered the workload to be increased during the pandemic while work environment deteriorated (physical work environment was considered worse by 47% of respondents while psychosocial work environment was considered worse by 59%). Despite this, many respondents (55%) believed that patient safety was not affected. Neither having had COVID-19 nor being afraid of contracting it, influenced these perceptions in any substantial way. Findings were consistent regardless of education, professional role, number of years in community pharmacies, or special assignments in the pharmacies. According to the respondents, the communication within pharmacy companies during the pandemic was inadequate.

Conclusions

The impact of the pandemic on working conditions is in line with previous findings but the effect on patient safety needs further studies. The respondents felt the management had a limited understanding of the conditions during the pandemic, which stresses the importance of good and clear communication during a crisis.

Patient care and customer services during the COVID-19 pandemic at accredited pharmacies: Pharmacists and patients' perspectives

Background

Community pharmacists are now the most accessible healthcare professionals, providing advice, information, drugs, and devices across the globe during the COVID-19 pandemic. In Thailand, accredited community pharmacies meet higher standards than qualified community pharmacies, but little is known about the perspectives of accredited community pharmacists and patients in this emergency situation. This study aimed to assess pharmacists' and patients' perspectives on the challenges and opportunities they faced in providing or receiving patient care and services during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted in March-August 2022 in a province located in the eastern part of Thailand. Participants of the study were full-time pharmacists and patients at accredited community pharmacies. A convergent mixed methods design was used and involved quantitative data about the perspectives of participants measured by online self-administered surveys and qualitative open-ended questions.

Results

Twenty pharmacists and 416 patients provided complete responses. The meta-inferences were expansive in three standards including physical evidence, quality management, and good pharmacy practices/services for both groups of participants. For the social/community involvement standard, pharmacists' and patients' opinions (free-text responses) confirmed their perspective scores.

Conclusions

This study highlights community pharmacy's crucial role in maintaining essential healthcare services during the pandemic, with patients acknowledging and appreciating the dedication of community pharmacists. The mixed methods findings provide valuable insights into pharmacists' and patients' perspectives, facilitating a deeper understanding and exploration of the potential roles community pharmacists can play in a post-pandemic world, embracing new technologies for improved systems.

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.

The Impact of Serum Levels of Vitamin D3 and Its Metabolites on the Prognosis and Disease Severity of COVID-19

Vitamin D is among the increasingly consumed dietary supplements during the COVID-19 pandemic. It plays a regulatory role in the immune system and moderates the renin-angiotensin system, which is implicated in infection pathogenesis. However, the investigation of serum levels of vitamin D3 forms and their relative ratios in COVID-19 patients is worth investigation to understand the impacts of disease severity. Hence, we investigated the serum levels of vitamin D3 (cholecalciferol) and its metabolites (calcifediol and calcitriol), in addition to their relative ratios and correlations with angiotensin-converting enzyme 2 (ACE2), interleukin-6 (Il-6), and neutrophil-lymphocyte ratio (NLR) in COVID-19 patients compared with healthy controls. Oropharyngeal specimens were collected from the study subjects for polymerase chain reaction testing for COVID-19. Whole blood samples were obtained for blood count and NLR testing, and sera were used for the analysis of the levels of the vitamin and its metabolites, ACE2, and IL-6. We enrolled 103 patients and 50 controls. ACE2, Il-6, and NLR were significantly higher in the patients group (72.37 ± 18.67 vs. 32.36 ± 11.27 U/L, 95.84 ± 25.23 vs. 2.76 ± 0.62 pg/mL, and 1.61 ± 0.30 vs. 1.07 ± 0.16, respectively). Cholecalciferol, calcifediol, and calcitriol were significantly lower in patients (18.50 ± 5.36 vs. 29.13 ± 4.94 ng/mL, 14.60 ± 3.30 vs. 23.10 ± 3.02 ng/mL, and 42.90 ± 8.44 vs. 65.15 ± 7.11 pg/mL, respectively). However, their relative ratios were normal in both groups. Levels of the vitamin and metabolites were strongly positively, strongly negatively, and moderately negatively correlated with ACE2, Il-6, and NLR, respectively. COVID-19 infection severity is associated with a significant decrease in vitamin D3 and its metabolites in a parallel pattern, and with a significant increase in ACE2, Il-6, and NLR. Higher levels of vitamin D and its metabolites are potentially protective against severe infection.

Bibliometric analysis of COVID-19 research publications in pharmacy practice journals

Objectives

Pharmacy practice journals are considered the main player in promoting pharmacy practice research and the pharmacy profession globally. The current study aimed to explore and analyze literature on the COVID-19 pandemic published in pharmacy practice journals.

Methods

COVID-19 research articles were extracted from 32 pharmacy practice journals indexed in Scopus for the study period from 01 January 2020, up until 31 December 2021

Key findings

A total of 581 documents were found with an average of 4.5 authors per article and 4.8 citations per document. The retrieved documents were published in 28 pharmacy practice-related journals with the Research in Social and Administrative Pharmacy and the American Journal of Health System Pharmacy journals being the leaders in this field. The major findings of the analysis indicated (1) a limited number of contributing countries with limited author-author interactions and cross country collaboration; (2) specific topics were encountered, mainly hospital pharmacy services, survey studies on knowledge, and pharmacy education; (3) several contributing countries in the Middle East, mainly Saudi Arabia; Egypt, and Jordan contributed to the retrieved documents, and (4) the highly-cited documents discussed issues related to pharmacy services and role of the community pharmacists during the pandemic.

Conclusion

Research activity on COVID-19 in pharmacy practice journals represents the commitment of researchers and professionals to transform and promote the profession of pharmacy. Research on pharmacy practice and pharmacists in low- and middle-income countries during pandemics needs to be prioritized by scholars and journal editors.

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study

BACKGROUND

Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries.

METHODS

An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants' demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values.

RESULTS

A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants' country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores.

CONCLUSION

The political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.

Assessing the pharmaceutical care provision to suspected COVID-19 patients in community pharmacies: a simulated patient study

BACKGROUND

In the wake of COVID-19, community pharmacists (CP) were called upon to free up healthcare providers to treat more serious conditions and alleviate overcrowded healthcare centers. CPs were placed under tremendous pressure, where many patients primarily sought their health advice. This situation raised concerns about the preparedness of CPs in facing these challenges. Therefore, this study aimed to assess the appropriateness of pharmaceutical care provided by CPs to patients with suspected COVID-19 and to investigate their communication skills.

METHODS

A simulated patient (SP) study was conducted among randomly selected community pharmacies in Beirut, Lebanon. Each pharmacy was visited by the SP who complained of fever and loss of smell sensation. Interactions between the attending pharmacist and the suspected COVID-19 patient were documented directly after each visit in a standardized data collection form.

RESULTS

More than half of the CPs (56%) did not retrieve any relevant information to assess the patient's condition. While pharmacists' responses were limited to one to two recommendations, with the majority recommending the patient to perform the PCR test (90%). Inappropriate recommendations made by the CPs included mainly the confirmation that the patient had COVID-19 without prior testing (9%), and prescribing either an antimicrobial drug (5%) or dietary supplements (20%), claiming that the latter are essential to boost the patient's immunity. As for the pharmacist-patient communication skills, the mean total score was 2.25 ± 0.79 (out of 4), displaying nonoptimal and ineffective communication.

CONCLUSION

An unsatisfactory and suboptimal provision of pharmaceutical care to a suspected COVID-19 case was evident. This may be a public health threat, particularly for developing countries that lack an efficient and unified healthcare system. The findings should alert health authorities to support and guide community pharmacists in assisting suspected COVID-19 patients.

The response to COVID-19 among drug retail outlets in Indonesia: A cross-sectional survey of knowledge, attitudes, and practices

Background

Pharmacists have been at the frontline of the COVID-19 response in Indonesia, providing medicines, advice, and referral services often in areas with limited healthcare access. This study aimed to explore their knowledge, attitudes, and practices during the pandemic, so that we can be better prepared for future emergencies.

Methods

A cross-sectional online survey of community pharmacists and pharmacy technicians in Indonesia was conducted between July and August 2020. The dataset was analysed descriptively, and logistic regression was used to explore willingness to participate in COVID-19 interventions.

Findings

4716 respondents participated in the survey. Two-thirds (66·7%) reported knowing only “a little” about COVID-19 and around a quarter (26·6%) said they had not received any COVID-19 guidelines. Almost all were concerned about being infected (97·2%) and regularly took steps to protect themselves and their clients (87·2%). Stock-outs of Personal Protective Equipment (PPE) and other products (32·3%) was the main reason for not taking any precautions. Around a third (37·7%) mentioned having dispensed antibiotics to clients suspected of having COVID-19. To support COVID-19 response efforts, most respondents were willing to provide verbal advice to clients (97·8%), distribute leaflets to clients (97·7%), and participate in surveillance activities (88·8%). Older respondents, those identifying as male, and those working in smaller outlets were more willing to provide information leaflets. Those working in smaller outlets were also more willing to engage in outbreak surveillance.

Interpretation

Drug retail outlets continue to operate at the frontline of disease outbreaks and pandemics around the world. These providers have an important role to play by helping to reduce the burden on facilities and providing advice and treatment. To fulfil this role, drug retail outlets require regular access to accurate guidelines and steady supplies of PPE. Calls for drug retail outlet staff to plat in response efforts including the provision of information to clients and surveillance could ease escalating pressures on the health system during future outbreaks.

Funding

This study was funded by a grant from the Department of Foreign Affairs and Trade, Australia, under the Stronger Health Systems for Health Security Scheme.

Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study

Background

Recent studies have reflected increased global concern regarding the possible acceleration of bacterial resistance secondary to the reported overuse and misuse of antibiotics during the COVID-19 pandemic. Therefore, this study aimed to investigate the nonprescribed sale of antibiotics by community pharmacies in Saudi Arabia during the COVID-19 outbreak and the pharmacists’ skills in triaging COVID-19 suspects.

Methods

Herein, 120 pharmacies were randomly selected and surveyed by simulated clients who presented gradual demands to convince the encountered pharmacists to agree to the over-the-counter sale of antibiotics. The pharmacists’ responses and counseling skills were documented in addition to their effectiveness in triaging suspected COVID-19 cases.

Results

Nineteen pharmacists (15.8%) were convinced to sell nonprescribed antibiotics after various levels of demand by clients. Moreover, twenty pharmacists (16.7%), who refused to sell nonprescribed antibiotics, referred the clients to clinics where they could easily obtain prescriptions, or to other pharmacies that violate the system. In addition, 29 pharmacists (24.2%) were not concerned about possible COVID-19 suspects, and 47–66 (39.2–55%) of them demonstrated different responses and recommendations. Moreover, 12 pharmacists of the 19 who violated the law did not offer any counseling regarding the use of the antibiotics.

Conclusions

The nonprescribed sale of antibiotics is still prevalent and may have increased during the COVID-19 outbreak in Saudi Arabia, thereby increasing the risk of accelerated bacterial resistance. The pharmacists’ skills in triaging COVID-19 suspects and patient education and counseling were below expectations. Further follow-up studies are highly recommended.

The coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 in Malaysia

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has resulted in profound health challenges across the globe. Pharmacists' readiness to cope with the pandemic is critical in supporting and sustaining the healthcare workforce to meet the challenges.

OBJECTIVE

This study aims to examine community pharmacists' views on their work environment, policies and preparedness for safe retail patronage to prevent the transmission of COVID-19 and assess the variables influencing coping strategies during the pandemic.

SETTING

An online survey of pharmacists practising in community pharmacy setting in Malaysia.

METHOD

A questionnaire-based, cross-sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilising a snowball sampling method.

MAIN OUTCOME MEASURE

Community pharmacists' perceptions on safety, resilience, organisational support, and pharmaceutical services offered during COVID-19 pandemic.

RESULTS

A total of 217 pharmacists participated in the study. The vast majority of community pharmacists reported a positive outlook and were able to balance working with self-care during this period. Most reported to have access to personal protective equipment such as gloves and hand sanitisers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb-side or drive-through delivery and pickup services.

CONCLUSION

The findings suggest the frontline and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.

Community pharmacists' preparedness and responses to COVID-19 pandemic: A multinational study

BACKGROUND

Community pharmacists play a pivotal role in healthcare worldwide. Their role became more critical during the COVID-19 pandemic. This study aims to investigate the community pharmacists' preparedness and responses to the COVID-19 pandemic and how efficiently they were prepared to contain and prevent the spread of infection.

METHODS

An online questionnaire was distributed to community pharmacists in Saudi Arabia, Lebanon, and Jordan through social media platforms. A scoring system was developed to measure their level of adherence to the preventive measures of the global infection.

RESULTS

The total included responses were 800. Around 44% of the pharmacists reported spending less than 15 min/d reading about COVID-19 updates. Although more than half of them were reviewing official sites, 73% of them were also retrieving information through non-official channels. Additionally, almost 35% of them were directly contacting customers without physical barriers, 81% reported encountering infected customers, and 12% wore the same facial masks for more than a day. Moreover, 58% of the pharmacies reported the absence of door signs requesting infected customers to declare the infection, 43% of the pharmacies were not limiting the number of simultaneous customers, and 70% were not measuring customers' temperatures prior to entry. Collectively, the mean total score of applied protective measures was 10.12 ± 2.77 (out of 17).

CONCLUSION

The level of preparedness of the community pharmacies in these three Middle Eastern countries was not adequate for facing the COVID-19 pandemic. Health authorities in these countries should closely monitor their adherence to the protective guidelines.

Exposure of community pharmacists to COVID-19: A multinational cross-sectional study

Objectives

Community pharmacists (CPs) are among the frontline healthcare providers who have been exposed to a high risk of being infected with SARS-CoV-2 during the pandemic. Unfortunately, there have been limited studies in the Middle East that provide an occupational risk analysis among CPs. Therefore, this study aims to evaluate the risk of COVID-19 exposure among Middle Eastern CPs and to identify the infection predictors.

Methods

A cross-sectional survey was conducted using an online, self-administered questionnaire that was distributed to CPs across KSA, Lebanon, and Jordan between November and December 2020. The bivariate logistic regression test was used to analyse the predictors associated with COVID-19.

Results

CPs were more susceptible to acquiring SARS-CoV-2 than the general public (12.9% vs. 1.5%). The significant predictors of infection included a family member with confirmed COVID-19 infection, age <40 years, encountering patients in pharmacy without a protective glass-barrier, and contact with confirmed COVID-19 patients or colleagues with confirmed COVID-19 during practice. Additionally, the mean level of the respondents’ expected rate of infection was 3.27 ± 1.04 (out of 5). This level was significantly higher among female pharmacists and Lebanese pharmacists.

Conclusions

This study demonstrates that CPs are at a higher risk of acquiring COVID-19 compared with the general public. This is attributed to several occupational factors that increase the risk of exposure to COVID-19. Therefore, healthcare authorities are advised to enforce strict occupational guidelines for CPs.

Knowledge, Attitude and Practice About Coronavirus Disease (COVID-19) Pandemic and Its Psychological Impact on Students and Their Studies: A Cross-Sectional Study Among Pharmacy Students in Saudi Arabia

Background

Individuals’ knowledge, attitude and practice towards preventive and precautionary measures of COVID-19 are essential to control the spread of the disease. Consequently, the aims of the study were to evaluate knowledge, attitude and practice of pharmacy students towards the pandemic and to assess its psychological impact on them to provide future guidance.

Methods

A cross-sectional, questionnaire-based study was conducted via a web-based survey in May 2020. All pharmacy students enrolled at Unaizah College of Pharmacy, Qassim University, were invited to take part in the study.

Results

A total of 232 out of 460 students took part in the study, giving a response rate of 50.43%. The mean total knowledge score was 9.87 ± 2.04 (maximum attainable score, 12). The majority of the participants (n=163; 70.3%) believed COVID-19 is a health threat to their community in the early months of the pandemic. Moreover, the majority (93%) also believed that the lockdown at the beginning of the pandemic was necessary to contain the pandemic. Encouragingly, 86.6% reported that they did not go to any crowded places during the pandemic with more female students avoiding crowded places compared to male students (91.6% versus 78.7%, respectively, P = 0.005). The majority (91%) also reported that they were following the strategies recommended by the authorities to prevent the spread of the virus. Encouragingly, 54.3% reported that the pandemic either had no effect or just a limited effect on their studies. However, 38.5% reported that they always felt or frequently felt nervous or anxious during the pandemic.

Conclusion

The study showed that pharmacy students had good knowledge as well as positive attitudes and good practices towards COVID-19 and the preventive measures. However, during the early months, the pandemic did have a negative psychological impact on a number of students. Consequently, proactive psychological and social support services to the students should be considered during the current and future pandemics. In addition, it is important to consider and proactively address key issues that could cause stress and anxiety among students when shifting to distance learning and assessments.