Provision of clinical pharmacy services during the COVID-19 pandemic: Experiences of pharmacists from 16 European countries

Pharmacy-based CLIA-waived testing in the United States: Trends, impact, and the road ahead

BACKGROUND

Federal authorization of the use of Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived point-of-care tests for SARS-CoV-2 by pharmacists during the pandemic resulted in a dramatic rise in the number of community pharmacies that became CLIA-waived test sites. Now as we exit the pandemic, the wide-ranging expansion of the scope of practice facilitated currently by the PREP Act is set to expire in fall 2024. As a result, American pharmacists' ability to offer CLIA-waived testing services will revert to a patchwork of state laws.

OBJECTIVE

This study aims to examine both the number of pharmacies in the United States with CLIA Certificates of Waiver before and after the SARS-CoV-2 pandemic and the state-by-state differences in the percentage of pharmacies with CLIA Certificates of Waiver.

METHODS

Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website on May 3rd, 2015, August 4th, 2019, November 26th, 2020, October 6th, 2021, November 23rd, 2022, and December 4th, 2023. The website allows for the exportation of demographic data on all CLIA-waived facilities by state.

RESULTS

The total number of pharmacies with a CLIA-waiver grew from 10,626 (17.9%) locations in 2015 to 12,157 (21.4%) locations in 2019, to 15,671 (27.6%) locations in 2020, and to 29,011 (51.6%) locations in 2023. States demonstrated considerable variability in the percentage of pharmacies possessing a CLIA certificate of waiver in 2023, with a range of 10.7%-87.9%.

CONCLUSIONS

Use of CLIA-waived tests in pharmacies has grown by 140% since 2019. The time period from 2019 to 2021 witnessed a 92.5% increase in pharmacies that possessed a certificate of waiver which was largely driven by the pandemic. Interestingly, from 2021 to 2023 the was continued growth in the market of 31.6%. This suggests that pharmacies continue to see opportunity in offering CLIA-waived testing services beyond those that had been extended as a result of the pandemic.

Clinical Pharmacist-Led Medication Review in Hospitalized Confirmed or Probable Patients with COVID-19 During the First Wave of COVID-19 Pandemic

Objectives

Drug-related problems (DRPs) result in serious problems among hospitalized patients, high rates of morbidity and mortality, and increased healthcare costs. This study aimed to identify DRPs by clinical pharmacist-led medication review in hospitalized probable patients with coronavirus disease-2019 (COVID-19) during the first wave of the COVID-19 pandemic.

Materials and Methods

This retrospective cross-sectional study was conducted at the COVID-19 inpatient services of a tertiary university hospital in Türkiye for 3 months (between March 2020 and June 2020) and included hospitalized confirmed or probable COVID-19 patients. The World Health Organization and Turkish Ministry of Health Guidelines case definitions were used to define confirmed and probable COVID-19 patients. Six clinical pharmacy residents provided medication review services during their education and training. DRPs were classified based on the Pharmaceutical Care Network Europe V9.00. The physician's acceptance rate of clinical pharmacists' recommendations was assessed.

Results

Among 202 hospitalized patients with probable or confirmed COVID-19, 132 (65.3%) had at least one drug-related problem. Two hundred and sixty-four DRPs were identified. Drug selection (85.6%) and dose selection (9.2%) were the most common causes of these problems. Among the 80 clinical pharmacist interventions, 48.8% were accepted by the physicians.

Conclusion

Clinical pharmacists identified a significant number of DRPs during the COVID-19 pandemic, particularly those related to drug interactions and drug safety, such as adverse drug reactions. This study highlights the importance of detecting and responding to DRPs in the COVID-19 pandemic.

Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska

BACKGROUND

The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies.

OBJECTIVE

To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska.

METHODS

A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27.

RESULTS

The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists.

CONCLUSIONS

Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

Scope, content and quality of clinical pharmacy practice guidelines: a systematic review

BACKGROUND

Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines.

AIM

To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument.

METHOD

Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument.

RESULTS

Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development.

CONCLUSION

Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.

Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review

Background and Aims

Continuous routine care is necessary to prevent long-term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic.

Methods

All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method.

Results

Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient-side factors and health system-side factors. Patient-side factors including psychological, individual and social, disease-related, and health system-side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic.

Conclusion

Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.

Council of Europe Resolution on the Implementation of Pharmaceutical Care-A Step Forward in Enhancing the Appropriate Use of Medicines and Patient-Centred Care

Pharmaceutical care was proposed to address morbidity and mortality associated with medicine-related problems. It utilises the pharmacist's expertise in medicines, their relationship with the patient and cooperation with other healthcare professionals to optimise the use of medicines. The European Directorate for the Quality of Medicines & HealthCare (EDQM), part of the Council of Europe, found significant variation in the acceptance of pharmaceutical care and in the implementation of pharmaceutical care in Europe. A multidisciplinary group was established to draft a statement of principles and recommendations concerning pharmaceutical care. Through face-to-face meetings, circulation of draft texts and informal consultation with stakeholders, the group produced a resolution. On 11 March 2020, the resolution was adopted by the Committee of Ministers of the Council of Europe. It explains pharmaceutical care and illustrates pharmacists' contribution to medicine optimisation in different care settings. Pharmaceutical care's value to health services and its place in health policy were emphasised by addressing the risks and harms from suboptimal use of medicines. Pharmaceutical care can improve medicine use, promote rational use of healthcare resources and reduce inequalities in healthcare by realigning the roles and responsibilities of pharmacists and healthcare professionals. EDQM will promote and advocate for the implementation of pharmaceutical care by enacting practice Resolution CM/Res(2020)3.

Medication management of COVID-19 patients during transition to virtual models of care: a qualitative study

INTRODUCTION

Expansion of hospital service models was one of the strategies implemented to manage the COVID-19 pandemic through virtual models of care. COVID-19 patients were hospital inpatients transferred to virtual wards and managed outside the hospital. Pharmacists had to provide distance medication management and support services. Virtual care patient support incorporated telehealth consultations by doctors, pharmacists and nurses. This study explored hospital clinicians' experiences and perspectives on medication management and safety issues of the COVID-19 patients transferred from inpatient units (IPUs) to virtual models of care at the time of transfer.

METHODS

Semi-structured qualitative interviews were conducted with purposively selected doctors, pharmacists and nurses involved in the management of COVID-19 patients in a virtual model of care (home or hotel). Clinicians were interviewed face-to-face or via MS Teams between March and May 2022. An interview schedule included 13 questions and prompts to explore perceptions of medication management and safety aspects.

RESULTS

Twenty clinicians were interviewed: six doctors, seven pharmacists, and seven nurses. The average interview time was 26 min (SD: 4.7; range 21-39). Four major medication management and safety themes emerged from the data: (1) complexities involved in efficient handover between IPU and virtual models of care; (2) lack of clarity on roles and responsibilities between hospital and primary care clinicians; (3) communication challenges when pharmacists work remotely; and (4) proactive management of specific medication safety risks. A common thread throughout the themes was concerns for potential impact on patient safety.

CONCLUSION

Overall, clinicians were supportive of the virtual models although patient safety issues were raised that need to be addressed in the development of future services. The results from this study may inform improvements in medication safety implementation of future virtual models of care.

Managing the COVID-19 health crisis: a survey of Swiss hospital pharmacies

BACKGROUND

The COVID-19 pandemic strained healthcare systems immensely as of 2020. Switzerland's hospital pharmacies' responses during the first wave were surveyed with a view to improving the quality of pharmaceutical management in future health crises.

METHODS

An online survey was sent to the heads of all of Switzerland's hospital pharmacies. The questionnaire was organised into eleven sections of questions covering many topics regarding the management of COVID-19's first wave. Data collection occurred from May to June 2020.

RESULTS

Analyses were performed using the 43 questionnaires (66%), with at least one answer per questionnaire, out of 65 distributed. Seventeen of 41 pharmacies responding (41%) had existing standard operating procedures or pandemic plans and 95% of these (39/41) set up crisis management steering committees. Twenty-nine of 43 pharmacies responding (67%) created new activities to respond to the pandemic's specific needs. Twenty-six of 39 pharmacies responding (67%) created new drug lists for: COVID-19-specific treatments (85%; 22/26), sedatives (81%; 21/26), anaesthetics (77%; 20/26) and antibiotics (73%; 19/26). Drug availability in designated COVID-19 wards was managed by increasing existing stocks (54%; 22/41 pharmacies) and creating extra storage space (51%; 21/41). Two drugs generated the greatest concern about shortages: propofol (49%; 19/39 pharmacies) and midazolam (44%; 17/39). Remdesivir stocks ran out in 26% of pharmacies (10/39). Twelve of 43 pharmacies (28%) drafted specific new documents to respond to medical needs regarding drug administration, 12 (28%) did so for drug preparation and 10 (23%) did so for treatment choices.

CONCLUSIONS

Switzerland's hospital pharmacies encountered many challenges related to the COVID-19 crisis and had to find solutions quickly, effectively and safely. The survey highlighted the key role that hospital pharmacies played in many aspects of the pandemic by providing logistical and clinical support to medical and nursing care teams. The lessons and experiences outlined could be used to improve the quality of hospital pharmacies' readiness for similar future events.

Pharmacy education in traditional and complementary medicines - A systematic review

BACKGROUND

Traditional and complementary medicines (T&CMs) are not typically covered in medical curricula despite 80% of the world's population using some form of herbal product as part of their healthcare. Concurrent use of T&CMs with conventional therapies is common, and both are primarily accessed in pharmacies. There is an expectation that pharmacists should be knowledgeable about T&CMs. Therefore, this review aimed to investigate what is currently known about pharmacists' T&CMs education and training to inform developments in pharmacy education.

METHODS

Eligible studies published between 01/01/2016 and 28/02/2023 were identified across six databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). Data were extracted from included studies and categorized into key themes and sub-themes and reported descriptively.

FINDINGS

Fifty-eight studies were identified, conducted across 30 countries, that included information about pharmacists' T&CMs education and training. Within the four main themes extracted, six subthemes were identified including: T&CMs education and training received; inadequate education and training opportunities; knowledge, and confidence towards T&CMs in the pharmacy setting; professional practice behaviour associated with T&CM; university education for pharmacy students; and continuing professional development for practicing pharmacists, including T&CM-drug interactions, interpreting T&CM research, T&CM-specific communication skills, T&CM use in pregnancy and breastfeeding, and efficacy and safety of T&CM in specific conditions.

CONCLUSION

Overall pharmacists are receiving limited T&CM education in undergraduate and continuing professional training and report a lack of resources to inform the advice they provide to consumers. The findings of this review can inform developments in T&CMs curriculum and accreditation standards that support the training needs of pharmacists who play a role in fostering the safe and appropriate use of these products.

COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit

BACKGROUND

Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care.

METHOD

A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out.

RESULTS

One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period.

CONCLUSION

Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.

Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis

OBJECTIVE

To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DESIGN

Systematic review with meta-synthesis.

DATA SOURCES

Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.

ELIGIBILITY CRITERIA

Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.

RESULTS

Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.

CONCLUSION

Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.

Pharmacists' approaches to vaccination consultations in Switzerland: a qualitative study comparing the roles of complementary and alternative medicine (CAM) and biomedicine

BACKGROUND

Many community pharmacies in Switzerland provide complementary and alternative medicine (CAM) approaches in addition to providing biomedical services, and a few pharmacies specialise in CAM. A common perception is that CAM providers are sceptical towards, or opposed to, vaccination.

OBJECTIVES

Key objectives of this study are to examine the potential roles of biomedically oriented and CAM-specialised pharmacists regarding vaccine counselling and to better understand the association between vaccine hesitancy and CAM.

DESIGN

We conducted semistructured, qualitative interviews. Transcripts were coded and analysed using thematic analysis. Interview questions were related to: type of pharmaceutical care practised, views on CAM and biomedicine, perspectives on vaccination, descriptions of vaccination consultations in community pharmacies and views on vaccination rates.

SETTING

Qualitative interviews in three language regions of Switzerland (German, French and Italian).

PARTICIPANTS

We interviewed 18 pharmacists (N=11 biomedically oriented, N=7 CAM specialised).

RESULTS

Pharmacist participants expressed generally positive attitudes towards vaccination. Biomedically oriented pharmacists mainly advised customers to follow official vaccination recommendations but rarely counselled vaccine-hesitant customers. CAM-specialised pharmacists were not as enthusiastic advocates of the Swiss vaccination recommendations as the biomedically oriented pharmacists we interviewed. Rather, they considered that each customer should receive individualised, nuanced vaccination advice so that customers can reach their own decisions. CAM-specialised pharmacists described how mothers in particular preferred getting a second opinion when they felt insufficiently advised by biomedically oriented paediatricians.

CONCLUSIONS

Vaccination counselling in community pharmacies represents an additional option to customers who have unmet vaccination consultation needs and who seek reassurance from healthcare professionals (HCPs) other than physicians. By providing individualised vaccination counselling to vaccine-hesitant customers, CAM-specialised pharmacists are likely meeting specific needs of vaccine-hesitant customers. As such, research and implementation efforts should more systematically involve pharmacists as important actors in vaccination provision. CAM-specialised pharmacists particularly should not be neglected as they are important HCPs who counsel vaccine-hesitant customers.

Medication Reconciliation Service in Hospitalized Patients with Infectious Diseases During Coronavirus Disease-2019 Pandemic: An Observational Study

Objectives

To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the coronavirus disease-2019 (COVID-19) pandemic.

Materials and Methods

This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with infectious diseases. Medication reconciliation service (including patient counseling) was provided in person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacists' recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge were assessed by telephone.

Results

Among 146 patients, 84 (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacists' recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.15-4.40; p<0.05], being at a high risk for medication error (OR: 2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR: 1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30 day hospital readmission and admission to the emergency medical service were 12.3% and 15.8%, respectively.

Conclusion

Medication reconciliation service provided by in-person or by telephone was useful for detecting and solving unintentional medication discrepancies during the COVID-19 pandemic.

Generic Substitutions and Therapeutic Interchanges in Hospital Pharmacies: A Qualitative Study from Western Saudi Arabia

Background: The aim of the present study was to understand hospital pharmacists' views and practices regarding generic substitution and therapeutic interchange. Method: This was a qualitative study involving pharmacists from three Western Saudi governorates: Taif, Makkah, and Jeddah. It included respondents from the Ministry of Health (MoH), military and private hospitals. Pharmacists were selected using a convenient sampling technique and data were collected using a structured face-to-face interview. Results: Fifty-seven pharmacists agreed to participate in this study. In MoH and private hospitals, generic substitution is a pharmacist-initiated act, while therapeutic interchange requires physician approval. Medication unavailability, side effects, patient characteristics, outcomes, and economic status justified most substitution decisions. In military hospitals, both types of substitutions are controlled by an auto-switch policy and physicians should be informed. In all hospitals, there are policies regulating substitution. Medications eligible for interchange mentioned by pharmacists from different hospitals were comparable to some extent. Pharmacists from the private sector considered substitution a supportive economic measure for both hospitals and patients. Most pharmacists highlighted that patient convenience and physician approval are the most challenging situations in substitution practice. Conclusions: An enhanced understanding of substitution and knowledge about medications included in the hospital formulary will be valuable support to the implementation of substitution practice which responds to the patients' needs to improve their outcomes.

Use of pharmacy services in community-dwelling middle-aged and older adults; findings from The Irish Longitudinal Study on Ageing (TILDA)

Introduction

The role of community pharmacists has evolved in recent years with expansion in pharmacy services offered. The extent to which patients utilise such services in community pharmacies in Ireland is unclear.

Objective

To assess pharmacy services use among adults aged ≥56 years in Ireland, and determine the demographic and clinical factors associated with pharmacy services use.

Methods

This cross-sectional study included community-dwelling participants in wave 4 of The Irish Longitudinal Study on Ageing (TILDA), aged ≥56 years who were self-respondents. TILDA is a nationally representative cohort study, with wave 4 data collected during 2016. TILDA collects participant demographics and health data, in addition to information on the use of several services when visiting the pharmacy in the last 12 months. Characteristics and pharmacy services use were summarised. Multivariate logistic regression was used to examine the association of demographic and health factors with reporting (i) any pharmacy service use and (ii) requesting medicines advice.

Results

Among 5782 participants (55.5% female, mean age 68 years), 96.6% (5587) reported visiting a pharmacy in the previous 12 months, and almost one fifth of these (1094) utilised at least one non-dispensing pharmacy service. The most common non-dispensing services reported were requesting advice about medications (786, 13.6%), blood pressure monitoring (184, 3.2%), and vaccination (166, 2.9%). Controlling for other factors, female sex (odds ratio (OR) 1.32, 95% CI 1.14-1.52), third-level education (OR 1.85, 95% CI 1.51-2.27), higher rates of GP visits, private health insurance (OR 1.29, 95% CI 1.07-1.56), higher number of medications, loneliness, and respiratory condition diagnosis (OR 1.42, 95% CI 1.14-1.74) were associated with higher likelihood of utilising pharmacy services. The relationship between these factors and requesting medicines advice was similar.

Conclusion

A high proportion of middle-aged and older adults visit community pharmacy and a fifth utilise specified pharmacy services. Despite advances in the services offered in pharmacies, medicines advice remains at the core of pharmacists' practice.

Understanding the Risk Factors and Stressors Impacting Optimal Work Practices in New Zealand Pharmacies: A S.H.E.L.L Model Analysis

(1) Background: The safe performance of pharmacists is an important issue for patients and regulators. It is recognized that pharmacists interact with a variety of healthcare professionals and act as a bridge between other healthcare providers and systems and patients in the health setting. There has been growing activity in exploring factors that impact optimal performance and determinants that are linked with medication errors and practice incidents. The aviation and military industries have used S.H.E.L.L modeling to identify how personnel interact with factors that affect outcomes. A human factors approach is a useful angle to take when trying to improve optimal practice. Little is known about the experiences of New Zealand pharmacists and S.H.E.L.L factors that affect day-to-day practices in their work environment. (2) Methods: We investigated environment, team, and organizational considerations as the determining factors of optimal work practices using an anonymous online questionnaire. The questionnaire was built from a modified version of the software, hardware, environment, and liveware (S.H.E.L.L) model. This identified components of a work system that were vulnerable and that provided risks to optimal practice. Participants were New Zealand pharmacists approached through a subscriber list provided by the regulatory authority of the profession. (3) Results: We received responses from 260 participants (8.56%). The majority of participants indicated that optimal practice was occurring. More than 95% of respondents agreed that knowledge, fatigue interruptions, complacency, and stress affected optimal practice. Equipment and tools, medication arrangement on the shelf, lighting, physical layout, and communication with staff and patients were important factors for optimal practice. A smaller cohort of participants, 13 percent (n = 21), stated that dispensing processes, dissemination, and enforcement of standard operating procedures and procedural guidance did not affect pharmacy practice, 21.3% responded that professional and ethical requirements did not affect optimal practice, 20% stated that having a staffroom affected optimal practice, 20% did not think substance use affected optimal practice, and 30% did not state that cultural differences affected optimal practice. Optimal practice is constrained when there is a lack of experience, professionalism, and communication among staff, patients, and external agencies. COVID-19 also has had an impact on pharmacists both personally and in their work environments. Exploring how the pandemic has affected pharmacists and their work environment warrants further research. (4) Conclusions: Pharmacists across New Zealand agreed that optimal practices were occurring and considered other factors that were perceived to not affect optimal practice. A human factor S.H.E.L.L framework has been used to analyze themes to understand the optimal practice. The rising body of international literature on the effect of the pandemic on pharmacy practice serves as a foundation for many of these themes. Longitudinal data would be useful in exploring some factors, such as pharmacist well-being over time.

The National Implementation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI) through the English Pharmacy Quality Scheme 2020 to 2022

Since 2020, England's Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. To build and embed these initiatives, in 2021/22, the PQS required the use of the TARGET Antibiotic Checklist (an AMS tool for use when patients present with a prescription for antibiotics to support conducting and recording of a series of safety and appropriateness checks against each prescribed antibiotic). This paper describes the implementation of the national PQS criteria from 2020 to 2022, and details community pharmacies' AMS activities and barriers to implementation of the 2021/22 criteria. A total of 8374 community pharmacies submitted data collected using the TARGET Antibiotic Checklist for 213,105 prescriptions; 44% surpassed the required number for the PQS. Pharmacy teams reported checking the following: duration, dose, and appropriateness of antibiotics; patient allergies and medicine interactions (94-95%); antibiotic prescribing guideline adherence (89%); and the patient's previous use of antibiotics (81%). The prescriber was contacted for 1.3% of TARGET Antibiotic Checklists (2741), and the most common reasons for such contacts were related to dose, duration, and possible patient allergy. A total of 105 pharmacy staff responded to a follow-up questionnaire, which suggested that some AMS principles had been embedded into daily practice; however, the necessary time commitment was a barrier. The PQS was able to incentivise mass AMS activities at pace over consecutive years for England's community pharmacies simultaneously. Future research should monitor the continuation of activities and the wider impacts on primary care.

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.

Hospital pharmacy response to the COVID-19 pandemic: experience from a regional referral center in the United Arab Emirates

BACKGROUND

The recent SARS-CoV-2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing  an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy's experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose.

METHODOLOGY

We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020.

RESULTS

We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges.

CONCLUSIONS

This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced.

Impact of COVID-19 pandemic on medicine supply chain for patients with chronic diseases: Experiences of the community pharmacists

Problem considered

Coronavirus disease(COVID-19) outbroke towards the end of December 2019 in China, soon it started spreading rapidly to various countries leading to an outburst of pandemic. Due to the restrictions imposed to control the spread of the infection, globally the manufacturing, import and export of medicine and the healthcare services to patients with chronic illness had been affected. This study aimed to explore the perspectives of the pharmacists on the medicine supply chain for patients with chronic diseases during COVID-19 pandemic in India.

Methods

This study is a prospective, qualitative research involving telephonic, semi-structured in-depth interviews. An interview guide for pharmacists was prepared and validated using "Interview Protocol Refinement" method. Purposive sampling method was used to recruit the pharmacists; a telephonic oral consent was obtained. The interview session was audio recorded and the recordings were transcribed verbatim. Further, transcripts were validated and later analysed using NVivo software.

Results

A total of 8 participants were interviewed during our study. Thematic analysis of the transcripts resulted in seven main themes. The study showed that there was deficiency in medicine supply during the COVID-19 pandemic and the pharmacists faced several challenges in procuring and storing the medication, arranging for unavailable medicines, medication dispensing and provision of the services such as medicine delivery, patient counselling. There was also scarcity of manpower leading to extra workload and working overtime.

Conclusion

Uninterrupted supply of essential medicine is the backbone of health care system. An effective plan and appropriate strategies are vital to combat such future emergencies.

Complementary and alternative medicine use during the COVID-19 pandemic: Community pharmacists' knowledge, attitudes, and practices

BACKGROUND

The challenges in COVID-19 treatment have driven patients to seek Complementary and Alternative Medicine (CAM) for the prevention and/or treatment of the disease. Pharmacists are uniquely positioned to promote the effective and safe use of CAM.

OBJECTIVE

Assess the beliefs, practices, and knowledge of community pharmacists in Lebanon about existing evidence for the use of CAM for the prevention and/or treatment of COVID-19.

METHODS

A national cross-sectional survey was conducted among community pharmacists during the COVID-19 pandemic in Lebanon (n = 310 respondents). Participants completed an online questionnaire addressing, in addition to the socio-demographic characteristics; the beliefs, practices, and knowledge of pharmacists regarding the existing evidence of CAM use for COVID-19 prevention and/or treatment.

RESULTS

Pharmacists (70%) received frequent inquiries about CAM for COVID-19 prevention or treatment. Only 25.5% of the pharmacists reported having enough time to get information about CAM and COVID-19. Almost all participants believed that pharmacists have a major role in the fight against COVID-19 (98%) and that they have enough information to counsel patients in that regard (75%). For practices, the majority of pharmacists reported counseling their patients on proper use (98%) and possible adverse reactions (93%) of CAM, but only 51% reported toxic or undesirable effects. Regarding knowledge, although most pharmacists answered correctly the questions on the role of CAM in preventing COVID-19, few knew about its role in treating the infection. Pharmacists who trust the WHO website as a credible source had a higher knowledge score (β = 0.52, 95%CI: 0.05-0.986).

CONCLUSIONS

The positive beliefs and practices of pharmacists towards CAM during the pandemic were coupled with a few gaps, especially in their knowledge about existing evidence for CAM use. Concerted efforts ought to be dedicated to supporting pharmacists in playing a more prominent role during health crises such as the COVID-19 pandemic.

Ensuring Doctor of Pharmacy Graduates Have the Essential Competencies for Innovative Practice

As the pharmacy profession continues to evolve from product oriented to patient centered, pharmacy programs have been transitioning from a traditional pharmacy curriculum to a competency-based education pedagogy. Competency-based education has been developed to instill the required clinical competencies in graduates to better meet the contemporary role of pharmacists in accordance with the latest scientific knowledge and evidence-based practices in an ever-evolving health care landscape. While these ideas have helped shape the new Accreditation Council for Pharmacy Education (ACPE) Standards and Center for the Advancement of Pharmacy Education (CAPE) Educational Outcome domains, recent publications have indicated that it is integral for these Standards to include public health emergency preparedness and response. Updated Standards and Educational Outcomes must be integrated longitudinally in pharmacy curricula to ensure that graduates will be practice-ready health care professionals. This commentary highlights the strategic use of workforce development of population health based on two perspectives: emergency preparedness and response and digital health.

The 2022 human monkeypox outbreak: Clinical review and management guidance

PURPOSE

The objective of this clinical review is to provide an overview of antiviral therapies for monkeypox treatment and summarize the role of vaccines in monkeypox prevention.

SUMMARY

The human monkeypox virus is a double-stranded DNA virus of the Orthopoxvirus genus of the Poxviridae family. The estimated case fatality rate for monkeypox ranges between 0% and 11%. The first human monkeypox infection was reportedly due to an unidentified animal reservoir. Per the Centers for Disease Control and Prevention, isolation and infection control procedures should be followed in the care of those infected with monkeypox virus. Monkeypox virus infection symptoms include rash, fever, chills, headache, muscle aches, backache, and fatigue that may progress to exhaustion. Severe complications such as encephalitis, pneumonia, and retropharyngeal abscess could appear in immunocompromised or critically ill patients. There are currently no specific Food and Drug Administration (FDA)-approved therapies for monkeypox. As with most viral infections, supportive care is the backbone of monkeypox clinical management. However, therapies effective for smallpox, such as cidofovir, brincidofovir, and tecovirimat, have previously been reported to be effective in the management of monkeypox. Pre- and postexposure prophylaxis to prevent monkeypox transmission are recommended in the US for those at high risk for disease transmission.

CONCLUSION

There are no FDA-approved treatments for monkeypox infection. Surveillance and detection of monkeypox among high-risk populations should be implemented to help understand the epidemiology of this disease.

The COVID conversations: A content analysis of Canadian pharmacy organizations' communication of pharmacists' roles and services during the COVID-19 pandemic

Background

The COVID-19 pandemic presented a unique challenge for pharmacists as they navigated information scarcity on the frontlines while being identified as information experts. Alberta pharmacists looked to their professional organizations for direction regarding what their roles should be in a crisis. The objective of this study was to explore pharmacists' roles and services and how they were communicated by pharmacy organizations during the first year of the COVID-19 pandemic.

Methods

The study used a conventional content analysis method to explore the online communication of relevant pharmacy organizations for Alberta pharmacists. Five organization websites (National Association of Pharmacy Regulatory Authorities, Canadian Pharmacists Association [CPhA], Canadian Society of Hospital Pharmacists [CSHP], Alberta College of Pharmacy [ACP] and the Alberta Pharmacists' Association [RxA]) were examined to identify and catalogue publicly accessible documents that communicated pharmacists' roles and services during the first year of the pandemic for Alberta pharmacists.

Results

A total of 92 documents were collected from CPhA (60), CSHP (2), ACP (26) and RxA (4). While most documents communicated information about pharmacists' roles in public health, patient care and drug and personal protective equipment supply, more than one-third of the documents (32/92, 34.8%) required contextual information to interpret the communication. There was an observed shift in the communication after the first 6 months, becoming more direct in its messaging and context.

Conclusion

These pharmacy organizations communicated information for pharmacists' roles and services to provide direction and guidance in the ever-changing context of the COVID-19 pandemic for Alberta pharmacists. Their communication became clearer and more direct as the pandemic progressed, requiring less inference to understand the intended message.

Utilizing questionnaires for medication counselling of patients taking antipsychotics during the COVID-19 pandemic: a single site, community pharmacy-based survey study

BACKGROUND

During the coronavirus disease (COVID-19) pandemic, general strategies for preventing infectious diseases, such as social distancing and the use of protective equipment have resulted in communication barriers between pharmacists and patients in community pharmacies.

METHODS

To resolve these communication challenges to medication counselling during the COVID-19 pandemic, during their waiting time at our community pharmacy, we administered two questionnaires to patients receiving at least one antipsychotic drug. The first questionnaire, Questionnaire (A), included questions about any problems with wearing a mask and face shield, forgetting to take medication and adverse effects of their medication. The second questionnaire, Questionnaire (B), included questions regarding the evaluation of medication counselling and the ease of using the first questionnaire.

RESULTS

Questionnaire (A) showed that 26.8% of participants had communication problems due to the mask and face shield and 33.8% sometimes forgot to take their medication. The most common adverse effects of the medications were weight gain (43.7%), dry mouth (39.4%) and sexual dysfunction (31%). In the case of Questionnaire (B), more than 80% responded that it was either very easy or easy to fill out Questionnaire (A). Additionally, 93% participants responded that they felt either very good or good about the pharmacist's medication counselling using Questionnaire (A).

CONCLUSIONS

These results strongly suggest that the utilization of questionnaires in medication counselling may be a useful strategy for preventing communication problems between pharmacists and patients receiving antipsychotics in community pharmacies during and after the COVID-19 pandemic.

Community Pharmacists' Beliefs about Suboptimal Practice during the Times of COVID-19

Introduction: Community pharmacies are high-performance workplaces; if the environment is not conducive to safe practice, mistakes can occur. There has been increasing demand for pharmacists during the COVID-19 pandemic as they have become integral to the response. Suboptimal practices in the work environment and with pharmacists and their teams can impact the safe delivery of services. New Zealand pharmacists' perceptions of the current work environment and beliefs around whether suboptimal practice have increased within the last five years and the effect of the COVID-19 pandemic on their practices are unknown. Aim/Objectives: To assess what New Zealand pharmacists associate with suboptimal practice in their workplace and investigate the effect of the COVID-19 pandemic on pharmacists and their workplaces. Methods: We employed an anonymous online questionnaire derived from a human factors framework utilised in the aviation industry to explore the potential environment, team and organisational factors as the determinants of suboptimal work practices. The software, hardware, environment and liveware (S.H.E.L.L) model was adapted to create questions classifying the risk factors to potentially identify aspects of work systems that are vulnerable and may provide risks to optimal practice. Additional perceptions around the effect of COVID-19 on their workplace and roles as pharmacists were explored. Participants were community pharmacists working in New Zealand contacted via a mailing list of the responsible authority for the profession. Findings: We received responses from 260 participants. Most participants indicated that suboptimal practice had increased in the last 5 years (79.8%). The majority of participants indicated that COVID-19 had impacted their workplaces (96%) and their roles as pharmacists (92.1%). Participants perceived that suboptimal practice was associated with a lack of leadership and appropriate management; poor access to resourcing, such as adequate staff and narrow time constraints for work tasks; a lack of procedures; competition; and stress. A lack of experience, professionalism and poor communication between staff, patients and external agencies were also issues. COVID-19 has affected pharmacists personally and their work environments. Further study in this area is required. Conclusions: We have identified that pharmacists across all sectors of New Zealand agreed that suboptimal practices had increased in the last 5 years. A human factors S.H.E.L.L framework can be used to classify themes to understand the increases in suboptimal practice and the role of COVID-19 on pharmacist practice. Many of these themes build on the growing body of the international literature around the effect of the pandemic on pharmacist practice. Areas for which there are less historical data to compare longitudinally include pharmacist wellbeing and the impact of COVID-19.

The impact of the COVID-19 pandemic on pharmacy personnel in primary care

INTRODUCTION

The coronavirus (COVID-19) pandemic has impacted healthcare worldwide. It has altered service delivery and posed challenges to practitioners in relation to workload, well-being and support. Within primary care, changes in physicians' activities have been identified and innovative work solutions implemented. However, evidence is lacking regarding the impact of the pandemic on pharmacy personnel who work in primary care.

AIM

To explore the impact of the pandemic on the working practice (including the type of services provided) and job satisfaction of pharmacists and pharmacy technicians within Scottish general practice. Due to the stressful nature of the pandemic, we hypothesise that job satisfaction will have been negatively affected.

METHODS

An online questionnaire was distributed in May-July 2021, approximately 15 months since initial lockdown measures in the UK. The questionnaire was informed by previous literature and underwent expert review and piloting. Analysis involved descriptive statistics, non-parametric statistical tests and thematic analysis.

RESULTS

180 participants responded (approximated 16.1% response rate): 134 pharmacists (74.4%) and 46 technicians (25.6%). Responses indicated greater involvement with administrative tasks and a reduction in the provision of clinical services, which was negatively perceived by pharmacists. There was an increase in remote working, although most participants continued to have a physical presence within general practices. Face-to-face interactions with patients reduced, which was negatively perceived by participants, and telephone consults were considered efficient yet less effective. Professional development activities were challenged by increased workloads and reduced support available. Although workplace stress was apparent, there was no indication of widespread job dissatisfaction.

CONCLUSION

The pandemic has impacted pharmacists and technicians, but it is unknown if changes will be permanent, and there is a need to understand which changes should continue. Future research should explore the impact of altered service delivery, including remote working, on patient care.

A qualitative exploration of pharmacy students' opinions and experiences of volunteering during the COVID-19 pandemic

INTRODUCTION

This study explored the experiences of pharmacy students volunteering during the COVID-19 pandemic and the perceived impact of volunteering on experiential learning and development of core pharmacy skills.

METHODS

Online semi-structured interviews were conducted with current master of pharmacy, entry-to-practice, professional degree students in the United Kingdom (UK). Participants were recruited through email invitations sent to six schools of pharmacy in the UK, pharmacy student organisations in the UK, and social media. Data were analysed using thematic analysis. Implications from the findings were mapped against the Higher Education Learning Framework.

RESULTS

Fifteen students from a range of UK universities were interviewed. The participants described their motivations for volunteering, experiences of working during COVID-19, and the impact of COVID-19 on their learning experiences. A prominent motivating factor for joining the workforce was a sense of moral responsibility to contribute towards the global effort. The opportunity to learn above and beyond routine coursework placements, personal and professional development, social wellbeing at the time of crisis, and national lockdowns were key outcomes that the participants linked to their experiences of volunteering.

CONCLUSIONS

Participants of this study perceived a high level of satisfaction, pride, and humanity in their contribution to the global effort to fight the COVID-19 pandemic. Harnessing students' motivation, skill sets, and opportunities during the pandemic added an important workforce in the fight against COVID-19 while increasing the student learning experience.

Contributions and challenges of community pharmacists during the COVID-19 pandemic: a qualitative study

Background

Healthcare services across the world have been deeply impacted by the COVID-19 pandemic. In primary care, community pharmacists have had an important role in the frontline healthcare response to the pandemic.

Objectives

This study aimed to explore the experiences, contributions and perceived challenges of community pharmacists regarding the provision of healthcare services during the COVID-19 pandemic.

Methods

Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of pharmacists combined with a snowballing technique. Interviews were transcribed and then analyzed using thematic analysis.

Results

A total of 16 community pharmacists participated in the interviews. Study participants described providing a range of novel services in response to the pandemic on top of continuing their usual services. All participants described providing preventative services to reduce and mitigate the spread of SARS-CoV-2, such as education on hygiene and social distancing, delivery of face masks and hand sanitizer and adjusting pharmacy premises. Most respondents also described being involved in SARS-CoV-2 detection through screening and performing antigen testing in pharmacies. Participants reported being actively involved in COVID-19 vaccination by educating the general public about vaccines, facilitating their distribution to general practitioners as well as administering vaccines. Over half the respondents described rapidly changing guidelines and service users’ anxiety as challenges to the provision of healthcare services during the pandemic.

Conclusions

This study suggests that community pharmacists have significantly contributed to the response to the COVID-19 pandemic by ensuring continuity of pharmaceutical services and providing novel screening, testing and vaccination services. Their roles and responsibilities during the COVID-19 health crisis indicate that they can play an important role in the management of emerging infectious diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00438-8.

Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices

Background

Specialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population.

Objective

This study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population.

Setting

Analyses of publicly available prescribing and demographics data pertaining to primary care in England.

Methods

Prescribing data from 15 specialist homelessness practices in England were extracted for the period 04/2019-03/2020 and compared with data from (a) general populations, (b) the most deprived populations, and (c) the least deprived populations in England.

Main outcome measure

Prescribing rates, measured as the number of items/1000 population in key disease areas.

Results

Data corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population.

Conclusions

Most of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11096-022-01399-3.

“Never waste a good crisis”: Opportunities and constraints from the COVID-19 pandemic on pharmacists’ scope of practice

Background

In response to the COVID-19 pandemic, many pharmacy-based or pharmacist-delivered services were introduced or amended to mitigate the pandemic's health and social impact. This happened within the context of pharmacists seeking more opportunities to increase their clinical responsibilities and play a larger role in primary care.

Objective(s): To analyse the policymaking context and pharmacy responses to COVID-19 that enable or constrain the expansion of pharmacists’ scope of practice.

Methods

This study is a policy analysis of documentary data detailing changes in pharmacy policy in Australia, drawing on a “policy space analysis” framework to identify opportunities and constraints to policy reform. Data were collected from news for health professionals; federal/jurisdictional legislation and media releases; and guidelines and directives from government health departments and agencies. Changes to pharmacy practice were identified and classified according to type. For each change, potential opportunities and constraints for expanding pharmacists’ scope of practice were identified.

Results

Four categories of changes were identified: medicines limits/restrictions; alternatives to paper prescriptions; public health measures; and community pharmacist-delivered services. Opportunities from the pandemic response that could expand scope of practice include the potential permanence of temporary measures that increase pharmacists' responsibilities; remuneration to legitimise services; political acknowledgement of medicines safety and access as a priority; and government need to quickly address crises. Constraints include the potential permanence of temporary measures that restrict pharmacists’ practice; negative perceptions of pharmacists from other clinicians; intra-professional disagreements regarding pharmacy-based services; and lack of pharmacist representation in institutional structures.

Conclusions

This analysis demonstrates that the pandemic responses and policy context may facilitate expansion of pharmacists’ scope of practice, and identifies possible avenues to do so; it also highlights constraints that need to be further addressed to achieve this goal.

A Review on Curcumin-Loaded Electrospun Nanofibers and their Application in Modern Medicine

Herbal drugs are safe and show significantly fewer side effects than their synthetic counterparts. Curcumin (an active ingredient primarily found in turmeric) shows therapeutic properties, but its commercial use as a medication is unrealized, because of doubts about its potency. The literature reveals that electrospun nanofibers show simplicity, efficiency, cost, and reproducibility compared to other fabricating techniques. Forcespinning is a new technique that minimizes limitations and provides additional advantages to electrospinning. Polymer-based nanofibers-whose advantages lie in stability, solubility, and drug storage-overcome problems related to drug delivery, like instability and hydrophobicity. Curcumin-loaded polymer nanofibers show potency in healing diabetic wounds in vitro and in vivo. The release profiles, cell viability, and proliferation assays substantiate their efficacy in bone tissue repair and drug delivery against lung, breast, colorectal, squamous, glioma, and endometrial cancer cells. This review mainly discusses how polymer nanofibers interact with curcumin and its medical efficacy.

Exploring the Pharmaceutical Care of Pharmacists in China During COVID-19—A National Multicenter Qualitative Study

Background

Pharmacists are one of the coronavirus disease-2019 (COVID-19) treatment team members in China, yet only a few single-center studies have described the work experience of pharmacists during the pandemic.

Purpose

This study aimed to explore in-depth experiences of hospital pharmacists providing pharmacy services during the COVID-19 pandemic in China on a national scale.

Methods

This is a nationwide multicenter qualitative study that used the purposive sampling method. Semi-structured interviews were conducted with 11 pharmacists from large-scale tertiary hospitals in representative provinces of mainland China. The Colaizzi seven-step method was applied to analyze the interview data.

Results

Eleven semi-structured interviews were conducted. Each interview lasted 25–70 min. By analyzing the work experiences of pharmacists in COVID-19 designated treatment hospitals, five descriptive themes were categorized: (1) drug supply service; (2) routine clinical pharmacy services; (3) expanded pharmacy services during the epidemic; (4) drug management loopholes; (5) areas of improvements of pharmacy services during a pandemic.

Conclusion

During the COVID-19 epidemic, Chinese hospital pharmacists played various vital roles. However, there were loopholes in managing narcotic drugs, psychotropic drugs, and donated drugs. The study uncovered areas of improvement in pharmacy services during the pandemic. The emergency response capacity of hospital pharmacists should be continuously improved in the future.

A qualitative study on the working experiences of clinical pharmacists in fighting against COVID-19

BACKGROUND

The spread of coronavirus disease 2019 (COVID-19) has overwhelmed healthcare systems across the world. Along with the medical team, clinical pharmacists played a significant role during the public health emergency of COVID-19. This study aimed to explore the working experience of clinical pharmacists and provide reference for first-line clinical pharmacists to prepare for fighting against COVID-19.

METHODS

A qualitative study based on descriptive phenomenology was employed with face-to-face and audio-recorded interviews to study the working experience of 13 clinical pharmacists (including two clinical nutritional pharmacists). All interviews were transcribed verbatim, and the interview data were analyzed thematically using NVivo software.

RESULTS

Four themes emerged from interview data, including roles of clinical pharmacists, working experiences of clinical pharmacists, psychological feelings of clinical pharmacists, and career expectations of clinical pharmacists.

CONCLUSIONS

The results contributed to a deeper understanding of the clinical pharmacists' work experiences in COVID-19 and offered guidance to better prepare clinical pharmacists in participating in a public health crisis.

Will the Public Engage with New Pharmacy Roles? Assessing Future Uptake of a Community Pharmacy Health Check Using a Discrete Choice Experiment

BACKGROUND

Pharmacists are increasingly providing more clinically orientated services that focus on enhancing patient care and health promotion. However, little is known about how acceptable this is to the public. This study explored public preferences for a community pharmacy-based health check for cardiovascular disease (CVD).

METHODS

A convenience sample of 423 individuals was recruited (from a community pharmacy, a dental practice, a shopping centre, a university campus and a sports centre) to complete a discrete choice experiment (DCE) survey administered face to face on a tablet. The DCE included six attributes: day of the week (weekday or weekends); way of accessing the service (walk-in and wait or by appointment); provider of health check (trainee pharmacist, pharmacist or nurse); duration of health check (30 or 45 min); follow-up phone call (no, yes and within 3 months); and cost (included to estimate the monetary value of health checks). Experimental design methods were used to create 12 choice tasks describing different health check services. Mixed logit (MXL) was used to analyse response data.

RESULTS

Respondents had a preference for a community pharmacy-based CVD health check over no health check. They preferred a service provided (i) at the weekend; (ii) by appointment; (iii) by a nurse; (iv) for 30 min and (v) with follow-up after 3 months. Respondents were willing to pay £50 for this health check.

CONCLUSION

Findings affirm the public's acceptance and value of a pharmacy-led CVD health check. The findings can inform pharmacy-based screening services before they are introduced, guide new service design and support resource allocation decisions.

Disadvantages of using Traditional, Interactive and Distance Learning Methods when Studying the Specialty "Pharmacy"

<p>Interactive and remote technologies are being actively introduced into the training process in the specialty “Pharmacy.” In addition to ease of use, they have several advantages and disadvantages for all stakeholders. The purpose of the work is to analyze the disadvantages of traditional, interactive, and remote methods of teaching in the specialty “Pharmacy” at the Far Eastern State Medical University. This is a sociological survey of students of the Faculty of Pharmacy and Biomedicine (higher education), as well as the Medical-Pharmaceutical College (secondary education). Statistical processing was performed using the non-parametric Mann-Whitney, Kruskal–Wallis, Spearman’s rank correlation coefficient. Traditional teaching methods are characterized by the inconvenience of tight time frames. During on-line classes, it is more difficult to use an individual methodology for the student and change the teaching method. The most characteristic shortcomings of distance learning include the lack of motivation and the possibility of violations (writing off, forgery, etc.) by the student. Despite the geographical remoteness of the regions, material, and technical difficulties in switching to distance learning, as a rule, did not arise. The lack of an individual approach and the subjectivity of student assessments in distance and traditional teaching methods are due to the high occupancy of groups and their frequent combination (10-25 people) during the class. The disadvantage of remote methods is the complexity of regular control by the teacher, the lack of secure personality identification systems when sending written works and testing on-line, and the low level of consciousness of future specialists. According to the results of the questionnaire, the least number of shortcomings have interactive teaching methods, implying the active participation of the student himself and an individual approach.</p>

Contextualising the Perceptions of Pharmacists Practicing Clinical Pharmacy in South Africa-Do We Practice what We Preach?

The National Department of Health published their Quality Standards for Healthcare Establishments in South Africa and introduced the National Health Insurance, with the pilot phase that commenced in 2012. The system requires an adequate supply of pharmaceutical personnel and the direct involvement of clinical pharmacists throughout the medication-use process to ensure continuity of care, minimised risk with increasing improvement of patient outcomes. The study aimed to provide insight into the pressing issues of clinical pharmacy practice in South Africa, and sets out to contextualise the current profile of the pharmacist performing clinical functions. The study used a quantitative, explorative, cross-sectional design. The population included pharmacists from private and public tertiary hospitals. A questionnaire was administered, using Typeform™. Ethics approval was obtained from Sefako Makgatho Health Sciences University, National Department of Health and Private Healthcare groups. Categorical data were summarised using frequency counts and percentages; continuous data were summarised by mean values and standard deviations. The sample size included 70 pharmacists practicing clinical pharmacy (private sector n = 59; public sector n = 11). Most participants hold a BPharm degree (busy with MPharm qualification) (64%; n = 70). No statistical significance was found between participants in private and public practice. Most pharmacist agreed (32% (private); n = 59) and strongly agreed (45% (public); n = 11) to have sufficient training to perform pharmaceutical care. The majority respondents felt that interventions made by the pharmacist improved the rational use of medicine (47% (private); 55% (public). Pharmacist interventions influence prescribing patterns (42% (private); 64% (public); and reduce polypharmacy (41% (private); 55% (public). The clinical functions mostly performed were evaluation of prescriptions (private 90%; public 82%), while the top logistical function is daily ordering of medication (40.7%; private), and checking of ward stock (36%; public). Although not all pharmacists appointed in South Africa has completed the MPharm degree in clinical pharmacy, the pharmacists at ward level perform numerous clinical functions, even if only for a small part of their workday. This paper sets the way to standardise practices of clinical pharmacy in South Africa, with a reflection on the differences in practice in different institutions.

Pharmacist's Perspectives on Administering a COVID-19 Vaccine in Community Pharmacies in Four Balkan Countries

Community pharmacists expanded their roles and engaged in vaccination services in many countries around the world, but not in Balkan countries. This research aimed to assess the perceptions of pharmacists on involvement in the coronavirus disease (COVID-19) vaccine administration in four Balkan countries (Albania, Bulgaria, Romania, and Serbia). A cross-sectional survey was conducted using an online questionnaire that was distributed to community pharmacists across these countries between February and March 2021. A total of 636 community pharmacists were included in the analysis of the survey. The willingness to administer vaccines for COVID-19 (or other vaccines well established in the practice, like a flu vaccine) in community pharmacies is significantly different among the countries: the pharmacists from Albania were more willing to administer vaccines. The factors associated with the eagerness to vaccinate are almost the same among the countries: the lack of training in the faculty classes and the lack of a special place where to administer vaccines. Additional significant factors were found in Bulgaria (pharmacists from independent pharmacies wanted more than the pharmacists working in chain pharmacies to administer vaccines) and in Serbia (male pharmacists agreed more with administering vaccines than female pharmacists). Further national reforms are needed for adopting the expanding role of community pharmacists.

Community pharmacy cognitive services during the COVID-19 pandemic: A descriptive study of practices, precautions taken, perceived enablers and barriers and burnout

OBJECTIVE

The objectives of this study were to identify community pharmacist (CP)-led cognitive services and CPs' precautions taken related to COVID-19, perceived enablers and barriers related to pharmaceutical services and burnout levels during the COVID-19 pandemic.

METHOD

In this descriptive study, the survey was administered online to CPs in all regions of Turkey. The frequency of their provision of patient counselling, provision of medication information and practices towards precautions during the pandemic were evaluated based on CP self-reports. The Turkish version of the Burnout Measure Short Form was used, and a 30-item questionnaire based on the 12-domain Theoretical Domains Framework was developed to determine CPs' perceived enablers of and barriers to pharmaceutical service delivery during the COVID-19 pandemic. Data were collected using convenience sampling methods. Besides internal consistency reliability, principal component analysis, and correlation analysis, Mann-Whitney U-test was conducted in group comparisons.

RESULTS

A total of 1098 complete responses were received, for a response rate of 4.11% among 26 747 CPs. The CPs' median burnout score was 3.3 (2.5-4.2). More than half of the CPs (54.5%) referred probable patients with COVID-19 to the hospital. Commonly delivered cognitive CP-led services included preventive health services (89.5%) and medication information services (86.3%). Perceived barriers to delivering pharmaceutical services were a lack of environmental resources and support and a lack of innovation in pharmaceutical services. Perceived enablers were CPs' knowledge, skills, self-confidence, actions, impacts, emotions and perceived behavioural control.

CONCLUSION

To increase the preparedness of pharmacists for future pandemics or disasters, this study highlighted CP-led cognitive services, precautions taken related to COVID-19, perceived enablers and barriers and burnout during the COVID-19 pandemic. Pharmaceutical services guidelines that could be followed during a pandemic or other disaster should be designed by addressing these findings.

Strategies Adopted by Addiction Facilities during the Coronavirus Pandemic to Support Treatment for Individuals in Recovery or Struggling with a Substance Use Disorder: A Scoping Review

This review aimed to identify and synthesize strategies and actions adopted by addiction facilities to support and maintain treatment during the coronavirus disease 2019 (COVID-19) pandemic. A scoping review was conducted using the following information sources: Virtual Health Library, SCOPUS, Web of Science, PubMed, CINAHL, and Latin American and Caribbean Health Science Literature. From a total of 971 articles, 28 studies were included. The strategies to maintain the care offer were telehealth/telemedicine, counselling/screening, 24-h telephone, webinars, conducting group therapy and support among users, adaptation for electronic health records, increased methadone/naloxone dispensing, restriction in the number of medication dispensing/day, and electronic prescription and home delivery medications. These strategies can be used to support health professionals in addressing the impact of the pandemic on the treatment of those in recovery or struggling with a substance use disorder when in-person treatment is not possible.

A qualitative study of the challenges in rearranging community pharmacy service provision during the COVID-19 public health emergency: The prism of social practice theory

Objectives

While healthcare systems struggle to manage the COVID-19 pandemic, community pharmacies have changed the way in which they serve society by ensuring the availability of primary-level medical care. This study aims to examine the rearrangement of service provision at community pharmacies through the prism of social practice theory.

Study design

Qualitative in-depth semi-structured interviews.

Methods

In total, 21 community pharmacists, 3 hospital pharmacists and 10 experts in Estonia were interviewed. For data analysis, two-dimensional thematic textual analysis was performed according to four types of practices proposed in social practice theory and based on temporal distinction.

Results

The findings of this study reveal that, in order to maintain and improve community pharmacy service provision during the pandemic, there have been changes to all aspects of practice elements, including practical understandings, rules and teleological structures. The majority of challenges were experienced because of necessary changes to the habitual ways of providing pharmacy services, indicating resistance to these changes and reinforcing the need to continue existing 'practice-bundles'. Limited access to healthcare services during the COVID-19 pandemic has resulted in community pharmacists becoming the primary (and only) accessible healthcare contact; thus, leading to a shift in awareness about the role of pharmacists.

Conclusions

Although large-scale changes may result in the dissolvement of practice-bundles and require readiness to adjust current methods of service provision, dissolution is a gradual process. There is an urgent need to support pharmacists in managing the challenges of rearranging service provision, such as immediate organisational changes, lack of information and changing resources.

The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic

Nowadays, humanity is confronted with one of the most difficult challenges. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified for the first time in Hubei, China in December 2019 and produced the COVID-19 pandemic, a devastating disease that led to many complications and deaths. The authorities and the global healthcare system have been alerted regarding the prevention and treatment of this pathology. Even though worldwide quarantine was declared, health care professionals, including pharmacists, have been at the frontline in this war. Since the beginning of the pandemic, the authorities relied on the involvement of the community, hospital, or clinical pharmacists in offering support to the entire population. Also, the authorities implemented measures for emergency authorization of the vaccines, or the drugs used in COVID-19 treatment. In order to facilitate the population's access to healthcare services, the authorities have established regulations regarding, the extension of prescriptions by pharmacists, working hours, prevention of shortages and price-increase, drive-thru services, etc. However, several countries have taken financial measures to support the pharmacies' activity. At the same time, pharmaceutical associations elaborated guidelines for the protection of pharmacists and patients alike. Additionally, the pharmacies have come to support the health system and patients by adapting pharmaceutical care to the new needs like preparation and supply of disinfectants, patient care, information, and counseling, especially to COVID-19 patients, as well as the implementation of home drugs-delivery systems. The important roles played by pharmacists were to perform COVID-19 tests and further vaccines, as well as to combat the abundance of misinformation and fake news. The clinical and hospital pharmacy services have also been adapted. Strengthening the role of the pharmacist in the medical team was important for the purpose of providing correct and complete information regarding drugs used in the COVID-19 pathology. In all these activities, pharmacists needed creativity and professionalism, but also the support of pharmacy owners and managers. With this crisis, pharmaceutical care has entered a new phase, demonstrating the ability of pharmacists to be competent and accessible providers of public health. Based on this information, we conducted a narrative review whose purpose was to identify the impact of the authorities' decisions on pharmaceutical practice, the involvement of professional associations, and the responsibilities of the pharmacy owners and management. On the other hand, we performed a global assessment on the pharmaceutical care services provided by community pharmacists as well as by clinical or hospital pharmacists during the COVID-19 pandemic.

Cancer Services During the COVID-19 Pandemic: Systematic Review of Patient's and Caregiver's Experiences

PURPOSE

Cancer patients have faced intersecting crises during the COVID-19 pandemic. This review aimed to examine patients' and caregivers' experiences of accessing cancer services during the pandemic and its perceived impact on their psychological wellbeing.

PATIENTS AND METHODS

A protocol-led (CRD42020214906) systematic review was conducted by searching six databases including EMBASE, MEDLINE and CINAHL for articles published in English-language between 1/2020 and 12/2020. Data were extracted using a pilot-tested, structured data extraction form. Thematic synthesis of data was undertaken and reported as per the PRISMA guideline.

RESULTS

A total of 1110 articles were screened, of which 19 studies met the inclusion criteria. Studies originated from 10 different countries including the US, UK, India and China. Extracted data were categorised into seven themes. Postponement and delays in cancer screening and treatment, drug shortages and inadequate nursing care were commonly experienced by patients. Hospital closures, resource constraints, national lockdowns and patient reluctance to use health services due to infection worries contributed to the delay. Financial and social distress, isolation, and spiritual distress were also commonly reported. Caregivers in addition felt anxious about infecting cancer patients with COVID-19.

CONCLUSION

Patients and caregivers experienced delays in cancer screening, treatment and care during the COVID-19 pandemic and negatively affected their psychological wellbeing. Their views and preferences should be accounted to minimise the impact of the current and any future pandemics and ensure resilient cancer services.

PROTOCOL REGISTRATION

Published protocol registered with Centre for Review and Dissemination CRD42020214906 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214906).

Pharmacists' involvement in COVID-19 vaccination across Europe: a situational analysis of current practice and policy

One year since the emergence of the COVID-19 pandemic, rapid response measures have been implemented internationally to mitigate the spread of the virus. Following rapid and successful pre-clinical and human trials, several vaccines have been authorised for use across Europe through the European Medicines Agency and national regulatory authorities. Clinical trials have shown promising results including important reductions in disease severity, hospitalisation and mortality. In order to maximise the public health benefit of available vaccines, there is a pressing need to vaccinate a large proportion of the population. Internationally, this has prompted coordination of existing services at enormous scale, and development and implementation of novel vaccination strategies to ensure maximum inoculation over the shortest possible timeframe. Pharmacists are being promoted as healthcare professionals that enhance roll-out of COVID-19 vaccination programmes. This paper aims to summarise current policy and practice in relation to pharmacists’ involvement in COVID-19 vaccination in 13 countries across Europe.

Response to the first wave of the COVID-19 pandemic in the community pharmacy of a University Center for Primary Care and Public Health

Background

Pharmacists played a key role during the coronavirus disease 2019 (COVID-19) pandemic: they contributed to preventing transmission and to maintaining continuity of primary care.

Objectives

To present the contributions of a Swiss pharmacy of an academic outpatient care department (Unisanté) to the prevention of COVID-19 transmission and the precautionary measures plan implemented as well as to evaluate the impact of Swiss semicontainment on its pharmacy services.

Methods

Contributions to COVID-19 transmission prevention and the precautionary measures plan are described. The impact on pharmacy services was measured by quantitative comparison before, during and after semicontainment.

Results

The pharmacy supplied protective equipment to the population and to liberal healthcare professionals and provided COVID-19 recommendations to patients and community pharmacies. The precautionary measures plan implemented required a reorganization of the premises, facilities, staff operation and pharmacy services. Semicontainment had a strong impact on pharmacy services; however, clinical bonds with patients and other healthcare professionals were maintained. Unseen negative impacts may exist and need to be investigated.

Conclusions

Although innovative solutions remain to be developed to guarantee continuous and secure remote communication with patients, this pandemic was an opportunity to demonstrate the versatility, benefit and importance of community pharmacy services.

A comprehensive review on global contributions and recognition of pharmacy professionals amidst COVID-19 pandemic: moving from present to future

BACKGROUND

COVID-19, a respiratory tract infection caused by SARS-CoV-2, is a burning question worldwide as it gives rise to a pandemic situation. No specific medications are still recommended for COVID-19; however, healthcare support is crucial for ameliorating the disease condition. Pharmacists are the frontline fighters who are responsible for providing healthcare support to the COVID-19 infected patients around the world. This review endeavored to briefly rationalize the contributions of several pharmacy professionals in diverse fields along with their collaborative efforts and dedication regarding their limitations during the COVID-19 situation and view the prospects of pharmaceutical care services in the post-pandemic period.

MAIN BODY OF THE ABSTRACT

Online databases were utilized to search for scholarly articles and organizational websites, to sum up the information about the contemporary and expanded role of pharmacists. Key articles were retrieved from Google Scholar, PubMed, and Science Direct databases using terms: "COVID-19," "novel coronavirus," "community," "industrial," "hospital," "clinical," "recognition," "obstacles," "collaboration," "SARS-CoV-2," "healthcare," and "outbreak" in combination with "pharmacist." The articles were included from the inception of the pandemic to January 25, 2021. The current review found pharmacist's global contributions and involvements with other professionals to provide healthcare services amidst COVID-19. This included testing of suspects, providing medical information, psycho-social support, debunking myths, mitigating drug shortage events, telemedicine, e-prescription, infection control, and controlling the drug supply chain. In many countries, pharmacists' activities were much appreciated but in some countries, they were not properly acknowledged for their contributions amidst COVID-19 outbreak. They played additional roles such as participating in the antimicrobial stewardship team, improving value-added services, conducting clinical data analysis to suppress the outspread of the SARS-CoV-2.

SHORT CONCLUSION

During the COVID-19 pandemic while the whole world is fighting against an invisible virus, the pharmacists are the earnest hero to serve their responsibilities along with additional activities. They need to be prepared and collaborate with other healthcare professionals further to meet the challenges of post-pandemic circumstances.

Impact of the COVID-19 Pandemic on the Prescribing Patterns of First-Line Antibiotics in English Primary Care: A Longitudinal Analysis of National Prescribing Dataset

The COVID-19 pandemic has impacted on public access to health services. This study aimed to investigate the impact of COVID-19 pandemic on commonly prescribed first-line antibiotics in English primary care. A secondary analysis of publicly available government data pertaining to primary care prescribing was conducted. A list of twenty first-line antibiotics used to treat common infections was developed following the National Institute of Clinical Excellence (NICE) guidelines. All primary care prescription and cost data pertaining to commonly prescribed first-line antibiotics in England between March and September of 2018-2020 were extracted and adjusted for inflation. Analysis suggests prescribing of antibiotics significantly reduced by 15.99% (p = 0.018) and 13.5% (p = 0.002) between March and September 2020 compared with same time period for 2018 and 2019, respectively. The most noticeable decrease in 2020 was noticed for prescribing for meningitis (-62.3%; p = 0.002) followed by respiratory tract infections (-39.13%; p = 0.035), in terms of indications. These results are suggestive of reduced transmission of infections in the community due to national lockdowns, social distancing and hygiene practices. In addition, the impact of reduced face-to-face consultations in general practices needs to be investigated as a potential reason for reduced prescribing. The pandemic also offers an opportunity to rationalize antibiotics use in the community.

Complementary and alternative medicines use in COVID-19: A global perspective on practice, policy and research

The COVID-19 pandemic has met international health systems with a low level of preparedness and emergency response. While the emergence of effective vaccines has offered the Governments, scientific communities, and members of the public a possible way out of the pandemic, effective pharmacotherapy, including immunotherapy for COVID-19 prevention and treatment, are yet to be established. Internationally, this has led to a surge in the demand and supply of many complementary and alternative medicines (CAM) and practices. Recent studies have shown increasing CAM information requests made to pharmacists and other healthcare staff from members of public and patients aimed at prevention, symptoms relief or treatment of COVID-19.

In this context, it is imperative that healthcare professionals, including pharmacists, are acquainted with current practices, policies, and research in relation to CAM use in COVID-19. This narrative commentary will provide an update on global practices, policies and research in regards to CAM use in the context of COVID-19. Healthcare professionals’ understanding of popular CAMs and those tipped for potential benefits in COVID-19, patient and consumer behaviors in relation to CAM use; and healthcare professionals' awareness of cultural, religious, and self-care practices associated with CAM use are imperative to inform effective communication and counselling practices and promote evidence based self-care when patients present for advice. This narrative provides relevant discussions specific to different continents and regions historically linked to diverse CAM practices.

COVID the Catalyst for Evolving Professional Role Identity? A Scoping Review of Global Pharmacists' Roles and Services as a Response to the COVID-19 Pandemic

The COVID-19 pandemic requires a range of healthcare services to meet the needs of society. The objective was to explore what is known about the roles and services performed by frontline pharmacists during the first year of the COVID-19 pandemic. A scoping review was conducted of frontline pharmacists' roles and services during the first year of the COVID-19 pandemic. A medical librarian conducted comprehensive searches in five bibliographic databases-MEDLINE (via Ovid), Embase (Ovid), CINAHL, Scopus, and Web of Science Core Collection for articles published between December 2019 and December 2020. The initial search retrieved 3269 articles. After removing duplicates, 1196 articles titles and abstracts were screened, 281 full texts were reviewed for eligibility, and 63 articles were included. This scoping review presents a conceptual framework model of the different layers made visible by COVID-19 of pharmacist roles in public health, information, and medication management. It is theorized that there is an invisible layer of change representing evolving professional role identity that may influence permanent role change following the pandemic. Thus, the pharmacy profession needs to build upon the lessons and experiences of this global pandemic and not let the momentum of the visible and invisible changes go to waste.