Impact of COVID-19 on frontline pharmacists' roles and services in Canada: The INSPIRE Survey

Willingness of Canadian community pharmacists to adopt a proactive life-course approach to vaccination services

BACKGROUND

Most Canadian jurisdictions authorize pharmacists to administer vaccines, with differences in vaccine and patient age eligibility. Vaccination rates could be further optimized if pharmacists took a more proactive role in life-course vaccine screening and administration. Health professional vaccine fatigue following the COVID-19 pandemic may negatively impact service delivery.

OBJECTIVES

To assess vaccine fatigue among Canadian pharmacists, understand their willingness to provide proactive life-course vaccination services and identify associated vaccine practice facilitators.

METHODS

One-on-one interviews were conducted with pharmacists recruited through a national community pharmacist Facebook group. Purposive sampling was used to select a diverse sample considering gender, province, and years of practice. Online interviews were conducted using a semi-structured guide with questions about vaccination experiences, perceptions of assuming a more proactive vaccinator role for adults and children, and current level of fatigue related to offering vaccination services. Interviews were audio-recorded, transcribed, and coded independently by 2 researchers; content analysis was used to identify themes.

RESULTS

In spring 2023, interviews were conducted with 24 pharmacists from 5 Canadian provinces. Participants were receptive to a more proactive vaccinator role, feeling that vaccine fatigue had lessened, but strongly advocated for system and practice modifications to facilitate successful implementation. They emphasized the need for patient vaccination history access, the ability to administer all publicly funded vaccines, and fair compensation. Participants requested the development of electronic tools that connected to pharmacy systems that helped them navigate complex vaccine guidelines and clinical decision making, and the required documentation/billing. They also spoke of logistical concerns related to the incorporation of vaccination into their workflow and adequate staffing. Most participants were willing to vaccinate younger children if legislated age limits were lowered, provided they were trained and compensated appropriately.

CONCLUSION

Pharmacists are interested in furthering their vaccination services offerings, including proactive screening and vaccination of young children.

Comparison of Perceived Importance and Performance of Community Pharmacists' Role in South Korea During the Coronavirus Disease 2019 Pandemic

OBJECTIVE

This study aimed to identify the roles of community pharmacists (CPs) during the coronavirus disease 2019 (COVID-19) pandemic, the differences in their role performance compared with their perceived importance, and limiting factors.

METHODS

A cross-sectional online survey of CPs was conducted. The CPs self-measured the importance and performance of each role during the pandemic using a 5-point Likert scale. A paired t-test was used to compare each role's importance and performance scores. A logistic regression analysis of the roles with low performance scores, despite their level of importance, was conducted to determine the factors affecting performance. The limiting factors were also surveyed.

RESULTS

The 436 responses to the questionnaire were analyzed. The performance scores were significantly lower than the perceived importance scores for 15 of the 17 roles. The source and update frequency of COVID-19 information and participation in outreach pharmaceutical services were associated with low performance scores. Insufficient economic compensation, the lack of communication channels, and legal limitations were the limiting factors in performing the CPs' roles.

CONCLUSIONS

The participation in outreach pharmaceutical services, economic compensation, and communication channel should be improved to motivate the CPs in performing their roles.

Impact of the Novel CoronaviruS (COVID-19) on Frontline PharmacIsts Roles and ServicEs: INSPIRE Worldwide Survey

Background: Pharmacy has been recognized as a vital healthcare profession during the COVID-19 pandemic. The primary objective of the INSPIRE Worldwide survey was to determine the impact of COVID-19 on pharmacy practice and pharmacists’ roles around the world. Methods: A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Participants were recruited through social media, with assistance from national and international pharmacy organizations between March 2021–May 2022. The questionnaire was divided into (1) demographics, (2) pharmacists’ roles, (3) communication strategies, and (4) practice challenges. The data were analyzed using SPSS 28, and descriptive statistics were used to report frequencies and percentages. Results: A total of 505 pharmacists practicing in 25 countries participated. The most common role that pharmacists undertook was responding to drug information requests (90%), followed by allaying patients’ fears and anxieties about COVID-19 (82.6%), and addressing misinformation about COVID-19 treatments and vaccinations (80.4%). The most common challenges were increased stress levels (84.7%), followed by medication shortages (73.8%), general supply shortages (71.8%), and inadequate staffing (69.2%). Conclusions: Pharmacists within this study were significantly impacted by the COVID-19 pandemic and took on new or adapted roles (e.g., providing COVID-specific information, managing patients’ emotions, and educating on public health measures) to meet the needs of their communities. Despite, the significant challenges (e.g., increased stress, supply chain challenges, addressing misinformation, and staffing shortages) faced by pharmacists, they continued to put their patients’ needs first and to provide pharmacy services.

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.

Community pharmacists’ acceptance of prescribing for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV)

Background:

Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. Pharmacists can increase PrEP accessibility through pharmacist prescribing. This study aimed to determine pharmacists’ acceptance of a pharmacist PrEP prescribing service in Nova Scotia.

Methods:

A triangulation mixed methods study consisting of an online survey and qualitative interviews was conducted with Nova Scotia community pharmacists. The survey questionnaire and qualitative interview guide were underpinned by the 7 constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct.

Results:

A total of 214 community pharmacists completed the survey, and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment) and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service) and perceived effectiveness (education/training, public awareness, laboratory test ordering and reimbursement).

Conclusion:

A PrEP prescribing service has mixed acceptability to Nova Scotia pharmacists yet represents a model of service delivery to increase PrEP access to underserved populations. Future service development must consider pharmacists’ workload, education and training as well as factors relating to laboratory test ordering and reimbursement.

Exploring the well-being of community pharmacy professionals, turnover intention, and patient safety: Time to include operational responsibility

Background:

The COVID-19 pandemic added significant occupational pressures on community pharmacists. The objective of this research project was to investigate the level of distress and burnout among community pharmacy professionals and its association with their retention within their occupation as well as patient safety outcomes.

Method:

We conducted a cross-sectional study on 722 community pharmacy professionals from all Canadian provinces using an online survey, including scientifically validated measures. The data were analyzed using multiple regression analysis.

Results:

In Canada, 85% of community pharmacy professionals reported their mental health had suffered since the COVID-19 pandemic. Younger pharmacy professionals and those paid hourly reported a worsening level of mental health and an increasing level of turnover intention. Pharmacists with more dynamic/disrupted work schedules and those working for a large pharmacy chain (more than 25 pharmacies in Canada) reported lower levels of mental health quality. Pharmacy professionals working in pharmacies that are open more than 70 hours a week reported a lower level of patient safety culture. Pharmacists’ mental health was the significant predictor of their turnover intention, implying a heightened risk to professional effectiveness and retention. Compassion satisfaction was positively associated with patient safety culture and safety behaviour, while compassion fatigue and secondary traumatic stress were significantly associated with pharmacists’ level of risk-taking behaviours.

Conclusion:

This study emphasized the importance of prioritizing the mental health and well-being of community pharmacy professionals and demonstrated individual and systemic factors predicting the well-being and turnover intention of community pharmacists, as well as patient safety culture within their pharmacy. This research makes a case to consider actions to shift the monitoring focus from community pharmacists (also known as “individual responsibility”) to community pharmacies (also known as “operational responsibility”) for managing patient safety. Additionally, community pharmacists should be provided with the professional autonomy to affect their working conditions and alleviate the stress that has the potential to negatively affect the delivery of care.

Behind the Counter: Exploring Pharmacists' Stressors and Lessons Learned During the Pandemic in Ontario, Canada

Background

The onset of the COVID-19 pandemic has contributed to increased stress among healthcare professionals. Among these healthcare providers are Ontario pharmacists, who are facing new and pre-existing challenges and new stressors since the pandemic.

Objectives

This study aimed to understand the stressors and lessons learned by Ontario pharmacists during the pandemic through their lived experiences.

Methods

In this descriptive qualitative study, we conducted semi-structured one-on-one interviews with Ontario pharmacists virtually to learn about their stressors and lessons learned during the pandemic. Interviews were transcribed verbatim, then analyzed using thematic analysis.

Findings

We reached data saturation after 15 interviews and identified 5 main themes: (1) Communication/miscommunication with the public and other care providers; (2) high workload due to staff shortage and low appreciation/acknowledgement; (3) mismatch in market demand and supply; (4) informational gaps pertaining to the COVID-19 pandemic along with rapid protocol changes; and (5) lessons learned to improve the future of pharmacy practice in Ontario.

Discussion

Our study helped us gain a better understanding of the stressors pharmacists faced, their contributions, and the opportunities that arose due to the pandemic.

Conclusion

Drawing on these experiences, this study provides recommendations to improve pharmacy practice and increase preparedness for future emergencies.

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.

Increased self-reported pharmacist prescribing during the COVID-19 pandemic: Using the Theoretical Domains Framework to identify barriers and facilitators to prescribing

Background

Community pharmacists are positioned to improve access to medications through their ever-expanding role as prescribers, with this role becoming more pronounced during the COVID-19 pandemic.

Objectives

Our research aimed to determine the extent of self-reported pharmacist prescribing pre-COVID-19 and during the COVID-19 pandemic, to identify barriers and facilitators to pharmacist prescribing, and to explore the relationship between these factors and self-reported prescribing activity.

Methods

A questionnaire based on the Theoretical Domains Framework (TDFv2) assessing self-reported prescribing was electronically distributed to all direct patient care pharmacists in NS (N = 1338) in July 2020. Wilcoxon signed-rank tests were used to examine temporal differences in self-reported prescribing activity. TDFv2 responses were descriptively reported as positive (agree/strongly agree), neutral (uncertain), and negative (strongly disagree/disagree) based on the 5-point Likert scale assessing barriers and facilitators to prescribing from March 2020 onward (i.e., ‘during’ COVID-19). Simple logistic regression was used to measure the relationship between TDFv2 domain responses and self-reported prescribing activity.

Results

A total of 190 pharmacists (14.2%) completed the survey. Over 98% of respondents reported prescribing at least once per month in any of the approved prescribing categories, with renewals being the most common activity reported. Since the pandemic, activity in several categories of prescribing significantly increased, including diagnosis supported by protocol (29.0% vs. 58.9%, p < 0.01), minor and common ailments (25.3% vs 34.7%, p = 0.03), preventative medicine (22.1% vs. 33.2%, p < 0.01). Amongst the TDFv2 domains, Beliefs about Consequences domain had the largest influence on prescribing activity (OR = 3.13, 95% CI 1.41–6.97, p < 0.01), with Social Influences (OR = 2.85, 95% CI 1.42–5.70, p < 0.01) being the next most influential.

Conclusion

Self-reported prescribing by direct patient care community pharmacists in Nova Scotia increased during the COVID-19 pandemic, particularly for government-funded services. Key barriers to address, and facilitators to support pharmacist prescribing were identified and can be used to inform future interventions.