A cross-sectional survey on community pharmacists readiness to fight COVID-19 in a developing country: knowledge, attitude, and practice in Lebanon

Crisis management in community pharmacies during a pandemic

BACKGROUND

Although the COVID-19 pandemic required community pharmacies to implement several adaptation strategies to ensure medicines' and services' availability, related empirical research based on crisis management theory is lacking.

OBJECTIVE

This study sought to holistically depict crisis management in Finnish community pharmacies and explore whether (1) pre-existing crisis plans, (2) crisis teams, (3) shared decision-making or (4) collaboration and communication with external stakeholders can protect staff resilience, pharmacy owners' resilience, organisational cohesion ('team spirit') and pharmacies' resources or finances during the pandemic.

METHODS

A cross-sectional survey was developed based on the crisis management process model and sent to Finnish community pharmacy owners (n = 602) during the pandemic's second wave in October-November 2020. Descriptive statistics were calculated, and logistic regression analysis was performed to explore effects of crisis management efforts. Open-field responses were analysed qualitatively using deductive content analysis.

RESULTS

In total, 221 (36.7 %) pharmacy owners participated in the study. Pharmacies responded to the pandemic with increased order volumes and new suppliers, home deliveries and remote consultations, hand sanitiser production and additional customer counselling concerning the COVID-19. Shared decision-making with pharmacy colleagues (p = 0.025) and collaboration with peers or stakeholders in the supply chain (p = 0.015) protected pharmacy owners' resilience during the pandemic. Additionally, shared decision-making protected pharmacies' finances (p = 0.040). Crisis teams or collaboration with social and healthcare operators did not provide advantage to pharmacies. However, pre-existing pandemic plans associated with reduction of pharmacies' resources (p = 0.006).

CONCLUSIONS

Community pharmacies responded to the COVID-19 pandemic with several measures to ensure the continuity of pharmaceutical services and care and the availability of medicines, disinfectants and personal protective equipment. Developing shared decision-making in pharmacies and active collaboration with peers and supply-chain stakeholders could improve pharmacies' finances and their owners' resilience in future crises.

Navigating the crisis: A review of COVID-19 research and the importance of academic publications - The case of a private university in Lebanon

Objectives

The threat of the Corona virus has had a profound global impact, prompting extensive discussions among academicians and medical researchers seeking to understand its implications across various fields. Consequently this review aims to explore the COVID-19 research approaches adopted at the Lebanese American University (LAU) between 2019 and 2022 and, to eventually shed light on the importance of the academic publications during this crisis period in the context of Lebanon.

Design Data sources Eligibility criteria

Studies related to "Coronavirus", "SARS-CoV-2," or "COVID-19″ were extracted from the SciVal database spanning the period 2019 to 2022. The identified studies, totaling 97 publications, were indexed in Scopus and Web of Science and underwent narrative analysis along with an evaluation using a predefined scale to determine their eligibility. The majority of the studies were literature reviews, followed by observational studies, modeling studies, systematic reviews, and meta-analyses.

Results

The majority of the identified studies (31 %) were focused on the medical field, primarily the impact of SARS-CoV-2 infection. Additionally, 22 % of studies discussed updates related to global finance and economic markets, while 18 % addressed the psychological burden of the pandemic. Other areas covered in the literature included the impact on performance, nutrition, tourism, politics, and telecommunication.

Conclusion

This study marks a pioneering endeavor that sparks a crucial dialogue regarding peer-reviewed scientific literature during a period of immense need for accurate information. The prevalence of literature reviews can be attributed to the demand for swift dissemination of preliminary findings and the increased call for COVID-19-related research. However, despite the abundance of publications in this specific domain, it is imperative for future research to shift its focus towards the development of novel therapies, preventive measures, psychological insights, and strategies to address the socioeconomic and financial burdens stemming from the pandemic. This study has the potential to establish a standardized framework for addressing similar crises across diverse fields and at various levels.

Limitations

The review readily acknowledges certain limitations. By solely relying on specific databases like Scopus and WoS, there is a possibility of inadvertently overlooking relevant studies. Although the study provides insights into the impact of COVID-19 across different fields and their respective publications, it is important to recognize that the continuous updates to databases and potential exclusions of related studies may have imposed constraints on the findings. Moreover, the urgency for expeditious peer-review during the pandemic may have heightened the chances of errors and diminished transparency. This urgency has unfortunately increased the risk of fraudulent activities and misconduct.

Academic pharmacist competencies in ordinary and emergency situations: content validation and pilot description in Lebanese academia

BACKGROUND

In the absence of a similar study in the Lebanese context, this study aimed to validate the content of the specialized competencies frameworks of academic pharmacists (educators, researchers, and clinical preceptors) and pilot their use for practice assessment in the context of multiple severe crises.

METHODS

A web-based cross-sectional study was conducted between March and September 2022 among academic pharmacists enrolled by snowball sampling using a questionnaire created on Google Forms.

RESULTS

The suggested frameworks had appropriate content to assess the competencies of academic pharmacists. Educators and clinical preceptors were confident in all their competencies except for emergency preparedness. Researchers had varying levels of confidence, ranging from moderate to high confidence for many competencies, but gaps were reported in fundamental research, conducting clinical trials, and pharmacy practice research (mean < 80). Educators and researchers relied primarily on experience and postgraduate studies, while clinical preceptors emphasized undergraduate studies to acquire their respective competencies. Continuing education sessions/programs were the least cited as a competency-acquiring venue across all roles.

CONCLUSION

This study could develop and validate the content of frameworks for specialized competencies of academic pharmacists, including educators, researchers, and clinical preceptors, in a challenging setting. The frameworks were also piloted for practice assessment, which could contribute to supporting effective performance and sustained development of practitioners and help link the skills and competencies pharmacists learn during their studies with those required for a career in academia.

Has the COVID-19 pandemic changed the utilization and provision of essential health care services from 2019 to 2020 in the primary health care network in Lebanon? Results from a nationwide representative cross-sectional survey

There is limited research soliciting the patient and staff perspectives on the overall effects of COVID-19 on the utilization and provision of primary care in Lebanon. The present study was part of a larger study on the overall effect of COVID-19 on both utilization and provision of essential health care services within the Lebanese primary health care network (PHCN). Here, we present the patient and staff perspectives on continuity of service provision, adherence to infection prevention and control measures, and the role of the PHCN in epidemic preparedness and response. We conducted a cross-sectional survey between June and July 2021 among patients who had received a health care service in 2019 or 2020 from registered primary healthcare centers (PHCs) in the network and among the respective PHC staff working during the same period. A total of 763 patients and 198 staff completed the surveys. Services were reported as interrupted by 15% of the total patients who used services either in 2020 only or in both 2019 and 2020. Access to chronic (67%) and acute medications (40%) were reported as the main interrupted services. Immunization also emerged as a foregone service in 2020. Among the staff, one third (33%) reported interruptions in the provision of services. Financial barriers rather than fear of COVID-19 were reported as main reasons for interruption. Both groups considered that the facilities implemented adequate infection prevention and control measures. They perceived that the PHCN maintained some essential healthcare services and that it should have played a bigger role in the response to the pandemic. There was a continuity in utilization and provision of services in the PHCN that was higher than expected, with non-communicable diseases and immunizations suffering more than other services.

Global overview of pharmacist and community pharmacy actions to address COVID-19: A scoping review

Introduction

Pharmacists and community pharmacies play an important role in managing, identifying and preventing the spread of the COVID-19 outbreak.

Objectives

To characterize the global panorama of action by pharmacists and community pharmacies in facing the COVID-19 pandemic.

Methods

The scoping review was based on the search for scientific articles in the databases: PubMed; Scopus; ScienceDirect and Web of Science. The search was carried out on August 31, 2021. The selection process was divided into 3 phases: i) title analysis; ii) analysis of study abstracts; iii) analysis of the full texts of the studies selected in the previous step. Studies were independently selected by two investigators and discrepancies resolved by consensus during focus group discussions led by a third reviewer.

Results

The final search yielded 36 articles for the review. The main strategies for coping with COVID-19 were grouped into 4 categories defined by consensus between the authors: (1) services for providing care to the patient; (2) product management; (3) infection prevention and control practices in community pharmacy; (4) preparation, sources of information used and training offered/received. Through these, the aim was to involve technical managerial, technical assistance and pedagogical technical actions adopted, as well as structure and process indicators that allowed the continuity of the offer of services.

Conclusion

During the pandemic, pharmacists and community pharmacies have been providing essential health services to communities. The results of this review may help to identify the changes adopted to face the COVID-19 pandemic and may contribute to improving the quality of practices in these establishments during the pandemic and after it, in similar situations.

Evaluation of patient safety culture in community pharmacies

Background

The majority of medical mistakes risking patient safety have been related to medication. Numerous international health organizations support assessing safety culture in healthcare organizations as a successful tactic for long-term safety development.

Objective

This study aimed to assess patient safety culture, investigate determinants of patient safety in community pharmacies and identify strengths and possible improvements concerning patient safety in the Lebanese community.

Method

An observational descriptive cross-sectional study was conducted using the Pharmacy Survey on Patient Safety Culture (PSOPSC). It was distributed among Lebanese community pharmacists.

Results

One hundred forty-five community pharmacists completed the survey. High percent positive response (PPR) was seen in the domains of patient counseling (86.4%) and teamwork (83.9%). "Staffing, Work Pressure, and Pace" composite scored 41.2%. Female pharmacists were shown to be more dedicated to patient safety culture, namely in patient counseling skills (P < 0.05). Working for 32 to 40 h per week (β = 19.305), and for >40 h per week (β = 18.315) were significantly associated with increased patient safety score.

Conclusion

An overall positive perception towards patient safety culture was seen among Lebanese community pharmacists.

Adherence to Good Pharmacy Practices by Community Pharmacies in Lebanon and Opportunities for Quality Improvement: It is Time to Act

Purpose

Good pharmacy practice is an important standard that highlight the quality of services in community pharmacies. In 2018, The Order of Pharmacists in Lebanon (OPL) published their own good pharmacy practices (GPP) guidelines. The need exists for investigational studies to assess GPP implementation status and the professional conduct of on-site staff towards these standards.

Methods

Data collection was carried out between February and August 2020 using a questionnaire covering: Socio-demographic variables; Indicator A (Attitude of the Community Pharmacists); Indicator B (Services and Facilities); Indicator C (Dispensing); Indicator D (Storage). Data analysis were performed on SPSS version 25, T-Test and ANOVA were used. A significant p value of <0.001, 95% confidence interval and variables with missing data counting less than 10% were considered.

Results

A total of 211 staffers from pharmacies were enrolled in the study, each representing one community pharmacy. The mean percent of adherence to GPP standards by community pharmacies in the South of Lebanon was below the recommended threshold of 75%. Only 65.09% adhered to all tested indicators (27% to Indicator A, 56.91% to Indicator B, 68.61% to Indicator C, 66.31% to Indicator D). Higher indicators were seen among providers who were aware of OPL standards (OR = 4.021), female (OR= 2.011) and being a licensed pharmacist (OR=3.506). Cronbach alpha of the overall score was 0.615.

Conclusion

Further steps shall be taken to improve the compliance to GPP standards. Steps shall include, identification of the core standards, such as dispensing, provision of adequate information, monitoring of storage conditions, and ensuring the presence of a licensed pharmacist. It is highly recommended that the OPL and the Ministry of Public Health develop a "Self-assessment tool" and an efficient training program to increase community Pharmacists' awareness status. Regular assessment shall be carried to monitor the progress overtime.

Public Perceptions Regarding the Preparedness of Government to Combat the Third Wave of COVID-19 (SARS-CoV-2) Infection Across Various States of India

India has already passed through 2 waves of the coronavirus disease (COVID-19) pandemic losing many lives. The reason for losing lives may be due to the unpreparedness of the health care system of India for this unprecedented pandemic. To assess the government's preparedness, an institutional-based cross-sectional prospective survey was conducted among the adult population of selected states in India. A self-administered 30-item questionnaire divided into 5 sections (demography of the participants, steps to create awareness, prevent spread of infection, handle the emergency, and prognosis) was distributed online through Google Forms. The responses were collected in an Excel file. SPSS software was used to perform the descriptive statistics and analysis of variance (ANOVA). Nearly a quarter of the participants "strongly disagree"/"disagree" about the government's preparedness for the third wave. Considering their perception, it cannot be assured that the government is well prepared to handle the emergency. So, the government must maintain emergency funding and develop a health infrastructure. The government should take steps to reduce social stigma, prevent spreading of unscientific propagation, and make people aware of the World Health Organization (WHO) as the reliable source of information for health emergencies to avoid a human crisis in the future.

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

Background

Community pharmacists like other health care professionals in Lebanon have been grappling with a series of multifaceted, country-wide and ongoing challenges that have formed the impetus for this research. We aimed to explore experiences of community pharmacists in Beirut, Lebanon, during three concurrent crises in 2020: the Lebanese financial crisis, COVID-19 pandemic and the Beirut Port explosion.

Methods

A qualitative approach using a constructivist grounded theory methodology was employed. Between October 2020 and February 2021, semi-structured interviews were conducted with purposefully recruited community pharmacists working in Beirut. All interviews were conducted virtually, and data collected were analysed using inductive reasoning, with open coding and concept development.

Results

Thirty-five participants (63% female, mean age 30) were interviewed online. Emergent categories and theoretical concepts included 1. painting the picture - pharmacists describing the context/setting; 2. impact of the crises - on community pharmacists, the profession, patients and the system; 3. response to the crises - of community pharmacists, the profession (+ practice), patients and the system; and 4. need for advocacy and leadership. A theory was developed about "unsustainable resilience" in the scheme of ongoing crises.

Conclusions

The findings revealed a shared sense of futility and despair among pharmacists collectively as a profession, as well as a sense of unsustainable healthcare systems in Lebanon, and environments impacting on the resilience of pharmacists at an individual level. A call for action is needed for urgent sustainable structural and financial reforms, advocacy and planning for future resilient systems, as well as a resilient pharmacy profession and protection of pharmacists' wellbeing and livelihood.

Pharmacy education and workforce: strategic recommendations based on expert consensus in Lebanon

Pharmacy in Lebanon has been taught for years, and the profession has known the golden ages in previous years. However, with the recent graduation of hundreds of pharmacists, without prior workforce planning, the oversupply of non-specialized pharmacists caused a mismatch with the needs of the market. The context of severe socioeconomic and sanitary crises has further exacerbated the situation, with hundreds of pharmacists leaving the country. A group of pharmacy experts joined to suggest strategic solutions to face such challenges, suggesting a clear strategy for education and the workforce, overarched by educational and professional values and based on six main pillars: (1) implement a national competency framework (including the core and specialized competency frameworks) to be used as a basis for licensure (colloquium); (2) implement a national pharmacy program accreditation, encompassing standards related to competencies adoption and assessment, curricula, teaching methods, research and innovation, instructors' and preceptors' skills, and experiential training; (3) organize training for students and early-career pharmacists; (4) optimize continuing education and implement continuous professional development, fostering innovation and specialization among working pharmacists; (5) develop and implement a pharmacy workforce strategy based on pharmacy intelligence, job market, and academic capacities; (6) develop and implement a legal framework for the above-mentioned pillars in collaboration with ministries and parliamentary commissions. Under the auspices of the relevant authorities, mainly the Order of Pharmacists of Lebanon and the Ministry of Education and Higher Education, the suggested strategy should be discussed and implemented for a better future for the pharmacy profession.

Developing a national pharmaceutical research strategy in Lebanon: opportunities to bridge the gaps and reach the goals

Pharmaceutical research can be structured into clear national strategies that optimize patient health and foster innovation. The objectives of this document are to assess the need for a national pharmaceutical research strategy based on the current situation in Lebanon, to identify the strengths and weaknesses of pharmaceutical research in Lebanon, and to suggest a pharmaceutical research strategy for Lebanon, including goals and objectives. In Lebanon, in the absence of a national health research policy, pharmaceutical research is conducted in academia or hospitals, although projects are the result of personal or team initiatives that should be organized to better serve the needs of the country. Many strengths of pharmaceutical research were identified, such as the pharmaceutical workforce and academics who are willing to contribute to research, while the implementation of the national pharmaceutical strategy represents an important opportunity to promote research. Among the weaknesses is the lack of research culture in some institutions and interinstitutional/interprofessional collaborations. Thus, the suggested strategy aims to structure pharmaceutical research in Lebanon, including the priorities towards which research is directed, the process by which research is conducted, and the workforce conducting research. It will mainly rely on the World Health Organization's interrelated goals (organization, priorities, capacity, standards, and translation). The implementation of the suggested pharmaceutical research strategy will only be achieved through the leadership of the pharmaceutical authorities and the collaboration of stakeholders.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A national study on the resilience of community pharmacists in Lebanon: a cross-sectional survey

Background

Community pharmacists are among the most accessible healthcare professionals and are likely to experience the full brunt of public health crises. In Lebanon, the COVID-19 pandemic, added to a severe economic meltdown, have significantly disrupted an already suffering profession.

Methods

The objective of this study was to determine the level of resilience and its relationship to burnout, job satisfaction, intention to quit, and changes in practice. The study utilized a cross-sectional design to survey community pharmacists using an online questionnaire that included the Connor-Davidson Resilience Scale and the Copenhagen Burnout Inventory. All community pharmacists were invited to participate. Multiple logistic regression identified variables significantly associated with the resilience of pharmacists.

Results

A total of 459 community pharmacists completed the questionnaire. Respondents had a relatively low resilience level (68.0 ± 13.37). They also had higher scores on the client-related burnout (58.06 ± 17.46), followed by the personal burnout (56.51 ± 16.68) and the work-related burnout (55.75 ± 13.82). In this sample, 52.3% of pharmacists indicated that they are dissatisfied with their job and 41.1% indicated an intention to quit in the coming year. According to multivariate analysis, marital status (ß = 0.38; 95% CI 0.16–0.91; p = 0.03), intention to quit (ß = 0.384; 95% CI 0.149–0.987; p = 0.047), workload (ß = 0.275; 95% CI 0.096–0.783; p = 0.016), perception of safety (ß = 0.267; 95% CI 0.078–0.909; p = 0.035), and personal burnout (ß = 0.321; 95% CI 0.152–0.677; p = 0.003) were independent influencing factors for resilience.

Conclusions

Multiple challenges and crises have culminated to the low job satisfaction, high burnout, and high the intention to quit of community pharmacists. This seriously destabilized the labor market of pharmacists which could negatively affect public safety. Effective interventions are essential to enhance the well-being and job satisfaction of pharmacists during public health crisis.

A cross-sectional evaluation of knowledge, attitudes, practices, and perceived challenges among Palestinian pharmacists regarding COVID-19

OBJECTIVES

This study aims to evaluate knowledge, attitudes, practices, and perceived challenges regarding coronavirus disease 2019 among pharmacists in Palestine.

METHODS

An online method was used to collect the data. Three hundred sixty-four pharmacists participated in the study from all areas in the Palestinian territories. The questionnaire consisted of three sections: sociodemographics; knowledge, attitudes, practices regarding coronavirus disease 2019; and barriers that prevent the implementation of infection control measures. The Statistical Package for the Social Sciences program Version 21 was used to analyze the data. Variables were expressed as frequencies, percentages, mean, and median. The chi-square test, Kruskal-Wallis test, Mann-Whitney U test, and Pearson's test were applied, along with logistic regression analysis.

RESULTS

The median age of the participants was 29 years old, and most of them were female (70.9%). The analysis found that 76.4% of pharmacists had good knowledge regarding coronavirus disease 2019, and 52.7% had good practices. The median attitude score recorded by the participants was 32 points [Q1-Q3: 30-34] out of 35. Notably, the level of concern regarding coronavirus disease 2019 was significantly associated with all three tools of measurement; knowledge (p = 0.001), attitudes (p = 0.001), and practices (p = 0.001). It also appears that more years of experience had higher odds (3-5 years of experience: odds ratio, 2.560; 95% confidence interval, 1.413-4.639; p = 0.002, more than 5 years: odds ratio, 2.931; 95% confidence interval, 1.188-7.232; p = 0.020) of good practice.

CONCLUSION

Although an acceptable level of knowledge was found, it might be considered inadequate. Moreover, there is a lack of appropriate adherence to safety measures from pharmacists. Therefore, we recommend the responsible authorities generate an organized training program to expand pharmacists' knowledge and experience regarding coronavirus disease 2019.

The implementation of a FIP guidance for COVID-19: insights from a nationwide survey

Background

The International Pharmaceutical Federation (FIP) has established an interim guidance of coronavirus disease 2019 (COVID-19) for pharmacists worldwide. The aim of this study was to identify the implementation of FIP guidance in China and provide applicable strategies for further actions.

Methods

A nationwide cross-sectional survey on Chinese pharmacists was distributed electronically through groups of WeChat between 9 December 2020 and 18 December 2020. The 29-item questionnaire for the survey was designed based on the FIP guidance and knowledge, attitudes, and practices (KAP) framework.

Results

A total of 237 responses from 237 pharmacists (69.20% females) were received. Most pharmacists (81.86%) participated in work related to COVID-19. Respondents referred to other guidelines or consensus more than they did to FIP guidance. Most participants were qualified for the knowledge-based questions regarding COVID-19 (67.51%), had positive attitudes towards pharmacists’ roles and actions (61.18%), and were qualified in the practices of prevention measures, infection risk monitoring, and pharmacists’ advice (50.63%). Several factors were revealed as having impact on pharmacists’ KAP, such as the relevance of participating in work related to COVID-19, work entailments, and information source.

Conclusions

The FIP guidance has a certain degree of dissemination and implementation in China, which can be improved through effective actions directed towards impact factors.