Pharmaceutical care during COVID-19 pandemic: challenges and perspectives

Abstract COVID-19 (SARS-CoV-2) pandemic is raising many questions about the future of face-to-face interactions. The possible changes on healthcare delivery may provoke a long term disruption on pharmaceutical assistance requiring new approaches to provide pharmaceutical services. The proposal of pharmaceutical care is patient oriented, and its activities include different forms of interaction. The emergence of COVID-19 puts to the test all the efforts to reposition pharmaceutical care in the set of clinical activities. Now, the pharmaceutical consultations and group activities, which played a fundamental role in the reformulation of pharmacy practices, must be revised in order to reduce the risk of patient agglomeration and contamination. Several researchers suggest technology use to intermediate health care assistance. However, few studies had rigorously analyzed the effectiveness of virtual health care on the pharmaceutical field. Innovating the pharmacy workflow, during the course of a crisis like COVID-19, is the current challenge addressed to all pharmacists. This unforeseen situation requires us to reconsider our plans and actions. It will be necessary resilience, courage and creativity to achieve a consistent attitude, which provides a quick response to the health care needs in this time of crisis.

Pharmacogenomic testing to support prescribing in primary care: a structured review of implementation models.

The application of pharmacogenomics could meaningfully contribute toward medicines optimization within primary care. This review identified 13 studies describing eight implementation models utilizing a multi-gene pharmacogenomic panel within a primary care or community setting. These were small feasibility studies (n <200). They demonstrated importance and feasibility of pre-test counseling, the role of the pharmacist, data integration into the electronic medical record and point-of-care clinical decision support systems (CDSS). Findings were considered alongside existing primary care prescribing practices and implementation frameworks to demonstrate how issues may be addressed by existing nationalized healthcare and primary care infrastructure. Development of point-of-care CDSS should be prioritized; establishing clinical leadership, education programs, defining practitioner roles and responsibilities and addressing commissioning issues will also be crucial.

Providing pharmacy services in a basketball arena: Reflections on building a pharmacy in a COVID-19 surge facility.

PURPOSE: As Coronavirus disease 19 (COVID-19) has spread globally, hospital systems have seen an increasing strain on their ability to accommodate the growing caseload. This demand has led countries to adopt varying surge-facility or alternate care site (ACS) models to manage patient overflow. This report describes the experience of setting up pharmacy services at a city-run surge facility in Philadelphia. SUMMARY: The COVID-19 Surge Facility at the Liacouras Center (CSF-L) was initially developed to serve as a site for patients convalescing from acute inpatient stays in order to free up healthcare resources in surrounding hospitals. The CSF-L site required a distinct set of services to provide the desired level of care. This report details the preparations and challenges faced by the CSF-L pharmacy team in this endeavor, including identifying a pharmacy location that met regulatory requirements, obtaining proper licenses, coordinating drug procurement, filling staffing requirements, developing a formulary, defining the pharmacy and medication management workflow, and ensuring safety protocols were followed. This report explains the rational for developing certain processes and suggests alternative options and ideal plans for developing future pharmacy services in an ACS. CONCLUSION: Identifying a pharmacy leadership team early in the ACS planning process can lead to more efficient plans for pharmacy services. This report details the important steps taken, decisions made, and challenges faced in setting up pharmaceutical services at a COVID-19 field hospital.

Emergency preparedness and response (EP&R) by pharmacy professionals in India: Lessons from the COVID-19 pandemic and the way forward.

The COVID-19 pandemic highlights the importance of Emergency Preparedness & Response (EP&R) education, training, capacity building and infrastructure development in India. During the pandemic, pharmacy professionals (PPs) in India have continued to provide medications, supplies and services. India's public-private healthcare system is complex and of variable quality. Lacunae in pharmacy education, training, and lack of resolution around pharmacist roles present challenges in providing health services to patients. Such lack of differentiation creates challenges around role specifications and appropriate placement of PPs in patient care and on EP&R task forces or representation at the policy level. This study aimed to gain rapid insights from PPs in India regarding their roles and preparedness for the COVID-19 pandemic. An online survey comprising 20 questions regarding EP&R and Operations management was developed using the Qualtrics® survey software and administered to a sample of PPs. Survey results indicate that PPs were actively involved in essential pharmacy services despite minimal EP&R training. Based on lessons learned during COVID-19, lacunae in knowledge, training and regulations were identified and recommendations are provided to broaden PP roles and enable them to be better prepared and actively engaged in EP&R for future emergencies.

Community and hospital pharmacists in Europe: encroaching on medicine?

Pharmacy has been historically regarded as a discipline between health and chemistry devoted to drug development, production, and compounding. These tasks have been almost lost with the industrial manufacturing, and dispensing remains the main activity of pharmacists. Hospital pharmacists are usually employees in their workplace, while the professional framework of community pharmacists is very different, being pharmacies predominantly private shops in almost all European countries. In the last years pharmacists have strongly advocated that the focus of their services should switch from 'product' to 'patient'. Clinical pharmacy and pharmaceutical care are the two most cited concepts to support this shift. Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes. The practice of clinical pharmacy should embrace the philosophy of pharmaceutical care. The new wave of pharmacists' patient-centered care in Europe still seems to be a reaction against the loss of their traditional professional role after the drug manufacturing revolution. To depict a realistic scenario for progress, it is worth differentiating between hospital and community. Hospital pharmacists should strengthen their pivotal role of medication gatekeepers to improve among clinicians the appropriateness of drug prescriptions and generate savings in expenditures. Any proposal for clinical services provided by community pharmacists is inevitably affected by the issue of their potential remuneration, especially in countries where the remuneration for reimbursable drugs is still a proportion of the retail price.

Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond.

Background: Pharmacists have long been involved in public health and emergency preparedness and response (EP&R), including through preventive measures such as screening, vaccinations, testing, medical and pharmaceutical countermeasures, as well as ensuring medication safety and access during natural disasters and pandemics. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Community and hospital pharmacies are expanding services and hours to provide essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve public health. In addition, pharmacy professionals are increasingly integrating into global, national, state and local EP&R efforts, including into interprofessional teams, such as Medical Reserve Corps (MRCs). However, lacunae exist for further integration of pharmacists into public health and safety initiatives. There are increasing opportunities and recommendations that should be expanded upon to provide improved patient care and population health interventions, and to ensure healthcare worker and public health safety. Objective: Develop a Pharmacy Emergency Preparedness and Response (PEPR) Framework and recommendations for pharmacy professional pathways towards full integration within public health EP&R efforts (such as the COVID-19 pandemic), and enhanced recognition of pharmacists' skills, roles and contributions as integral members of the interprofessional healthcare team. Methods: This paper draws on the American Society of Health-System Pharmacists (ASHP) 2003 Statement on the Role of Health-System Pharmacists in Emergency Preparedness and lessons learned from previous and current public health emergencies, such as the 2009 H1N1 pandemic and the current COVID-19 pandemic, to provide expanded guidance for pharmacists and pharmacy professionals across all practice settings in EP&R. The proposed PEPR framework also incorporates information and recommendations from The Pharmacy Organizations' Joint Policy Recommendations to Combat the COVID-19 Pandemic (March 2020), CDC-NIOSH, International Pharmaceutical Federation (FIP) Guidance, health departments and emergency preparedness guidance and resources, Boards of Pharmacy, and other pharmacy professional organizations and educational institutions. Results: Based on methods and resources utilized in developing this proposed PEPR Framework, five key focus areas were identified, as follows:1)Emergency preparedness and response2)Operations management3)Patient care and population health interventions4)Public health pharmacy education and continuing professional education5)Evaluation, research, and dissemination for impact and outcomes. Conclusion: Pharmacists and pharmacy professionals have been at the frontlines in responding to the COVID-19 pandemic. Yet, challenges remain, such as limited availability of personal protection equipment, high risk of infectious exposures inherent in healthcare professions, and legislative hurdles resulting in lack of provider status and related reimbursements. Recommendations to enhance pharmacy's scope as public health professionals involved in EP&R include targeted training and education on key framework areas and policymaking. Pharmacy professionals should further integrate with interdisciplinary public health teams. Additional research and dissemination on impacts and outcomes of EP&R can enhance recognition of pharmacy professionals' contribution and value during public health emergencies. The proposed PEPR Framework can be utilized to develop, implement, evaluate, and disseminate results in order to strengthen existing efforts and to establish new initiatives in EP&R.

COVID-19 pandemic: Response plan by the Johns Hopkins Aramco Healthcare inpatient pharmacy department.

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic having caused a major health care crises across the globe. Pharmacy professionals are considered vital in preparation for optimal response to the COVID-19 pandemic. Therefore, in response to the estimated potential impact of COVID-19 on Johns Hopkins Aramco Healthcare (joint venture between Saudi Aramco and Johns Hopkins Medicine International), several initiatives were taken by the hospital's inpatient pharmacy department with focus on infection control, staffing, meeting clinical operational challenges, ethics, increased utilization of automation, and maintenance of employee wellness to prepare for this challenge. The plan implemented by the inpatient pharmacy department was prepared while incorporating information and recommendations from leading pharmacy organizations, ministry of health, institute's experience in battling another similar coronavirus (the Middle East respiratory syndrome-coronavirus) previously, and updated scientific research. The key focus areas include development of an institutionalized COVID-19 protocol, measures to improve infection control when handling and dispensing medications, modified staffing plan, system changes in peri-operative areas, keeping pharmacy professionals updated about new and scientific researches, increased utilization of automation, clinical interventions by pharmacist ensuring appropriate utilization of medications while monitoring for drug-drug interactions, adverse drug event prevention, and preparing for handling drug shortages. By implementing a robust plan, pharmacy professionals continue to show that they are an integral member of inter-professional health care teams.

Community Pharmacists: On the frontline of health service against COVID-19 in LMICs.

The COVID-19 outbreak is a global public health crisis which has affected healthcare practice across professions. In the context of this pandemic, there is a need to highlight the roles and responsibilities of pharmacists. Community pharmacists are the most accessible healthcare professionals to the general public and have a lot to offer amid the COVID-19 response. This have led to significant changes in the health systems of many countries. This article seeks to highlight additional roles and activities relating to the public health response that can be undertaken by community pharmacists that could help to reduce pressure on general practice and other areas of the health service.

Pharmacists' Patient Care Process: State "Scope of Practice" Priorities for Action.

To fully engage in the Pharmacists' Patient Care Process, pharmacists must be able to (1) participate in a Collaborative Practice Agreement, (2) order and interpret laboratory tests, (3) prescribe certain medications, (4) adapt medications, (5) administer medications, and (6) effectively delegate tasks to support staff. Each of these activities is dependent on state scope of practice laws, but these laws are not binary. Various state-level restrictions allow us to view these activities on a continuum from more restrictive to less restrictive. This continuum will allow pharmacy and public health stakeholders to identify priorities for action in their states.

Pandemic preparedness of community pharmacies for COVID-19.

Background: Community pharmacies provide an important healthcare service, which is broadly established, and constitutes the preferred and initial contact for members of the community. The significant value of community pharmacies was further highlighted during the COVID-19 pandemic crisis. Objective: The assessment of community pharmacies preparedness for the COVID-19 pandemic. Methods: A cross-sectional interview survey of 1018 community pharmacies working in four regions of Egypt (South, East, Centre, and North). Data collection was conducted from 8-19 April 2020. Results: Availability of personal protective equipment (PPE) and medication was better than alcohol (70% conc.). Home delivery services were available in 49.1% of pharmacies. Infection control measures covering interactions between staff were in place in up to 99.5% of pharmacies. Conversely, there was less frequent availability of contactless payment (29.1%), hand sanitizers (62.1%) or masks (86.5%) for customer use, or a separate area for patients with suspected COVID-19 (64%). Verbal customer education (90.4%) was used preferably to written (81.3%). Despite high clinical knowledge and awareness (97.6%-99.2%), only 8.8% of pharmacists had reported suspected COVID-19 cases, however this varied significantly with pharmacist demographics (geographic region P < 0.001; pandemic training p < 0.001; position p = 0.019; age p = 0.046). Conclusions: Government and policymakers strive to mitigate the shortage of PPE and medication. More attention should be given to infection control measures around interactions between staff and customers to ensure community pharmacists are fit and able to provide continuity in their important role. Educating customers using regularly-updated posters, banners or signs will contribute to decreasing contact with patients, and reducing the number and duration of visits to the pharmacy. Pandemic preparedness of community pharmacists must also extend to reporting procedures. By avoiding under-reporting or over-reporting, community pharmacists will contribute to accurate monitoring of the national spread of infection.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Análise das características e tendências do mercado da formação de farmacêuticos no Brasil / Analisys of the characteristics and trends of pharmacist training market in Brazil

A presente pesquisa tem como foco a graduação do farmacêutico. Com o intuito de estudar o mercado educacional do curso de Farmácia, buscou-se analisar a oferta de cursos e vagas desta profissão, a legislação pertinente ao ensino superior do Brasil e do ensino em farmácia, além da atualização da DCN pertencentes a este curso. As justificativas para realização deste estudo estão baseadas em quatro argumentos interligados, como a importância da formação de recursos humanos para saúde, as mudanças ocorridas no perfil curricular desse curso nos últimos anos, o papel das instituições de ensino privado e o aparecimento e crescimento da modalidade EAD, sendo observadas as tendências para o mercado de formação dessa categoria profissional. Trata-se de estudo descritivo e exploratório utilizando uma abordagem quali-quantitativa com associação de duas estratégias metodológicas: a combinação de pesquisa bibliográfica e narrativa sobre as características e tendências da formação do farmacêutico em nosso país, e a coleta de dados através do site do e-MEC. Os resultados da pesquisa junto ao site do e-MEC evidenciaram um total de 811 cursos de Farmácia divididos em 752 presenciais tanto em instituições públicas quanto privadas; já na modalidade EAD, foram encontrados 59, todos em instituições privadas. Em janeiro de 2021 foram ofertadas 107.786 vagas na modalidade presencial e 194.433 EAD, totalizando 302.219 vagas. Considerando a organização acadêmica dos cursos presenciais, a pesquisa encontrou a maior parte em faculdades totalizando 273; O mercado educacional para o curso de farmácia teve sua expansão durante os anos 1930 juntamente com políticas voltadas para o crescimento do setor farmo-químico no país. Nos últimos anos, ocorreram inúmeras mudanças nas políticas de ensino superior, como o crescimento da oferta de vagas em IES privadas com incentivos do governo federal como o FIES e o PROUNI. Este período foi marcado pelo crescimento acelerado do número de cursos, vagas, modalidades de ensino e matrículas, além da diversidade de instituições que pertencem ao sistema de ensino superior do Brasil. O ensino à distância ganhou visibilidade com o avançar da globalização e a criação de novas tecnologias voltadas para a educação. As mudanças no setor educacional permitiram mostrar a importância de pesquisar a formação de recursos humanos, a necessidade de políticas, diretrizes e estratégias que atendam à população e aos serviços de saúde, evitando assim a escassez de recursos humanos para o setor saúde, garantindo o acesso universal e integral como proposto na Lei no 8.080. A pandemia do COVID-19 destacou a importância do farmacêutico em relação ao uso racional de medicamentos e de uma formação qualificada que possa garantir a assistência farmacêutica.

The focus of this study is on pharmacist graduation. To analyze the educational market for the Pharmacy course, we looked at the supply of courses and places in this field, as well as the regulations governing higher education in Brazil and pharmacy education, as well as the DCN for this degree. The study's justifications are based on four interconnected arguments, including the importance of human resources training for health, changes in the curricular profile of this course in recent years, the role of private educational institutions, and the emergence and growth of distance education, as well as trends in the training market for this professional category. This is a descriptive and exploratory study that uses a quali-quantitative approach and combines two methodological strategies: a combination of bibliographic and narrative research on the characteristics and trends of pharmacist education in our country, as well as data collection through the e-MEC website. The survey found a total of 811 Pharmacy courses, divided into 752 face-to-face courses in both public and private institutions, and 59 distance learning courses, all in private institutions, on the e-MEC website. In January 2021, 107,786 on-site places and 194,433 distance learning vacancies were available, amounting 302,219 places. During the 1930s, the educational market for pharmacy courses grew in line with policies aimed at expanding the pharmochemical sector in the country. There have been several changes in higher education regulations in recent years, such as the increase of vacancies in private HEIs with federal government incentives like FIES and PROUNI. The number of courses, vacancies, education modalities, and enrollments increased rapidly throughout this period, as did the diversity of institutions that make up Brazil's higher education system. With the advancement of globalization and the introduction of new educational technology, distance learning has become more visible. The changes in the educational sector highlight the importance of studying human resource formation, as well as the need for policies, guidelines, and strategies that benefit the population and health services, avoiding a human resource shortage in the health sector and ensuring universal and integral access, as proposed in Law 8.080. The COVID-19 pandemic underscored the necessity of pharmacists in terms of medication rationalization and specialized training that can ensure pharmaceutical assistance.

Update on Pharmacist Workforce Data and Thoughts on How to Manage the Oversupply.

The annual number of Doctor of Pharmacy (PharmD) graduates is projected to exceed the number of annual pharmacist job openings over the next 10 years. Loss of retail sector jobs will be partially offset by projected gains in several other sectors; however, oversupply will persist until the number of graduates is more reflective of job market capacity. Large-scale practice transformation will not happen overnight; consequently, schools and colleges of pharmacy must immediately change their perspective from producing graduates to fill pharmacist roles, to producing graduates who are prepared with expertise and professional skills to excel in many types of well-paying positions. Students need career advice including to convince potential employers how a PharmD education has prepared them with transferable high-level skills that are applicable beyond traditional pharmacist roles. Better communicating the value of pharmacy skills to students and employers may also have a positive impact on admission numbers as prospective applicants become more aware of the breadth of pharmacy career opportunities.

Years of Rampant Expansion Have Imposed Darwinian Survival-of-the-Fittest Conditions on US Pharmacy Schools.

The number of applicants to US pharmacy schools has been declining since 2013, leading to a national enrollment crisis. Enrollment challenges threaten the viability of many pharmacy programs. Some schools are better equipped than others to confront the risk of having to downsize or close, creating survival-of-the-fittest conditions. Four potential risk factors have been identified based on how applicants might perceive the comparable value of respective programs. Schools with lower risk are public, established before 2000, located within an academic health center, and traditional (ie, four-year) programs. The Academy cannot sustain more than 140 schools much longer. Market forces are establishing a new equilibrium between the number of graduates and the availability of pharmacist jobs. As more jobs become available, more applicants will apply. Until then, the fittest Doctor of Pharmacy programs will thrive, while others might have to downsize to survive, and the weakest will be at risk of extinction.