Community Pharmacists' Contributions to Disease Management During the COVID-19 Pandemic

Assessing Community Pharmacists' Perception on Readiness to Initiate Point-of-Care Testing for SARS-CoV-2 in New York State During the Pandemic

Introduction: Pursuant to the COVID-19 pandemic, an executive order issued by the New York State (NYS) governor allowed pharmacists to act as laboratory directors for a limited-service laboratory (LSL) to order and perform Food and Drug Administration (FDA) and Emergency Use Authorization (EUA) Clinical Laboratory Improvement Amendment (CLIA)-waived COVID-19 point-of-care testing (POCT). Objectives: To (i) assess the status of NYS community pharmacists with POCT in the early stages of the COVID-19 pandemic, (ii) assess the readiness and willingness of community pharmacists to incorporate COVID-19 POCT into their workflow during a pandemic, and (iii) assess community pharmacists' perception of the barrier to initiating COVID-19 POCT. Methods: This is a prospective cross-sectional study conducted from February 4 to February 21, 2021. An electronic survey consisting of 66 Likert-type questions, select all that apply, and fill-in-style questions were emailed to 250 Community Pharmacy Enhanced Service Network (CPESN) NY pharmacies, with a follow-up email sent halfway into the data collection period. The data were analyzed using descriptive statistics. Results: The result indicated that most participants (median = 5) demonstrated readiness and willingness to offer COVID-19 testing. Barriers to COVID-19 POCT were identified: impact on pharmacy workflow (59%), lack of payment mechanism (55%) and lack of sufficient training (21%). Most participants expressed interest in continuing POCT beyond the pandemic (86.1%). Conclusion: Community pharmacists in NYS reported willingness to initiate COVID-19 POCT. Addressing the identified barriers, such as workflow disruption and reimbursement challenges, will enable pharmacies to be better prepared to provide patient care, including POCT.

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.

Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce

This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.

2022 national survey of immunizing community chain pharmacists: The case for codifying the PREP Act emergency authorities into practice

BACKGROUND

Pharmacy-based immunization services have expanded since the mid-1990s but still face multiple challenges. Amendments to the Public Readiness and Emergency Preparedness (PREP) Act broadened patient-care scope and the pool of eligible pharmacy personnel who could administer vaccinations. The expiration of these amendments in 2024 may threaten recent gains in vaccine and other health care access newly available through pharmacies.

OBJECTIVES

This study aimed to elicit community chain pharmacists' perspectives on immunization time demands, corporate guidance, data flow and information technology, workflow and workforce issues, and other newly provided services.

METHODS

A survey questionnaire was developed, pretested, and electronically administered in mid-2022 to a randomly sampled national database of pharmacists maintained by the American Pharmacists Association. Descriptive analyses of survey responses were performed and findings used to identify salient themes.

RESULTS

The survey collected 742 responses from a sample of 7845 community chain pharmacists (9.5% response rate). During the 2021-2022 influenza season, pharmacies administered on average 114 vaccinations daily (range 3-1000), mostly by appointment (51%). Pharmacists expressed somewhat greater preference for administering vaccinations (39%) than dispensing prescriptions (36%), and most (92%) considered it at least as important as other practice responsibilities. However, only 27% of pharmacists had adequate staff support and 67% spent more time addressing patients' vaccination confidence issues than before the pandemic. Most respondents (67%) had access to their patient's vaccination status, but only 51% said their company's computer system gave easy access. Only 49% considered corporate immunization feedback effective at enhancing their practice. Provision of nonvaccine services has expanded.

CONCLUSIONS

Frontline community chain pharmacists reportedly preferred administering vaccinations over dispensing prescriptions. The pandemic resulted in an increased responsibility among pharmacists as immunizers. Notwithstanding recent progress, pharmacists continue to face staffing, corporate guidance and feedback, information management, and other structural and process barriers to optimally provide comprehensive immunization services. Survey findings support making permanent and expanding the emergency authorities that pharmacists gained under the PREP Act.

Trends, Capacity Growth, and Current State of Community Pharmacies in Saudi Arabia: Findings and Implications of a 16-Year Retrospective Study

Purpose

Community pharmacies provide access to medicines and pharmaceutical services. Consequently, adequate availability and sufficient workforce capacity must be ensured for effective healthcare delivery. This study assessed the community pharmacy sector in Saudi Arabia, including density, workforce capacity, and evolution from 2007 to 2022.

Methods

This retrospective study measured community pharmacy infrastructure and workforce capacity using international indicators and standardized measures, including community pharmacy and community pharmacist density per 10,000 people and ratio of community pharmacists per pharmacy. Several data sources and platforms were used to collect the data including the Ministry of Health, Saudi General Authority for Statistics, and Ministry of Human Resources and Social Development.

Results

The number of community pharmacies increased by 89.30%, from 5466 in 2007 to 10,347 in 2022, and density increased from 2.25 to 3.22. However, density varied by region, from 3.97 to 1.95. The number of community pharmacists increased by 98.02%, from 10,932 in 2007 to 21,648 in 2022, and community pharmacist density increased from 4.51 to 6.73. However, the ratio of community pharmacists per pharmacy remained unchanged (2.0 in 2007 and 2.1 in 2022). Female pharmacists were first issued licenses to practice in community pharmacies in 2016, and the proportion of female pharmacists to total increased from 0.29% (n=42) in 2016 to 10.95% (n=2370) in 2022. The nationalization policy for community pharmacies was implemented in 2020, and the proportion of Saudi pharmacists increased from 3.08% (n=581) in 2019 to 19.90% (n=4306) in 2022, while proportion of expatriate pharmacists decreased from 96.92% (n=18,292) to 80.10% (n=17,342).

Conclusion

The findings showed that the community pharmacy sector in Saudi Arabia recently experienced substantial growth comparable to high-income countries. However, further improvements are required in some regions to increase community pharmacy density. Moreover, the ratio of pharmacists per pharmacy should be improved to meet the healthcare system needs.

Patient preferences for the design of a pharmacy-based colorectal cancer screening program

PURPOSE

To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating).

METHODS

We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit.

RESULTS

Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4).

CONCLUSION

Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.

Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities

ABSTRACT

Inequity in preexposure prophylaxis (PrEP) care in the US South and rural communities is likely attributed to Social Determinants of Health and structural issues beyond individuals' control. We describe three approaches to modify PrEP care practice models to make access easier-"normalizing," "digitalizing," and "simplifying." "Normalizing" approaches are defined as practice models where medical providers who have access to PrEP candidates prescribe PrEP routinely (e.g., primary care providers, community pharmacists); these approaches are found to be highly applicable in real-world settings. Telehealth and other dHealth tools are examples of "digitalizing" PrEP, and their use has been increasing rapidly since the COVID-19 pandemic. "Simplifying" PrEP care (e.g., with HIV self-testing, on-demand PrEP) is highlighted in the most recent World Health Organization PrEP guideline. Identifying, implementing, and scaling up these new strategies can allow PrEP candidates to access it, potentially addressing inequities and promoting HIV risk reduction in the US South and rural communities.

Comparison of Community Pharmacist and Non-Community Pharmacist Perceptions of a Community Pharmacy Specialty Board Certification

Background: Pharmacy board certification provides pharmacists with formal recognition of their careers and their involvement in direct and comprehensive patient care. Credentialing as a board-certified pharmacist demonstrates that the pharmacist has specialized expertise and is able to provide advanced level patient care in a specific pharmacy practice specialty. There is currently not a community pharmacy board certification available in the United States. With the expanding role and clinical expectations of community pharmacists nationwide, perspectives regarding the utility of a community pharmacy specialty board certification are necessary. Methods: A cross-sectional survey with demographic and perception questions (5-point Likert scale) was distributed electronically via Qualtrics. A random sample of pharmacists registered in Rhode Island, Ohio, and Nebraska were selected and surveyed. Results: 53 survey responses were collected. There was a statistically significant difference in board certification history (P = .001) and history of post-graduate training (P < .001) between community pharmacists and non-community pharmacists. Community pharmacists were more likely to simultaneously see community pharmacists as general practitioners (P = .030) and as pharmacy practice specialists (P = .001). Non-community pharmacists were more likely to be familiar with current maintenance requirements for pharmacy board certifications (P < .001) and to feel that a board certification is an appropriate indicator of experience in a pharmacy specialty area (P = .016). Conclusion: Views regarding community pharmacy and board certification differed between community and non-community pharmacists. There was not a statistically significant difference in the perceived value of community pharmacy board certification between community and non-community pharmacist.

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

Since the rebirth of pharmacogenomics (PGx) in the 1990s and 2000s, with new discoveries of genetic variation underlying adverse drug response and new analytical technologies such as sequencing and microarrays, there has been much interest in the clinical application of PGx testing. The early involvement of pharmacists in clinical studies and the establishment of organizations to support the dissemination of information about PGx variants have naturally resulted in leaders in clinical implementation. This paper presents an overview of the evolving role of pharmacists, and discusses potential challenges and future paths, primarily focused in the U.S. Pharmacists have positioned themselves as leaders in clinical PGx testing, and will prepare the next generation to utilize PGx testing in their scope of practice.

Implementation of a pharmacy-based blood lead testing program: A retrospective analysis

BACKGROUND

In 2014, a change in the water source in Flint, Michigan, exposed residents to dangerous levels of lead in their drinking water. The concern for lead toxicity created the opportunity for pharmacies to provide quick and accessible blood lead testing services.

OBJECTIVE

The primary objective was to create a pharmacy-based blood lead testing program through collaboration with the Michigan Department of Health & Human Services and community pharmacies in Flint, Michigan.

PRACTICE DESCRIPTION

The partnership was established in 2016 and Magellan LeadCare II blood analyzers were placed at three pharmacies. Walk-in testing was offered from June 2016 to August 2016.

PRACTICE INNOVATION

Community pharmacists aimed to provide more accessible lead screening services to limit health disparities and medical complications.

EVALUATION METHODS

A retrospective analysis using descriptive statistics was conducted to assess the benefits of early blood lead screening and to determine when a patient should seek further evaluation. Blood lead screening values were based on the Center for Disease Control (CDC) and Prevention's blood lead reference value (BLRV). The BLRV at the time of the study was ≥ 5 μg/dL, but this was eventually changed to ≥3.5 μg/dL.

RESULTS

A total of 77 individuals were screened in the pharmacies. Four (5%) individuals had lead levels ≥5 μg/dL. Of these, two patients were <6 years of age. Fifteen (19%) patients had lead levels ≥3.5 μg/dL. The highest lead level detected was 24.2 μg/dL in a 70-year-old patient. If the result was ≥5 μg/dL, patients were instructed to follow up with their physician or the Genesee County Health Department. All patients with elevated blood levels were referred to the appropriate health care provider.

CONCLUSION

This model demonstrates the feasibility of a public health/community pharmacy collaborative lead testing program. This program can serve as a template for future crisis-focused collaborative models.

Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study

BACKGROUND

The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion.

METHODS

We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™.

RESULTS

We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic.

CONCLUSION

If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.

The Report of the 2022-2023 AACP Professional Affairs Standing Committee: Focused Integration of Community-Based Pharmacy Practice Within the AACP Transformation Center

The 2022-2023 Professional Affairs Committee was charged to (1) Devise a framework and 3-year workplan for the Academia-Community Pharmacy Transformation Pharmacy Collaborative to be integrated within the American Association of Colleges of Pharmacy (AACP) Transformation Center. This plan should include the focus area(s) to be continued and developed by the Center, potential milestone dates or events, and necessary resources; and (2) Provide recommendations on focus areas and/or potential questions for the Pharmacy Workforce Center to consider for the 2024 National Pharmacist Workforce Study. This report provides the background and methodology utilized to develop the framework and 3-year workplan focused on (1) community-based pharmacy pipeline development for recruitment, programming, and retention, (2) programming and resources for community-based pharmacy practice, and (3) research areas for community-based pharmacy practice. The Committee offers suggested revisions for 5 current AACP policy statements, 7 recommendations pertaining to the first charge, and 9 recommendations pertaining to the second charge.

Pharmacist-Led Management of HIV PrEP Within the Veterans Health Administration

Background

Uptake and access to HIV preexposure prophylaxis (PrEP) is key to reducing incident HIV infections. Pharmacists are one of the most accessible health care professionals in the United States and are well suited to address this need.

Observations

We describe a model of care at the Veterans Affairs Greater Los Angeles Healthcare System in which clinical pharmacist practitioners developed and implemented a pharmacy-led PrEP clinic colocated within an infectious disease clinic. Veterans Health Administration clinical pharmacists provide direct patient care under a scope of practice that includes ordering and interpreting laboratory tests and providing PrEP prescriptions. To improve access and patient acceptability, we also used novel telemedicine modes of care to ensure flexible appointment scheduling.

Conclusions

This model can be used by other federal and community-based health care organizations to implement interdisciplinary pharmacist-managed PrEP clinics and expand telehealth modalities to deliver outpatient 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.

Integrating community health workers within a pharmacy to address health-related social needs

BACKGROUND

Community pharmacies in the United States are beginning to serve as patient care service destinations addressing both clinical and health-related social needs (HRSN). Although there is support for integrating social determinant of health (SDoH) activities into community pharmacy practice, the literature remains sparse on optimal pharmacy roles and practice models.

OBJECTIVE

To assess the feasibility of a community pharmacy HRSN screening and referral program adapted from a community health worker (CHW) model and evaluate participant perceptions and attitudes toward the program.

METHODS

This feasibility study was conducted from January 2022 to April 2022 at an independent pharmacy in Buffalo, NY. Collaborative relationships were developed with 3 community-based organizations including one experienced in implementing CHW programs. An HRSN screening and referral intervention was developed and implemented applying a CHW practice model. Pharmacy staff screened subjects for social needs and referred to an embedded CHW, who assessed and referred subjects to community resources with as-needed follow-up. Post intervention, subjects completed a survey regarding their program experience. Descriptive statistics were used to report demographics, screening form, and survey responses.

RESULTS

Eighty-six subjects completed screening and 21 (24.4%) an intervention and referral. Most participants utilized Medicaid (57%) and lived within a ZIP Code associated with the lowest estimated quartile for median household income (66%). Eighty-seven social needs were identified among the intervention subjects, with neighborhood and built environment (31%) and economic stability challenges (30%) being the most common SDoH domains. The CHW spent an average of 33 minutes per patient from initial case review through follow-up. All respondents had a positive perception of the program, and the majority agreed that community pharmacies should help patients with their social needs (70%).

CONCLUSIONS

This feasibility study demonstrated that embedding a CHW into a community pharmacy setting can successfully address HRSN and that participants have a positive perception toward these activities.

Advancing Public Health through Community Pharmacy Practice

The overarching goal of public health is to advance the health of individuals, communities, and populations [...].

Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States

OBJECTIVES

To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service.

STUDY DESIGN

We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events.

RESULTS

During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication.

CONCLUSIONS

Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.

The influence of SARS-COV-2 pandemic in the pharmaceutical service in ALBANIA

Objective

In the second year of the COVID-19 pandemic, the role of the pharmacists was confirmed as central at the territorial level. The purpose of this study was to assess knowledge, attitudes, and practices of pharmacists in Albania, critical changes in the Albanian pharmaceutical market during the COVID-19 pandemic and evaluate factors influencing the quality of the pharmaceutical service.

Methods

A nationwide survey was conducted, using an online questionnaire targeting Albanian pharmacists during 2021.

Results

Most of the respondents were females (86.2%), belonged to the 30-39 age group (51.7%) and worked in community pharmacies (73%). Although most of the respondents did participate in training courses (62.8%), only about 38% of them had good knowledge about COVID-19 (score 5/8). Moreover, the level of knowledge increases the possibility to apply the rules. 65% of the pharmacists who were very afraid of getting infected with COVID -19, stated that they followed the WHO rules compared to 37 % of those who were not afraid. Regarding the medicines offered, 64% of the respondents claimed that there have been difficulties in ensuring the adequate medicines during the pandemic. Furthermore, although 61% of the pharmacists declared that the price of medicines during the pandemic has not changed, 58% of them thought that the revenues of all pharmaceutical sectors have risen.

Conclusion

From this study it is concluded that although the pharmacists in Albania have demonstrated strength, professionality, and commitment to offer pharmaceutical service to the highest level, they faced numerous challenges during this difficult time. In the future, the pharmacist's role can be extended in the community to provide successful medical service and their collaboration within and between pharmacists and physicians is essential.

The Federal Retail Pharmacy Program (FRPP) Impact on COVID-19 Vaccine Distribution During Pandemic: Effectiveness, Limitations, and Implications

The coronavirus disease 2019 (COVID-19) has altered the healthcare landscape for pharmacy practice and continues its global onslaught. As the COVID-19 vaccines began to reach the general population, many were left wondering where and when they would get the vaccine. With 90% of the American population living within 5 miles of a community pharmacy, vaccine distribution to these locations is vital for a successful vaccine campaign. The Biden Administration launched the Federal Retail Pharmacy Program (FRPP) in February 2021, a public-private partnership with 21 national pharmacy partners representing over 40,000 pharmacy locations to help expand the vaccine rollout. Community pharmacists are uniquely positioned to fulfill this mission by being a point of contact for the COVID-19 vaccination efforts. The FRPP has experienced some limitations, including the variable vaccine allocation, limited support from the healthcare system, and the lack of overwhelming public confidence in the vaccines. Improving the FRPP would require strong partnership with other healthcare professionals and the adoption of flexible vaccine dissemination. These can stem future pandemics.

A Culturally Competent Vaccine Hesitancy Educational Model for Community Pharmacists to Increase Vaccine Uptake, Louisiana, 2021-2022

In February 2022, an educational model was launched to train Louisiana pharmacists to become positive influencers of vaccination decisions via targeted, culturally competent interventions, with the objective of improving COVID-19 vaccine uptake in communities. A total of 47 pharmacists completed the course, and more than 90% noted that the education would help them optimize vaccine acceptance in their community practice settings. The pharmacists will participate in vaccine surveillance to assess the success of the educational model intervention and predictors of vaccine uptake. (Am J Public Health. 2022;112(S9):S900-S903. https://doi.org/10.2105/AJPH.2022.307070).

Pharmacy deserts and COVID-19 risk at the census tract level in the State of Washington

Community pharmacies are a crucial component of healthcare infrastructure, including for COVID-19 pandemic prevention services like testing and vaccination. Communities that are "pharmacy deserts," experience healthcare inequities. However, little research has characterized where these communities are, making it difficult for local leaders to prioritize resources for them. This study identifies pharmacy deserts at the census tract level in Washington state for the first time and explores their association with COVID-19 risk. Out of 1,441 tracts, 127 were pharmacy deserts, comprising approximately 454,000 adults, or 8% of the state's adult population. Among those tracts identified as pharmacy deserts, 67% were considered high risk for COVID-19. Solutions are needed to expand equitable access to pharmacy services in these communities. The methods and data presented herein provide healthcare leaders with information to address this pharmacy access gap in Washington and could be similarly applied to other settings. Three categories of policy changes could address health inequities found in our study: 1) improve financial incentives for pharmacists to practice in underserved areas, 2) prevent pharmacy closures, and 3) deploy innovative care delivery methods such as telehealth services.

Development and evaluation of an online training program based on the O-AMAS teaching model for community pharmacists in the post-COVID-19 era

Background

Formerly, the community pharmacists' work was mainly focused on drug supply. However, during the COVID-19 epidemic outbreak, community pharmacists in Wuhan played an important role in control and prevention of SARS-CoV-2 and in providing pharmaceutical care. Due to a lack of adequate knowledge and skills, many community pharmacists were not able to cope with healthcare work timely and efficiently. To improve community pharmacists' specialized knowledge and enhance their professional competence through systemic training in the post-COVID-19 era.

Methods

Based on the O-AMAS (Objective, Activation, Multi-learning, Assessment and Summary) teaching model and flipped classroom, an online continuing training program containing four sections was developed. It was a semi-experimental study with no control group. Quantitative tests before and after training as well as questionnaire were used to evaluate the outcome of this training program for community pharmacists.

Results

A total of twenty-six community pharmacists were invited to participate in continuing education, and twenty-five trainees finished this training program with a completion rate of 96.2 %. Quantitative tests before and after training and anonymous questionnaires were carried out to comprehensively evaluate the outcomes of this training program. Compared with the test scores before training (61.6 ± 6.6), the score after training was statistically higher, reaching 80.9 ± 7.5 (P < 0.001). Twenty-three questionnaires were received (returns ratio, 92.0%). Notably, most of the pharmacists were satisfied with the training program. The percentage of positive responses for each item in this anonymous questionnaire was more than 85 %.

Conclusion

It was suggested that the O-AMAS model and the flipped classroom-based continuing educational program achieved the expected training effects. It is a promising on-the-job training approach for pharmacy continuing education. Moreover, our study also demonstrated that online learning had advantages of no geographic constraints, flexible learning beyond time and easy interaction, over traditional face-to-face training style, especially in the post-pandemic era.

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.

Self-medication and ILI etiologies among individuals presenting at pharmacies with influenza-like illness: Guatemala City, 2018 influenza season

Objectives

We aimed to characterize the proportion of clients presenting to community pharmacies with influenza-like illness (ILI) and the severity of their illness; the proportion with detectable influenza A, influenza B, and other pathogens (i.e., parainfluenza I, II, and III, adenovirus, respiratory syncytial virus, human metapneumovirus); and to describe their self-medication practices.

Methods

A cross-sectional study was conducted in six pharmacies in Guatemala City. Study personnel collected nasopharyngeal and oropharyngeal swabs from participants who met the ILI case definition and who were self-medicating for the current episode. Participants were tested for influenza A and B and other pathogens using real-time RT-PCR. Participants’ ILI-associated self-medication practices were documented using a questionnaire.

Results

Of all patients entering the pharmacy during peak hours who responded to a screening survey (n = 18,016) 6% (n = 1029) self-reported ILI symptoms, of which 45% (n = 470/1029) met the study case definition of ILI. Thirty-one percent (148/470) met inclusion criteria, of which 87% (130/148) accepted participation and were enrolled in the study. Among 130 participants, nearly half tested positive for viral infection (n = 55, 42.3%) and belonged to groups at low risk for complications from influenza. The prevalence of influenza A was 29% (n = 35). Thirteen percent of the study population (n = 17) tested positive for a respiratory virus other than influenza. Sixty-four percent of participants (n = 83) reported interest in receiving influenza vaccination if it were to become available in the pharmacy. Medications purchased included symptom-relieving multi-ingredient cold medications (n = 43/100, 43%), nonsteroidal anti-inflammatory drugs (n = 23, 23%), and antibiotics (n = 16, 16%). Antibiotic use was essentially equal among antibiotic users regardless of viral status. The broad-spectrum antibiotics ceftriaxone and azithromycin were the most common antibiotics purchased.

Conclusions

During a typical influenza season, a relatively low proportion of all pharmacy visitors were experiencing influenza symptoms. A high proportion of clients presenting to pharmacies with ILI tested positive for a respiratory virus. Programs that guide appropriate use of antibiotics in this population are needed and become increasingly important during pandemics caused by respiratory viral pathogens.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13962-8.

Parents' perceptions on COVID-19 vaccination as the new routine for their children ≤ 11 years old

Canadian children 5-11 years old became eligible for COVID-19 vaccination on November 19, 2021, with eligibility for younger children expected later. We aimed to descriptively assess parents' COVID-19 vaccine intentions and acceptability of future doses, including co-administration and annual vaccination for their children. We conducted a cross-sectional Canadian online survey of parents from October 14-November 12, 2021, just prior to authorization of the pediatric formulation of the BNT162b2 COVID-19 vaccine for children aged 5-11 years. We assessed parents' intention to vaccinate their children aged 5-11 years, 2-4 years, and 6-23 months; reasons for their intention; and preferences for delivery and access to vaccines. Of 1129 parents, 56% intended to vaccinate their child aged 5-11 years against COVID-19; intentions were lower for children aged 6-23 months (41.9%) and 2-4 years (45.4%). Most parents who intended to vaccinate supported co-administration with routine (61.1%) or influenza (55.4%) vaccines, administration at school (63.6%), receipt of booster doses of COVID-19 vaccine (57.8%), and annual vaccination (56.4%) for their child. Despite parents' high COVID-19 vaccination uptake for themselves (88.8%), intentions for children aged 5-11 years was low. Currently, 56.9% of Canadian children aged 5-11 years have received one dose of a COVID-19 vaccine, and only 37.1% are fully vaccinated. Given that intentions for children <5 years was lower than those 5-11 years, we can also expect low uptake in this group. Parents' preferences regarding delivery and access to COVID-19 vaccination should be considered by public health officials when planning vaccination strategies for children.

COVID-19 pandemic: the role of community-based pharmacy practice in health equity

The COVID-19 pandemic disrupted the landscape of primary care practice, creating new gaps in chronic disease management and worsening existing health disparities. Community-based pharmacy practices have played a critical role in responding to the pandemic; however, their role in promoting health equity and addressing existing health disparities has not been fully characterized. The objective of this commentary is to highlight some of the challenges and opportunities to cultivate an equitable plain field for communities to overcome significant health crises. Moreover, this commentary underscores the potential role of integrating community-based pharmacies into the public health infrastructure. It is uncommon to find an individual or an organization that has not been impacted by the pandemic. As painful as it has been to lose so many lives due to COVID-19 infection, it is critical to dedicate the time to reflect on how we arrived at this point. Compounding this global health crisis, the pandemic did not weigh equally on all community members, but rather some population groups carried the brunt of the pandemic more than others. The disproportionate burden of COVID-19 has uncovered significant gaps in our healthcare system and the global public health response. Understanding how we arrived at that point in the pandemic is a crucial first step toward achieving health equity. While many factors have led us onto the pandemic path, using national and global health frameworks to address health disparities and monitor health inequalities are worth discussing to delineate a roadmap to optimal population health. As these pandemic lessons challenge the status quo throughout communities, facing these new realities allows us to envision a roadmap for social justice, health equity, and innovative models to optimize health. Leveraging community-based pharmacy services could promote health equity, close growing health gaps, increase access to health care, and rapidly detect and respond to public health threats.

Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future

Background:

Place is a social determinant of health, as recently evidenced by COVID-19. Previous literature surrounding health disparities in the United States often fails to acknowledge the role of structural racism on place-based health disparities for historically marginalized communities (i.e., Black and African American communities, Hispanic/Latinx communities, Indigenous communities [i.e., First Nations, Native American, Alaskan Native, and Native Hawaiian], and Pacific Islanders). This narrative review summarizes the intersection between structural racism and place as contributors to COVID-19 health disparities.

Methods:

This narrative review accounts for the unique place-based health care experiences influenced by structural racism, including health systems and services and physical environment. We searched online databases for peer-reviewed and governmental sources, published in English between 2000 and 2021, related to place-based U.S. health inequities in historically marginalized communities. We then narrate the link between the historical trajectory of structural racism and current COVID-19 health outcomes for historically marginalized communities.

Results:

Structural racism has infrequently been named as a contributor to place as a social determinant of health. This narrative review details how place is intricately intertwined with the results of structural racism, focusing on one's access to health systems and services and physical environment, including the outdoor air and drinking water. The role of place, health disparities, and structural racism has been starkly displayed during the COVID-19 pandemic, where historically marginalized communities have been subject to greater rates of COVID-19 incidence and mortality.

Conclusion:

As COVID-19 becomes endemic, it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality. Addressing structurally racist place-based health inequities through anti-racist policy strategies is one way to move the United States toward achieving health equity.

Antimicrobial Dispensing Practice in Community Pharmacies in Russia during the COVID-19 Pandemic

COVID-19 has had a significant impact on health care systems, including drug use. The present study aimed to evaluate the patterns of community supply of antimicrobials from community pharmacies during the COVID-19 pandemic in five cities of Russia. In a cross-sectional study, a random sample of pharmacies reported all episodes of antimicrobials supply during a one-week period. Patterns of supply (age and gender of customer, drug name and formulation, prescription availability, indication, etc.) were analyzed. Altogether, 71 pharmacies took part in the study and 5270 encounters were recorded. In total, 4.2% of visits resulted in supply of more than one antimicrobial agent and 5.2% were for parenteral formulations. The rate of prescription-based purchase in participated cities varied from 40.5 to 99.1%. Systemic antibiotics and antivirals accounted for the majority of supplies (60.5 and 26.3%, respectively). Upper respiratory tract infections were reported as the indication for antimicrobials usage in 36.9% of cases, followed by skin and soft tissue infections (12.1%) and urinary tract infections (8.7%); COVID-19 accounted for 8.4% of all supplies. Amoxicillin with clavulanic acid, azithromycin and amoxicillin were indicated as the top three antimicrobials purchased for upper respiratory tract infections, and azithromycin, umifenovir and levofloxacin were the top three for COVID-19. In general, a high rate of drugs dispensing without prescription was revealed. Antibiotics for systemic use remained the most common antimicrobials, whereas presumably viral upper respiratory tract infections were the main reason for their purchase. COVID-19 infection itself was responsible for a small proportion of the supply of antimicrobial agents, but systemic antibiotics accounted for more than a half of supplies.

Attitude and Willingness to Get COVID-19 Vaccines by a Community Pharmacist in Saudi Arabia: A Cross-Sectional Study

INTRODUCTION

Community pharmacists play a key role as vaccinators for COVID-19. They can reduce the burden of the disease worldwide.

OBJECTIVE

This study used a cross-sectional questionnaire to determine whether the Saudi Arabian public was willing to obtain the COVID-19 vaccine via community pharmacists.

RESULTS

The questionnaire focused on the satisfaction, concerns, and opinions towards providing vaccination by community pharmacists. The study featured 415 individuals aged 18 and older (eligible for the COVID-19 vaccine). Of the participants in this study, 58.1% were aged 18-25, with 55.4% female. Most participants (72.8%) have not been exposed to COVID-19 and are not aware of the approval of COVID-19 vaccination by community pharmacists. Of the 415 complete questionnaires, 45% believed that community pharmacists are not experienced in administering vaccines. However, 63% of participants are satisfied with getting the COVID-19 vaccination by a community pharmacist if no other option is available. More than 68% of the respondents agree that community pharmacies should expand their health care services to include vaccinations, prescriptions, checkups, and other forms of preventative medicine.

DISCUSSION

The availability of community pharmacist-administered vaccination in Saudi Arabia could be a significant factor in the success of the country's vaccination program. This study may serve as a model to expand the role of pharmacists in other countries' vaccination programs.

Study protocol for the Respond to Prevent Study: a multi-state randomized controlled trial to improve provision of naloxone, buprenorphine and nonprescription syringes in community pharmacies

Access to the opioid antidote naloxone is a critical component of addressing the opioid crisis. Naloxone is a population-level prevention intervention associated with substantial reductions in overdose mortality and reduction of nonfatal overdose. Pharmacies' pivotal role in dispensing medications like buprenorphine for the treatment of opioid use disorder and selling nonprescription syringes places them at the crossroads of opioid access and risk mitigation methods like naloxone provision. Testing ways to optimize pharmacy-based naloxone provision will be key as the country expands the implementation of naloxone through the medical system. In the Respond to Prevent Study, we conducted a large, practical study of a pharmacy-focused intervention in a sample of Washington, Oregon, Massachusetts and New Hampshire community chain pharmacies to increase naloxone dispensing and improve opioid safety. The intervention integrated two evidence-based educational toolkits and streamlined materials to enhance the focus on naloxone policy, stigma reduction, and patient communications around naloxone, nonprescription syringes and buprenorphine access. The real-world study implemented a stepped wedge, clustered randomized trial design across 175 community chain pharmacies to evaluate the effectiveness of the Respond to Prevent intervention in increasing: (a) pharmacy based naloxone distribution rates, naloxone-related patient engagement, and pharmacist and technicians' attitudes, knowledge, perceived behavioral control and self-efficacy toward naloxone; and (b) pharmacy nonprescription syringe sales, and pharmacist and technicians' attitudes, knowledge, perceived behavioral control and self-efficacy toward dispensing buprenorphine for opioid use disorder (secondary outcomes). This commentary provides a brief narrative about the study and presents insights on the design and adaptations to our study protocol, including those adopted during the unprecedented COVID-19 pandemic further compounded by Western wildfires in 2020.

Shedding the light on Pharmacists' roles during COVID-19 global pandemic

INTRODUCTION

(Background)The role of pharmacists revolves around providing the highest levels of care to society and ensuring the provision of medicine to all patients. However, with the spread of coronavirus disease 2019 (COVID -19), pharmacists as a very important part of healthcare professionals' team are responsible for fighting against the disease regardless of their setting of practice. The role of pharmacists will undergo a little change to extend and include other roles in order to ensure the safety of the community and limit the virus spread. Also, they will be required to obtain information from reliable sources, and to be up to date, so they can be reliable advisors to the community and raise their awareness.

OBJECTIVES

The purpose of this review is to highlight community and hospital pharmacists' roles during (COVID-19) global pandemic, and to clearly illustrate how they are contributing to maintain pharmacy services continuity, supporting other healthcare professionals, and facilitating the patient's education.

SUMMARY

Clinical pharmacists provide direct patient care through monitoring adverse drug reactions, ensuring individualized treatment, performing evidence-based practice, and evaluating drugs in clinical trials. On the other hand, community pharmacists which are the most accessible healthcare providers by the community increase their awareness regarding the preventive measures, balance medicines supply and demand, provide drive-thru and home delivery services, offer telehealth counselling, psychological support, refer suspected COVID-19 patients, and provide vaccination when available.

CONCLUSION

Innovative pharmacists' roles have emerged to adapt to changes during COVID-19 pandemic, however, they may be needed in the post COVID-19 world as well.

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.

Pharmacists and opioid use disorder care during COVID-19: Call for action

Opioid use disorder (OUD) is a chronic relapsing condition characterized by problematic opioid use causing significant impairment in daily life. Medication for opioid use disorder using buprenorphine, methadone, and naltrexone with behavioral therapy reduces illicit opioid use and risk of overdose death. Despite evidence and decades of experience, barriers limit access to treatment and care for individuals with OUD. Barriers include a lack of treatment centers particularly in rural areas, regulations on buprenorphine prescribing, and stigma from the community and health care professionals. While many barriers are longstanding, the coronavirus disease 2019 (COVID‐19) pandemic‐forced isolation and associated stress has exacerbated challenges for individuals with mental health conditions such as OUD. Pharmacists are well‐positioned to bridge existing gaps in OUD care, particularly during the COVID‐19 pandemic. Roles for pharmacists include OUD risk identification and screening, referral of patients to treatment and support programs, ensuring medication access, expanding naloxone access, and advocacy initiatives. This review article identifies barriers to care for patients with OUD during the COVID‐19 pandemic and explores opportunities and resources for pharmacists to improve OUD care during the pandemic and beyond.

Perceptions of COVID-19 vaccines in a predominantly Hispanic patient population from the Texas-Mexico border

BACKGROUND

Compared with nationwide averages, Hispanic individuals have experienced lower routine vaccination rates and have been disproportionately hospitalized for coronavirus disease 2019 (COVID-19). Few, if any, studies have examined the health beliefs surrounding the COVID-19 vaccines and adult vaccines among this population.

OBJECTIVES

This study aimed to (1) describe perceptions of COVID-19 vaccines in a predominantly Hispanic patient population in a federally qualified health center (FQHC) situated on the United States-Mexico border and (2) compare patient confidence in recommendations made by local clinic and government to obtain adult and COVID-19 vaccines.

METHODS

A bilingual (English or Spanish) written survey was administered to participants recruited from a convenience sample of patients in waiting areas of 4 clinic sites in an FQHC system on the Texas-Mexico border between March and May 2021. Survey items were derived from the Health Belief Model and captured beliefs surrounding perceived effectiveness, perceived harms, protection from the influenza vaccine, trust in the local clinic, and trust in the government.

RESULTS

A total of 58 participants aged 19-90 years, with a mean age of 57.28 years, completed the survey between March and May 2021, with 77.6% of respondents indicating they would accept a COVID-19 vaccine for themselves. Results revealed a trend among older adults in the study cohort to be more likely to trust the government in recommending vaccines than younger adults (r = 0.33, P ≤ 0.05) and a tendency toward higher vaccine acceptance among male survey participants (P = 0.026). The highest correlation that emerged was between perceived trust in local clinic provider and the perceived effectiveness of vaccines (r = 0.74, P < 0.01).

CONCLUSION

Trends related to perceptions of adult vaccines among Hispanic patients extend to the COVID-19 vaccines: especially trust in local clinic providers. Increased age may correlate to higher trust in a government-recommended vaccine. Results highlight the importance of the pharmacist giving the patient a clear recommendation to receive vaccination and strong local clinic messaging.

The Report of the 2020-2021 Professional Affairs Standing Committee: Pharmacists' Unique Role and Integration in Healthcare Settings

EXECUTIVE SUMMARY The 2020-21 Professional Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to the committee's work this year; (2) Identify opportunities and models of integration of pharmacist care services in physician and other health provider practices beyond primary care; (3) Differentiate and make the case for the integration of pharmacist care services from that of other mid-level providers; and (4) From the work on the aforementioned charges, identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides information on the committee's process to address the committee charges, describes the rationale for and the results from a call to colleges and schools of pharmacy to provide information on their integrating pharmacist care services in physician and other health provider practices beyond primary care practice, and discusses how pharmacist-provided patient care services differ from those provided by other healthcare providers. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to CTAP and AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Developing the "Upstreamist" through Antiracism Teaching in Pharmacy Education

Objective. To present antiracism teaching as a key modality and an upstream approach to addressing health disparities in pharmacy education. Relevant theoretical frameworks and pedagogical strategies used in other health disciplines will be reviewed to present how antiracism curricula can be integrated into pharmacy educational outcomes.Findings. Various disciplines have incorporated antiracism pedagogy in their respective programs and accreditation standards. While challenges to implementation are acknowledged, structural racism continues to compromise health outcomes and should be centralized when addressing health disparities.Summary. Pharmacy curricula has explored and implemented cultural competency as a means to address the social determinants of health. By intentionally addressing racism in the context of health disparities, student pharmacists will further acknowledge racism as a public health issue and a systemic barrier to patient-centered care.

Provision of pharmaceutical care to suspected high-risk COVID-19 patients through telehealth: a nationwide simulated patient study

BACKGROUND

The COVID-19 pandemic has overburdened the healthcare facilities, which demanded the use of alternative and effective methods for delivering healthcare services. The use of telehealth has become a necessity to provide initial health services.

OBJECTIVE

To identify the pharmaceutical care provided by community pharmacists to suspected high-risk COVID-19 patients using telehealth.

METHODS

A simulated patient (SP) phoned 100 randomly-selected community pharmacies throughout Lebanon using a standard scenario of uncontrolled diabetes mellitus with typical symptoms of COVID-19. Pharmacists' responses were compared with pre-defined ideal recommendations using a special form.

RESULTS

The mean of the retrieved medical information score obtained by the pharmacists was 2.48 ± 2.79 (out of 21), with 34 % of the participants not retrieving any relevant medical data from the SP. The relative patient information, the exposure to COVID-19, and the possible COVID-19 symptoms were not retrieved by 61 %, 70 %, and 41 % of the pharmacists, respectively. Two percent of the pharmacists assured that the SP's symptoms were related to common cold, while 5 % confirmed that the SP is infected with COVID-19. Notably, 35 % of the pharmacists did not offer any recommendation. Among them, 14 % claimed that they were too busy to respond. Only 39 % of the pharmacists provided an appropriate recommendation by referring the SP to her physician to seek medical attention within 24 h since the SP is a high-risk patient, and 41 % recommended doing a PCR test. Antipyretics, antibiotics, and dietary supplements were recommended by 27 %, 7 %, and 16 % of the pharmacists, respectively. Less than 16 % of the pharmacists recommended using protective measures against COVID-19. In addition, the overall communication skills of the pharmacists were generally below expectations.

CONCLUSIONS

This study is the first to assess the quality of pharmaceutical care provided by community pharmacists in the Middle East via Telehealth. An unsatisfactory level of preparedness through means of telehealth technology was evident. This resulted in the quality of pharmaceutical-care services provided to high-risk patients via telehealth to be below expectations. Therefore, health authorities should encourage community pharmacists to effectively adopt telehealth, by providing appropriate training, as well as recognizing their extra efforts with financial compensations, aiming to optimize patients' health outcomes.

Changes in Japanese Pharmacists' Recognition of Their Role in Community Public Health before and after the Spread of COVID-19

Background: In our previous study regarding infection prevention after COVID-19, many Japanese citizen respondents had not received education/training on infection prevention. However, a total of 47.7% (n = 143) of these respondents wanted to receive education from healthcare professionals regarding the methods and effects of infection prevention. Therefore, changes in recognition of the roles of Japanese pharmacists before and after COVID-19 were investigated. Methods: We conducted a survey to determine whether recognition of Japanese pharmacists’ roles, especially their role in public health in the community, changed after COVID-19. Results: A total of 93.9% (n = 307) of the pharmacist respondents showed an increased awareness of infection prevention. Before COVID-19, the hospital pharmacists (67.2%; n = 80) were more aware of infection prevention than were pharmacy pharmacists (51.7%; n = 74) and drugstore pharmacists (47.7%; n = 31). The number of pharmacists who felt that the role of pharmacists in the community had changed after the pandemic increased, but the numbers of community pharmacy pharmacists (51.8%; n = 74) and drugstore pharmacists (55.4%; n = 36) were found to be slightly higher than those of hospital pharmacists (47.9%; n = 57). Conclusions: In a society in which swift responses and changes are required, for individuals to work as medical personnel their ability to respond while always being aware of the needs of society is required now more than ever.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Coordinated Management of COVID-19 Response: Lessons From Whole-of-Society and Whole-of-Health Strategies in Wuhan, China

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has been challenging globally following the scarcity of medical resources after a surge in demand. As the pandemic continues, the question remains on how to accomplish more with the existing resources and improve the efficiency of existing health care delivery systems worldwide. In this study, we reviewed the experience from Wuhan - the first city to experience a COVID-19 outbreak – that has presently shown evidence for efficient and effective local control of the epidemic.

Material and Methods: We performed a retrospective qualitative study based on the document analysis of COVID-19-related materials and interviews with first-line people in Wuhan.

Results: We extracted two themes (the evolution of Wuhan's prevention and control strategies on COVID-19 and corresponding effectiveness) and four sub-themes (routine prevention and control period, exploration period of targeted prevention and control strategies, mature period of prevention and control strategies, and recovery period). How Wuhan combatted COVID-19 through multi-tiered and multi-sectoral collaboration, overcoming its fragmented, hospital-centered, and treatment-dominated healthcare system, was illustrated and summarized.

Conclusion: Four lessons for COVID-19 prevention and control were summarized: (a) Engage the communities and primary care not only in supporting but also in screening and controlling, and retain community and primary care as among the first line of COVID-19 defense; (b) Extend and stratify the existing health care delivery system; (c) Integrate person-centered integrated care into the whole coordination; and (d) Delink the revenue relationship between doctors and patients and safeguard the free-will of physicians when treating patients.

Pharmacist-provided SARS-CoV-2 testing targeting a majority-Hispanic community during the early COVID-19 pandemic: Results of a patient perception survey

Background

Racial and ethnic minority groups are disproportionally represented among U.S. coronavirus disease (COVID-19) cases, owing to long-standing systemic inequities in the social determinants of health. Among Hispanic populations, a lack of access to testing sites has resulted in delayed time to diagnosis, risking increased spread within high-risk communities. The accessibility and expertise of community pharmacists support expanded pharmacist roles in public health and pandemic response, including point-of-care (POC) diagnostic testing.

Objective

To determine the local impact of community pharmacist-provided COVID-19 testing among a majority-Hispanic, lower income population during the early COVID-19 pandemic, as assessed by a patient satisfaction survey.

Methods

A 10-question Likert-type questionnaire was administered in English and Spanish to patients who received a pharmacist-provided POC COVID-19 test at a large-chain community pharmacy in Arizona between May 1, 2020 and June 14, 2020. Questions surrounded patient perceptions of the testing process and subsequent pharmacist counseling on their test results.

Results

A total of 622 patients completed the survey (94.1% participation rate among successful contacts, representing 28.3% of all eligible patients). The mean age was 42 years, 51% were female, and 64% of patients identified as Hispanic. More than 97% of surveyed patients either agreed or strongly agreed that receiving a pharmacist-provided COVID-19 test at a community pharmacy was a comfortable experience, expanded their access to care, and allowed them to receive their test results in a timely manner. In addition, more than half of surveyed patients “did not know” where they would have alternatively sought testing if the community testing site was not available. Overall, the results of this study demonstrated highly favorable patient perceptions of pharmacist-provided POC testing for COVID-19, with more than 99% of surveyed patients satisfied with their testing experience.

Conclusion

Among patients in a lower income majority-Hispanic community, pharmacist-provided POC testing services for COVID-19 were well received and expanded patient access to testing during the early pandemic.

Cabenuva®: Differentiated service delivery and the community Pharmacists' roles in achieving UNAIDS 2030 target in Nigeria

The approval of the novel long-acting HIV injection; Cabenuva®- Cabotegravir and Rilpivirine injectable formulation) and the recent call by the World Health Organization for promoting community-based ART management, underscore the remarkable progress towards meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets by 2030. As the availability of antiretroviral therapy (ART) for the treatment of HIV/AIDS has increased in resource-limited settings, there has been a move to develop and implement alternative treatment delivery models such as Differentiated Service Delivery (DSD) in high prevalence countries to meet the global targets for HIV treatment while maintaining the quality of care. However, there is limited data on the involvement of community pharmacies in the delivery of ART within the community. Although, in western countries, several studies have documented the different roles community pharmacists can play in the management of HIV/AIDS. Community pharmacists are the most accessible and first points of health care for most clients. They are trusted, highly trained health care professionals. They should be incorporated and allowed to administer the Cabenuva® injection if the battle against the HIV pandemic is to be totally won. In this paper, we, therefore, aim to explore how the community pharmacist can be positioned in HIV service delivery regarding the administration of the Novel long-acting Cabenuva® injection formulation. It is therefore recommended that the Nigerian government embrace community pharmacy-led drug administration initiatives and embark on accredited training programmes for the profession in line with drug administration services. The government should also put in place necessary funding mechanisms for community pharmacists for the extra workload placed on them in administering injection drug formulation in their respective pharmacies.

Knowledge, attitude and practices of community pharmacists regarding COVID-19: A paper-based survey in Vietnam

Objective

To survey the knowledge, attitude, and practices of Vietnamese pharmacists regarding the COVID-19 pandemic.

Method

This cross-sectional, paper-based study was conducted from June to August 2020. A validated questionnaire (Cronbach’s alpha = 0.84) was used to interview 1,023 pharmacists in nine provinces of Vietnam. Analysis of covariance was employed to identify factors associated with the knowledge of pharmacists. The best model was chosen by using the Bayesian Model Averaging method in R software version 4.0.4.

Results

The mean knowledge score was 12.02 ± 1.64 (range: 6–15), which indicated that 93.4% of pharmacists had good knowledge of COVID-19. There was no difference in the average score between males and females (p > 0.05). The multivariate linear regression model revealed that the knowledge was significantly associated with pharmacists’ age, education level, and residence (p < 0.001). About attitude and practices, pharmacists daily sought and updated information on the COVID-19 pandemic through mass media and the internet (social network and online newspapers). Nearly 48% of them conceded that they communicated with customers when at least one person did not wear a face mask at the time of the COVID-19 outbreak. At medicine outlets, many measures were applied to protect pharmacists and customers, such as equipping pharmacists with face masks and hand sanitizers (95.0%), using glass shields (83.0%), and maintaining at least one-meter distance between two people (85.2%).

Conclusion

The pharmacists’ knowledge of COVID-19 transmission, symptoms, and prevention was good. Many useful measures against the spread of this perilous virus were applied in medicine outlets. However, pharmacists should restrict forgetting to wear face masks in communication with medicine purchasers. The government and health agencies should have practical remedies to reduce the significant differences in the COVID-19 knowledge of pharmacists among provinces and education-level groups.