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.

Keywords:
Pharmaceutical care; COVID-19; Pharmacist

COVID-19 (SARS-CoV-2) pandemic is raising many questions about the future of face-to-face interactions. The possible changes on health care 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. Its activities include different forms of interaction, such as interviews, exams, clinical evaluations and multidisciplinary performances. During the ongoing COVID-19 pandemic, the measures for reducing transmissions rates, like voluntary quarantine and social isolation, had affected many pharmaceutical follow-ups in progress. Faced with the demand for the maintenance of clinical care activities, professionals, services and institutions are being bombarded with new applications and approaches for the restoration of care. The highlights of some international experiences can serve as an example for pharmaceutical performance, not only in the current scenario, but also in the post-pandemic period.

More than rethink the pharmaceutical care structure; the emergence of COVID-19 puts to the test all the efforts to reposition pharmaceutical care in the set of clinical activities. From the beginning, there was a leading role on the face-to-face interaction and evaluation of drug therapeutic effects. Now, we are facing the possibility of maintaining the assistance mediated by technology and privilege other themes in consultations, such as self-care measures, the use of individual protection devices and psychological support.

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 risks of patient agglomeration and contamination. The Brazilian Pharmaceutical Assistance Department worked quickly at the beginning of the COVID-19 emergence, issuing guidelines regarding the execution of pharmaceutical care actions, aimed to reorganizing workflow (Brazil, 2020).

Recommendations included prioritizing individual consultations over group activities, as well as reinforcing the hygienic behavior (use of masks, social distance, environmental and hands sanitization). Regarding medication´s dispensing, the patients received orientation about the mandatory social distance (the use of floor marks reinforce it), the extension of medication prescriptions deadline, the long-term therapy medicine dispensing rules flexibilization that allows medicine to dispense with patient absence as well as prescription for long periods. In order to reduce the patient permanence in lines, it is suggested the adoption of strategies, such as previous screening and prioritization of patients as well as, when possible, the selection of external places, like waiting areas (Brazil, 2020; Ministry of Health, 2020).

These are strategies that impact directly the pharmaceutical care practices and it is necessary to have actions that guarantee the service sustainability and therapeutic follow-ups maintenance. However, how to maintain this care bonds, when the new conducts suggest the return of patients every 90 days and the presence of representatives (instead of patients) to receive the dispensed medication?

The way pharmacists are dealing with this pandemic requires creativity and innovation. Pharmaceutical care plays a crucial role in coordinating care and more than ever, in this moment of vulnerability, the pharmacist action must be directed to cooperate with the health system. Several researchers suggest technology use to intermediate health care assistance. Video, telephone and multimedia educational materials can be used during appointments and interviews, as a way to maintain the clinical bonds (Badreldin et al., 2020; Zheng et al., 2021; Li et al., 2021; Meng, Qiu, Sun, 2020). Historically, telehealth has focused its application on medicine and the support of health services (Caetano et al., 2020). With the institution of social distancing measures, its scope did expand with the possible inclusion of pharmaceutical services, adopting the Ministry of Health´s regulation (Presidency of the Republic, 2019), since the profession regulatory bodies hadn´t established specific regulations.

However, few studies had rigorously analyzed the effectiveness of virtual health care on the pharmaceutical field. Brazilian’s virtual pharmaceutical care experience are limited to the educational area (Jabbur-Lopes et al., 2012; Mesquita et al., 2015). Even the National Program of Telehealth Networks (Ministry of Health, 2011) considered the teleconsulting to be performed among health workers, professionals and managers, but not to monitor patients. The extensive use of telehealth to support health assistance is an innovation launched with COVID-19 and it presents difficulties to provide patient monitoring (Caetano et al., 2020).

Electronic medical record systems lack of integration, or even the absence and problems in communication between health care network, makes it difficult for professionals to maintain, or resume, the assistance and adds more obstacles to the proposal of virtual care, especially for the ones who are working remotely (Molina, Hoffmann, Finkler, 2020). Additionally, the Brazilian Unified Health System and part of the population suffers with precariousness and insufficient technological resources, which requires an intersectoral action to put into practice the proposal to inclusion of information and communication technologies in the public health care field (Silva, Moraes, 2012).

The COVID-19 pandemic will impact other pharmaceutical work tasks. The need to decrease the virus proliferation (which has to remain long time post-pandemic) requires reduction of its carriers, such as prescriptions, intervention papers and medicine packaging (Chinese Pharmaceutical Association, 2020). Hua and collaborators (2020) showed the Chinese hospitals experience on new medicine packaging development. They found an excellent material to pack and also easy to be cleaned, disposable plastic bags, which facilitate the identification and checking of dispensed drugs.

In Brazil, the guideline adopted was to use containers for delivering and withdrawing prescriptions and medications in order to avoid contact between hands (Brazil, 2020). Another study addresses the future need to make the pharmaceutical field sustainable, especially as a response to the COVID-19 post-crisis, by reducing the impact of the production and disposal of pharmaceutical inputs (Chan et al., 2020).

As medication experts and health providers, pharmacists are trained to better respond and analyze clinical information production to provide rational use of medicines. In the context of the COVID-19 pandemic, those actions deserve attention. The dissemination of inaccurate pharmacological information, the scientific information manipulation in frank political-ideological apology, breaks the evidence-based medicine procedures and it requires a precise positioning of pharmacists (Carvalheiro, 2020; Xavier et al., 2020). Their technical and bioethical ability to produce reasoned conduct, based on the highest scientific clinical rigor, will be preponderant to produce systematic information of balancing the urgency issued by the pandemic with the procedural requirements to establish safe and responsible evidence (Casas, 2020; d’Avila, Melo, Lopes, 2020).

Innovate the pharmacy workflow and leadership, 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. While we are immersed in such a tragic moment, with thousands of lives lost and the collapse of the public assistance network, it seems inappropriate to think about our own problems, and, right now, we need to balance to be able to provide prompt pharmaceutical services continuation. The new workflows implementation imposes enormous uncertainty, particularly on the pharmaceutical services effectiveness. However, it doesn’t mean to make hasty judgments and exclusions, but we need to learn to reframe health care segments, looking around for examples and learning from our colleagues. The Pharmaceutical Sciences evolved from new experiences, and to preserve health care bonds, with transparency and safety, it is necessary the contribution of professionals, managers, and patients, who must adjust and support themselves. This is the essence of overcoming a natural disaster described by Zuckerman and collaborators (2020) after the destruction of their pharmacy’s health-system. It takes resilience, courage and creativity to achieve a consistent attitude, which provides a quick response to the health care needs in this time of crisis.

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Publication Dates

• Publication in this collection
  02 Dec 2022
• Date of issue
  2022

History

• Received
  21 Jan 2020
• Accepted
  21 Sept 2020