Key-words:
Community pharmacists - COVID-19 - cross-sectional survey - education - extended roles
- health care - health-care roles - hospital pharmacists - pandemic - pharmacy practice
- prevention - surveys
Introduction
The coronavirus disease 2019 (COVID-19), this pandemic affected people from all walks
of life, dramatically changing practices, having a far-reaching impact on health-care
systems worldwide, and putting health-care workers under enormous physiological and
social pressures.[[1]],[[2]],[[3]]
Every day, pharmacists are on the front lines of health care, delivering critical
and essential health-care services throughout the pandemic. Pharmacists are pharmaceutical
specialists that provide patient care in various settings such as hospitals, clinics,
community pharmacies, general practice surgeries, and national and public health organizations.[[4]] According to the International Pharmaceutical Federation (IPF), community pharmacists
play a vital public health role during the COVID-19 public health emergency.[[5]]
Sharing pharmacists' experiences globally is critical for furthering the cause of
the fight against the COVID-19 pandemic and avoiding the need to reinvent the wheel.
The Middle East and North Africa (MENA) had previously experienced multiple pandemics,[[6]] and lessons from prior experiences must have been acquired in coping with the COVID-19
pandemic. As a result, we conducted this narrative of the international literature
to scope the interaction between COVID-19 and pharmacy practice, with a particular
focus on the Middle East and Africa, and the impact of clinical care on these regions,
intending to provide a comprehensive thematic account of where we stand.
Materials and Methods
This is a nonsystematic narrative review of the literature. Records were found in
a single major online resource, PubMed, between February 1, 2020, and June 30, 2021.
The database was searched using the search term ([(“Pharmacists”) AND (COVID-19 OR
coronavirus)] AND [Middle East OR Africa]). Fifty-seven records were found, and the
retrieved articles were reviewed to ensure their relevancy. Relevant publications
(n = 23) were read and thematically narrated to give a reasonably concise yet adequately
representative narration of the global literature on the impact of COVID-19 on all
the elements of pharmacy practice. The data in the original publications were not
statistically analyzed, and extensive numerical presentations were avoided. The original
articles of all kinds were featured. Several multilateral rounds of the debate were
held to fine-tune the final result.
Results
[[Table 1]] summarizes the emerging themes from our literature assessment. They are described
and addressed more below.
Table 1: The themes that emerged from the review of the literature
Evolving Clinical Roles in the COVID-19 Era, Including Classical and New Roles for
Pharmacists during the COVID-19 Pandemic
Evolving Clinical Roles in the COVID-19 Era, Including Classical and New Roles for
Pharmacists during the COVID-19 Pandemic
During the COVID-19 pandemic, pharmacists were emphasized as one of the first lines
of contact within the health-care system. In South Africa, pharmacists in the community,
hospital, and other settings are given guidance on handling patients with suspected
or confirmed COVID-19.[[7]] The situation was quickly changing at the time, and new data were emerging nearly
daily. The guideline paper contained recently emerging evidence and suggestions, notably
concerning the following aspects of COVID-19. In terms of epidemiology, the guideline
reviewed the known facts about the virus, its modes of transmission, and symptom identification
during the incubation period, including the distinction between influenza, allergic
rhinitis, sinusitis, and COVID-19. The authors emphasized the misconceptions and misinformation
that came about on social media. They also provided a summary of treatment guidelines
and medications that may need to be maintained on hand. They covered treatment and
preventive options, including an update on vaccine development and the pros and cons
of using nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors,
and angiotensin receptor blockers in COVID-19 patients. Finally, they emphasized the
pharmacist's interventions and patient counseling. Such recommendations demonstrate
how important it is for pharmacists to have access to the most up-to-date and authoritative
information to guide their practice as time passes and new data emerges.
Risk to Pharmacists from Involvement in COVID-19 Care in Hospitals and the Community
Risk to Pharmacists from Involvement in COVID-19 Care in Hospitals and the Community
Frontline health professionals are in danger of infection because they directly contact
infected individuals while doing their duties. The danger to community pharmacists
and pharmacy employees in this scenario is little known and poorly described. Dzingirai
et al. 2020[[8]] studied the infection risks unique to community pharmacy employees and proposed
some guidelines to lower the risk of COVID-19 infection in Zimbabwe.
They stressed that community pharmacists are vulnerable to catching the infection
at work.
The proposed detailed risk-reduction recommendations and these precise guidelines
were the first to be created for a low-income setting to reduce the likelihood of
disease transmission through the community pharmacy.
Willingness and Preparedness of Pharmacists to Undertake an Extended Role in COVID-19
Management
Willingness and Preparedness of Pharmacists to Undertake an Extended Role in COVID-19
Management
Several groups from MENA investigated the importance of pharmacists' knowledge, awareness,
readiness, and preparedness for their growing role during the region's COVID-19 outbreak.
Many surveys were deployed for knowledge, attitudes, and practices or qualitative
studies to assess preparedness. [[Table 2]] summarizes these investigations, which are briefly reviewed below.
Table 2: Summary of the studies on preparedness, knowledge, attitudes, and practices of pharmacists
or health-care workers (including pharmacists) from the Middle East and Africa
Nationwide studies of pharmacists came from Egypt, Jordan, Qatar, and Lebanon. In
April 2020, Basheti et al. 2021[[6]] did a 20-question survey cross-sectional regional study. There were 2589 participants
(mean age of 29.3 years) with an almost equal sex split. Egypt had the most participation
(40.8%), followed by Jordan, Algeria, and Syria. 60.8% said they acquired their COVID-19
management knowledge through social media, whereas 82.3% stated the most significant
barrier to doing their work was their fear of contracting the virus while on duty.
The authors concluded that pharmacists in MENA nations think they have had adequate
prior education concerning pandemics. Fear has been identified as a fundamental impediment
that governments and policy-makers must address.
Kasahun et al. 2020[[9]] used qualitative research at six pharmacies in Aksum, Ethiopia. Six in-depth interviews
with carefully chosen vital informants were done. Direct observation procedures were
also taken to examine the actions carried out in medicine retail. COVID-19 control
and prevention procedures were implemented with great success. According to interviewees,
they collaborated with key stakeholders and provided adequate patient information
and assistance to battle the pandemic. The authors found that all customers received
essential pharmaceutical services. However, the supply of pharmaceuticals and medical
supplies was limited, which hampered the optimal delivery of pharmacy services. They
advocated for the government and other responsible parties to collaborate to tackle
such issues and control the pandemic.
Mukattash et al. 2020[[10]] investigated pharmacists' willingness to test for COVID-19. Twenty community pharmacies
in Jordan were interviewed with an average experience of 8.8 years. The main themes
included aiding other health-care professionals, contributing to official efforts
to fight COVID-19, serving as an accessible testing location, and doing home testing.
The authors found that Jordanian pharmacists were willing to test patients for COVID-19
at community pharmacies, required more training and improved safety precautions.
Bahlol et al. 2021[[11]] conducted a cross-sectional interview study of 1018 community pharmacies in four
Egyptian provinces. The results highlighted that almost all pharmacies had good infection
control procedures in place, hand sanitizers (62.1%), masks (86.5%), and a separate
space for patients with probable COVID-19 (64%). Despite high clinical awareness (97.6%−99.2%),
only 8.8% of pharmacists reported suspected COVID-19 cases, and 49.1% of pharmacies
offered home delivery. The authors stated that infection control procedures around
staff and client contacts should be emphasized to ensure community pharmacists can
continue to offer continuity in their crucial duties. Finally, educating clients with
updated posters, banners, or signage should reduce patient interaction and pharmacy
visits. The job of community pharmacists should include precise reporting processes
to help track the countrywide spread of illness.
ElGeed et al. 2021[[5]] conducted a cross-sectional 38-item online survey of 311 community pharmacists
in Qatar. More than 75% of pharmacists “always” practiced hygiene and social distancing.
On the other hand, there was a vast range of 32%–73% of pharmacists participating
in patient assessment, education, or providing information related to COVID-19 and
applying the evidence-based protocol. Overall, 77% of pharmacists “strongly agreed”
or “agreed” that they had completed all essential COVID-19 emergency response preparation
and training. Undergraduate education and pharmaceutical specialty influenced the
overall opinion of emergency response preparation. Thus, notwithstanding their readiness
to connect with patients, community pharmacists (87%–96%) in Qatar are eager to undertake
extra training relevant to the COVID-19 public health problem.
Zeenny et al. 2020[[12]] evaluated pharmacists in Lebanese hospitals in response to this pandemic. An anonymous
78 questions were distributed through social media sites. A total of 81 surveys were
completed; participants correctly answered more than 90% of knowledge-based questions
on COVID-19. The majority of respondents expressed anxiety about being sick and infecting
their families due to their occupational exposure. Conversely, around 67% adhered
to safety advice. Most participants indicated that they are experiencing mask and
sanitizer shortages, price increases, and supply delays. Around 50% of hospitals have
taken actions toward COVID-19 preparedness. These findings indicated that respondents
from Lebanese hospitals have an adequate level of knowledge, while utilization expertise
of hospital pharmacists may help minimize/avoid future outbreaks of COVID-19.
Other research studies included pharmacists in the samples of mixed health-care workers
(HCWs). For example, Desalegn et al. 2021[[13]] investigated 1334 health workers' knowledge and preparation for COVID-19 in selected
institutions in Addis Ababa, Ethiopia. A facility-based cross-sectional survey was
undertaken. There were ten public and private hospitals involved. Nurses/midwives
accounted for 39.9% of participants, followed by doctors (29.8%) and pharmacists (14.5%).
One-third of these had official COVID-19 instruction. 76.5% of respondents indicated
that their significant sources of information were television, radio, and newspapers.
43%–57% of individuals verified the existence of established hospital preparation
measures. Thus, health professionals in Addis Ababa, Ethiopia, are aware of critical
information but have a limited understanding of the COVID-19 pandemic. This article
concluded that additional efforts are required among younger demographics, nonphysicians,
and females. Half of the respondents indicated that their hospitals were not adequately
equipped, indicating the need for increased global solidarity, particularly consumables
and equipment.
Bashir et al. 2021[[14]] reported a 26-item cross-sectional observational poll research on 597 HCWs on social
media. The questionnaire was distributed randomly on Arabic-language social media
platforms − the analysis from HCWs with physicians, nurses, medical students, and
pharmacists as participants. Most participants agreed that the virus could be transmitted
directly or indirectly. To avoid infection, most participants answered that they wash
their hands, avoid touching their eyes, nose, or mouth, and avoid crowded locations.
Most participating HCWs identified COVID-19 symptoms correctly. The findings of this
study may contribute to the development of effective techniques for preventing and
controlling COVID-19 infections during a pandemic.
Shehu et al. 2021[[15]] examined 138 clinical HCWs at Bingham University Teaching Hospital Jos using a
questionnaire. The data collecting method was successive sampling, and the response
distribution was given as frequencies and percentages. Doctors, pharmacists, and nurses
had the greatest mean of accurate replies for knowledge. The attitudes and practices
of the various clinical specialties were similar; nonetheless, the difference was
not statistically significant. Superior knowledge, attitudes, and practice were among
doctors and pharmacists, but regular training and updates are required.
Qadah et al. 2020[[16]] conducted cross-sectional research on 1023 HCWs in Jeddah city, Western province,
Saudi Arabia, to ascertain their comprehension of the infection's clinical characteristics.
Over 88% of participants demonstrated a favorable attitude and level of understanding
of COVID-19. Social media and the workplace were the primary sources of information
for the majority of respondents. Around 99.12% of responders were aware of the viral
pandemic and the agent responsible for it. When demographic factors were compared
to mean knowledge, a statistically significant correlation was discovered. The findings
of this study indicated that HCWs have appropriate knowledge and a favorable attitude
regarding COVID-19. However, hospital staff should be trained well and regularly to
deal efficiently with future pandemics.
Despite widespread anxiety around COVID-19, history may give significant insights
when students were recruited during crises.[[17]] Here, two studies assessed pharmacy senior students' knowledge, attitudes, and
behaviors on the COVID-19 pandemic.
Hamza et al. 2021[[18]] employed a 12-question online questionnaire to 238 senior pharmacist students in
Cairo. Results revealed their primary source of information was social media (70%),
written articles (48%), and television (48%). Most students demonstrated an adequate
level of COVID-19 understanding (72.5%). The more knowledge students possessed, the
surer they were that COVID-19 would be effectively handled. Females were 3.6 times
more likely than males to avoid going out. The detrimental behavioral pattern became
apparent when about 50% of students acknowledged not wearing masks when leaving their
residence. As a result, further measures should be made to safeguard future pharmacists
against this epidemic.
Basheti et al. 2021[[19]] used an online questionnaire to ascertain pharmacists' and pharmacy students' understanding
and source of information on the management of the COVID-19 pandemic. 94.6% of them
stay up to date on treatment changes, mainly via the media (59.5%), World Health Organization
(WHO) reports (58.7%), and published research (57%). Pharmacists' (n = 470) awareness
score (out of 20) was substantially higher (P < 0.001) than that of students (n =
256). While most pharmacists and pharmacy students claimed that they play a significant
role in the pandemic management through community pharmacies, the majority also keep
up with the newest coronavirus news through media. This discovery is significant considering
the various contradictory messages aired throughout the pandemic by the media.
Knowledge, Attitudes and Practices of Pharmacists toward COVID-19
Knowledge, Attitudes and Practices of Pharmacists toward COVID-19
Some professional repercussions of COVID on pharmacy practice, education and research
were addressed by several workers [[Table 3]] and [[Table 4]]. Ashiru-Oredope et al. 2020[[20]] investigated the challenges faced by pharmacy teams in commonwealth countries in
Africa, Asia, the Americas, Europe, and the Pacific during the COVID-19 pandemic.
The study assessed 545 pharmacy professionals' comprehension of crucial topics covered
at the Commonwealth Pharmacists Association's COVID-19 webinar (CPA). A quantitative
32-item survey was used to collect the data. The final survey was sent via member
organizations of the CPA. The majority of respondents (90%) expressed some concern
about the impact of COVID-19 on their personal and professional lives, whereas more
than 65% expressed significant concern. Almost two-thirds of respondents indicated
that working efficiently during the pandemic was very or extremely challenging. Most
pharmacy professionals (82%) have never participated actively in a global health emergency
or received global/public health emergency preparation (62%). Their study reaffirms
pharmacists' worries about practicing during a pandemic and offers early data on the
profession's problems and educational needs. The CPA has since taken action on these
findings, offering continuous opportunities for the profession to develop and update
materials as the pandemic progresses.
Table 3: Professional and patients’ perspectives
Table 4: Real-world experience of pharmacists during the coronavirus disease-2019 pandemic
Jarab et al. 2021[[21]] assessed the knowledge and information needs through a cross-sectional web-based
design survey to determine sociodemographic characteristics and awareness of COVID-19
among 860 pharmacy and pharmacy students enrolled in reputable Universities in Jordan.
The findings indicated that students had a fair amount of awareness of COVID-19 (mean
knowledge score was 5.6 out of 10). Students revealed a lack of understanding when
quizzed on the incubation time and degree of contagion. Variation of responses was
found to relate to students' knowledge levels, including their subject of study and
academic year. Few students relied heavily on their course for knowledge regarding
the virus, whereas most depended on self-reading and social media. The findings of
this study reveal an insufficient level of understanding regarding COVID-19. Additional
efforts should be made to educate pharmacy students about COVID-19, focusing on the
importance of universities taking more active roles in accomplishing this aim.
Real-World Experiences
Several studies reported hospital and community pharmacists' real-world experiences
during the COVID-19 outbreak in the Middle East and African countries [[Table 4]]. Abdel Jalil et al. 2020[[22]] reported on a cross-sectional electronic survey of 449 Jordanian pharmacists examining
pharmacists' knowledge, educational efforts, and views on traditional and nontraditional
roles during the COVID-19 pandemic as specified by the IPF. The pharmacists reported
varied educational initiatives and general awareness of COVID-19. However, the authors
found several information gaps that needed to be filled. The authors found that pharmacists
had a positive perception of their duties as defined by the IPF. They found that pharmacists
in Jordan can help limit community transmission. However, more must be done to keep
pharmacists up to date on disease outbreaks to respond effectively in a crisis.
Infection control, personnel, managing clinical, operational issues, ethics, greater
automation, and employee health were all addressed by the inpatient hospital's pharmacy
department in Saudi Arabia, as reported by Arain et al. 2021.[[23]] The strategy developed by the inpatient pharmacy department was developed while
incorporating information and suggestions from top national and worldwide pharmacy
organizations and regulatory agencies benefiting from the experience. The authors
described more focus needed for a modified staffing plan, system changes in perioperative
areas, keeping pharmacy professionals updated on new and scientific research, increased
use of automation, clinical interventions by pharmacists ensuring appropriate medication
utilization while monitoring for drug-drug interactions, adverse drug event prevention,
and preparing for handling drug shortages. By creating a solid plan, pharmacists continue
to demonstrate their value as interprofessional health-care team members.
Al Mazrouei et al. 2021[[24]] studied community pharmacists' (n = 491) in the United Arab Emirates, understanding
COVID-19 and readiness for the pandemic via a cross-sectional online survey. The majority
of participants (n = 400) were well-versed in COVID-19 and had a high degree of preparedness
for the pandemic control. Most pharmacists (n = 212) agreed or strongly agreed (n
= 910) that they play a significant role in crisis management. However, nearly a quarter
(n = 103) of the individuals wrongly believed a DNA virus caused COVID-19. Those with
5–10 and >10 years of experience were 3.95 and 1.59 times more likely to have strong
knowledge than participants with <2 years of experience, respectively. Compared to
those with limited understanding, individuals with high awareness were more likely
to know clients with suspected COVID-19 symptoms. This study found that years of experience
and understanding of COVID-19 were essential predictors of pharmacists' preparation
for pandemic control.
Alsharif et al. 2020[[25]] assessed Saudi Arabia's National eHealth Strategy and proposed an integrated eHealth
framework capable of effectively managing health care operations and services during
pandemics. A questionnaire was distributed to 5 Hospitals/316 HCWs to review Saudi
Arabia's current national eHealth framework. 187 (59.2%) of participants regarded
the existing eHealth framework as ineffective, and more than half of the participants
reported that the framework was missing several critical components. Additional components
and objectives focusing on eHealth for information management, raising awareness,
increasing accessibility and reachability, promoting self-management and self-collaboration,
promoting electronic services, and extensive stakeholder engagement were deemed the
most critical factors by more than 80% of total participants. Pandemic management
demands an effective and efficient eHealth framework capable of managing multiple
health care services by integrating diverse eHealth components and collaboration with
all stakeholders.
Haque et al. 2020[[26]] evaluated 111 pharmacies' use and price variations and shortages of appropriate
medications and equipment throughout the pandemic's early phases in India, increased
purchasing on personal protective equipment (PPE) (over 98%). Antimalarials and antibiotics
prices were unchanged in 83.8 and 91.9% of pharmacies, respectively, despite shortages
at 70.3% of pharmacies for antimalarials and 9.9% for antibiotics. However, price
increases were frequently observed for PPE (over 90% of retailers) and analgesics
(over 50% of pharmacies). There were also shortages seen for PPE (88.3%). The pandemic
has influenced the use and pricing of relevant medications and PPE in India, but increased
inspection has mitigated this effect. In the future, key stakeholder groups may contribute
to enhancing evidence-based approaches and reducing improper purchasing.
Self-care initiatives can help the WHO accomplish three of its goals: To increase
universal health coverage, to reach people in humanitarian circumstances, and to improve
health and well-being. El Bizri et al. 2021[[27]] evaluated the role of community pharmacists in expanding access to and usage of
self-care treatments for sexual and reproductive health (SRH) in the Eastern Mediterranean
Region (EMR). In light of WHO has consolidated guidelines on self-care interventions
to strengthen SRH in EMR, pharmacists from four countries (Egypt, Jordan, Lebanon,
and Somalia) discussed the current state of SRH, disparities in access to SRH services,
and the pharmacist's critical role as a first-line responder to patients before, during,
and after the COVID-19 pandemic. This paper emphasizes community pharmacists' critical
role in promoting self-care interventions and empowering people, families, and communities.
Therefore, knowledgeable individuals will be able to make authoritative health decisions.
Before the COVID-19 pandemic, it was discovered that community pharmacists were excluded
from both government and nongovernment SRH initiatives. Throughout the pandemic, community
pharmacists assisted patients with self-care measures, either on their initiative
or via the efforts of their pharmacy organizations. This demonstrates the importance
of health care decision-makers, including and assisting community pharmacists in influencing
policy and advocating for self-care initiatives. Self-care strategies can help individuals
gain more control and autonomy over their SRH. Supporting community pharmacists will
undoubtedly boost SRH in the EMR and contribute to a more efficient and focused health
system.
Numerous nations' preventive and control actions to combat the development of COVID-19
may negatively influence medication and chronic illness management, impairing patients'
ability to achieve their treatment goals. Akour et al. 2021[[28]] assessed the influence of the COVID-19 lockdown on these factors while also examining
the involvement of community pharmacists. Cross-sectional research was undertaken
using a web-based questionnaire to collect data from individuals (n = 431) in Jordan
diagnosed with chronic conditions. Convenience sampling was used to recruit participants,
who were asked to self-report their accessibility to get medicine and their perception
of the function of community pharmacists. Participants mainly reported challenges
with medication access (45.9%), drug shortages or unavailability (49.4%), medication
non-adherence owing to lack of access (22.7%), and excessive expenses (19.7%). Participants
opted out of follow-ups due to infection (82.5%) or the length of time required to
wait in clinics (74.7%). 39.9% of participants indicated an increased dependence on
community pharmacies for medical assistance, with more than half (50.3%) relying on
pharmacists for guidance on over-the-counter drugs and COVID-19-related information.
There is an immediate need to integrate community pharmacists in medication and chronic
illness management, emphasizing patient adherence, to offer the best possible care
for these vulnerable patient populations. Future research is needed to determine the
influence of pharmacists' contributions to improving medication/disease management.
Alhamad et al. 2021[[29]] used a different approach, examining public opinions of pharmacists' teaching and
prescribing roles and the drug delivery service offered during the COVID-19 pandemic.
They performed a 10-day cross-sectional survey of 578 Jordan's general population
members utilizing a straightforward sample approach. According to the survey, the
public supported the pharmacist's teaching role, drug delivery services, and the rise
in pharmacists prescribing authority during the pandemic. In addition, this study
offered a forum for examining public perceptions of pandemic illnesses and educating
policymakers on how to respond by modifying existing regulations to expand pharmacy
services and prescription roles during the COVID-19 pandemic.
Conclusions
During the COVID-19 pandemic, the entire world was engaged in a battle against an
invisible virus. Pharmacy professionals had to fulfill their responsibilities while
also participating in additional activities. It was much more complicated than previously
because the novel coronavirus is intractable, there was no vaccine or established
therapeutic guidelines, and it manifested itself unexpectedly. To handle the pandemic
problems and the postpandemic situations, pharmacists must be prepared, trained, and
equipped, as well as working together with other health-care professionals. As members
of an interdisciplinary team, community pharmacists may fulfill their responsibilities
and play a key role in disease prevention, containment, and management efforts.
Authors' contributions
RA drafted an initial manuscript, HA further developed it for intellectual content,
and all other authors reviewed and helped with shaping the article. The final product
was refined through several rounds of discussion.
Compliance with ethical principles
Ethical approval is not required for review types of studies.
Reviewers:
Not Applicable (invited Review)
Editors:
Salem A Beshyah (Abu Dhabi, UAE)
