Role of pharmacist during the COVID-19 pandemic: a scoping ...€¦ · 30/6/2020 · and reviewing the titles and abstracts, 62 articles were selected for full-text reading. In addition,

Role of pharmacist during the COVID-19 pandemic: a scoping review

Marília Berlofa Visacria, Isabel Vitória Figueiredob,c, Tácio de Mendonça Limad*

aFaculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil

bFaculty of Pharmacy, University Coimbra, Coimbra, Portugal

cCoimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal

dDepartment of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropédica, RJ,

Brazil

*Corresponding author: T. M. Lima. Department of Pharmaceutical Sciences, Federal

Rural University of Rio de Janeiro. Centro Integrado de Ciências da Saúde, R. UAJ -

UFRRJ, Seropédica, Rio de Janeiro, Brazil.

E-mail address: [email protected], [email protected]

Abstract

Background

Since the start of the new Coronavirus (COVID-19) outbreak in December 2019,

pharmacists worldwide are playing a key role adopting innovative strategies to minimize

the adverse impact of the pandemic.

Objectives

To identify and describe core services provided by the pharmacist during the COVID-19

pandemic.

Methods

A literature search was performed in MEDLINE, Embase, Scopus, and LILACS for

studies published between December 1st, 2019 and May 20th, 2020 without language

restriction. Studies that reported services provided by pharmacists during the COVID-19

pandemic were included. Two independent authors performed study selection and data

extraction with a consensus process. The pharmacist’s intervention identified in the

included studies were described based on key domains in the DEPICT v.2.

Results

A total of 1,189 records were identified, of which 11 studies fully met the eligibility

criteria. Most of them were conducted in the United States of America (n=4) and China

(n=4). The most common type of publication were letters (n=4) describing the workplace

of the pharmacist in hospitals (n=8). These findings showed the different roles of

pharmacists during the COVID-19 pandemic, such as disease prevention and infection

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https://doi.org/10.1101/2020.06.30.20143859

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control, adequate storage and drug supply, patient care and support for healthcare

professionals. Pharmacists’ interventions were mostly conducted for healthcare

professionals and patients (n=7), through one-to-one contact (n=11), telephone (n=6) or

video conference (n=5). The pharmacists’ main responsibility was to provide drug

information for healthcare professionals (n=7) as well as patient counseling (n=8).

Conclusions

A reasonable number of studies that described the role of the pharmacists during the

COVID-19 pandemic were found. All studies reported actions taken by pharmacists,

although without providing a satisfactory description. Thus, future research with more

detailed description as well as an evaluation of the impact of pharmacist intervention is

needed in order to guide future actions in this and-or other pandemic.

Keywords: COVID-19; pharmacists; pharmaceutical services; review

Introduction

The Coronavirus Disease 2019 (COVID-19) is an infection caused by the Severe Acute

Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first emerged in Wuhan (China) in

December 2019, spreading rapidly across the world.1 On the 11th of March 2020, the

World Health Organization (WHO) declared COVID-19 a pandemic.2 At the time of

writing there have been 10 million cases of COVID-19 reported globally, with more than

500 000 deaths reported across 216 countries.3 Currently, the COVID-19 pandemic is a

major public health problem worldwide.

The most common symptoms for patients infected with COVID-19 are fever, cough,

difficulty breathing, fatigue, and headache.4 Most symptomatic patients will develop mild

symptoms. However, some patients may progress to serious illness, such pneumonia,

acute respiratory distress syndrome, multi organ dysfunction and even death.5 So far,

there are no proven effective treatments against COVID-19 and widespread effort is being

devoted towards the development of a safe vaccine.3 Thus, the population must follow

recommendations to decrease the transmission of SARS-CoV-2, including social

distancing, wearing masks and strict hand hygiene.6

While millions of people are in their homes in order to decrease the risk of transmission

of the infection, health workers are on the frontline against COVID-19.7 These



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professionals are committed to ensuring that the population have access to health services

and to minimize the adverse impact of the pandemic. Given the seriousness of the

coronavirus outbreaks, health professionals with expertise in public health are essential.

As healthcare professionals, pharmacists can play key role during the pandemic, acting

directly with the community,8 continuing to care for patients with chronic diseases,9,10

working in hospital pharmacies and providing pharmaceutical care to COVID-19

patients.11 Moreover, they may provide reliable information for preventing, detecting,

treating and managing coronavirus infections.12,13 As a result, several challenges have

emerged and innovative strategies are being adopted by pharmacists to overcome them.14

Since the beginning of the outbreak, many guidelines have been published with

recommendations for pharmacists as well as their responsibilities during the pandemic.

However, few describe pharmacists’ experiences in this novel context. Therefore, this

scoping review is aimed to identify and describe core services provided by the pharmacist

during the COVID-19 pandemic.

Method

A scoping review was performed to explore the literature, map and summarize the

evidence regarding the role of the pharmacist during COVID-19 pandemic.15 This review

was conducted following the recommendations of the Preferred Reporting Items for

Systematic reviews and Meta-Analyses statement for Scoping Reviews (PRISMA-ScR)16

and the review protocol registered on Open Science Framework

(https://doi.org/10.17605/OSF.IO/NE2GY).

Search strategy

A comprehensive literature search was performed in the MEDLINE (PubMed), Embase,

Scopus, and LILACS (Latin American and Caribbean Health Sciences Literature)

databases published between December 1st, 2019 (first reports of COVID-19 in China)

and May 20th, 2020 in order to identify relevant studies. The search strategy included

combinations of terms relating the COVID-19 and pharmacy. The full strategies search

for all databases can be found in S1 Appendix. Additionally, it was conducted a grey

literature search in DOAJ - Directory of Open Access Journals (https://doaj.org/) aiming

to identify not indexed studies in the databases listed above. No language restriction was



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applied. Duplicated studies were eliminated. In addition, references cited in all included

articles were reviewed to identify any studies that might have been missed.

Study selection

Studies that described services provided by the pharmacist during the COVID-19

pandemic were included. In addition, all publication types were eligible for inclusion.

Studies that did not describe the role of the pharmacist during the COVID-19 pandemic;

reviews, recommendations, and-or guidelines of pharmacist’s role during the pandemic;

presented only pharmacotherapeutic options for COVID-19; and involved graduate

students were excluded.

All titles and abstracts were independently screened and selected by the authors. Full-text

articles were obtained and reviewed to determine whether the article met the eligibility

criteria. If the full texts of the articles were not available in the databases, the

corresponding authors were contacted by email or through ResearchGate

(www.researchgate.net). Disagreements were resolved through discussion.

This process was performed using Rayyan QCRI, a free web application designed to help

researchers working on systematic reviews.17

Data extraction and analysis

For each included study, information such as the: author, date of publication or

availability online, publication type, region, workplace of the pharmacist, participants,

and results summary were extracted. The pharmacist interventions reported in these

studies were described based on key domains in the Descriptive Elements of Pharmacist

Intervention Characterization Tool (DEPICT) version 2: 1) contact with recipient (how

the contact with the recipient occurs); 2) method of communication with recipient; 3)

setting of the intervention (where the recipient received the service); 4) action(s) taken by

pharmacist (what is done to address the identified problems); and 5) materials that support

action(s) (items developed or provided by the pharmacist as part of the service).18 The

authors independently completed the data extraction, using a preformatted spreadsheet in

Microsoft Excel. Disagreements were resolved through discussion.

The results of this scoping review are presented as a narrative synthesis due to the

heterogeneity of the studies included. The studies were categorized according to the

characteristics of the publication and summarized in tables.



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Following the PRISMA-ScR16, no quality assessment was performed due to the fact that

scoping reviews aim to identify all the available evidence and highlight their main

characteristics, regardless of the quality.

Results

Search results

The electronic search found 1,189 potentially relevant studies. After removing duplicates

and reviewing the titles and abstracts, 62 articles were selected for full-text reading. In

addition, no relevant studies were identified from searching the reference lists of the

included studies. Of these, 11 studies met the inclusion criteria and were included for

review. A flowchart of the literature search is shown in Fig. 1. The references for the

excluded studies, with the reasons for their exclusion, are available in S2 Appendix.



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Figure 1. Study selection flowchart through literature search.

Records identified through

databases (n = 1,189):

MEDLINE (PubMed) (265)

Embase (556)

Scopus (214)

LILACS (95)

DOAJ (59)

Records screened on titles

and abstracts

(n = 965)

Records excluded

(n = 903)

[not pharmaceutical studies; not related with

COVID-19; involved graduate students]

Full-text articles assessed for

eligibility

(n = 62)

Full-text articles excluded

(n = 51)

- Not described activities and-or services adopted by the

pharmacist (n = 38)

- Reviews, recommendations, and-or guidelines (n = 5)

- Pharmacotherapeutic options (n = 4)

- Not related the pharmacist professional (n = 1)

- Involved graduate students (n = 1)

- Interview (n = 1)

- No access (n = 1)

Total studies included

(n = 11)

(n = xx)

Duplicates

(n = 224)

Additional records identified through

complementary search

(n = 0)

(n = xx)



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Characteristics and summary of the results of the included studies

The characteristics of the 11 studies included in this scoping review are summarized in

Table 1. Studies were conducted in the United States of America (n=4)20,21,27,29, China

(n=4)22,23,25,28, Saudi Arabia (n=1)19, Taiwan (n=1)24, and Macao (n=1).26 All studies were

published in English and reported between February and May 2020. The publication type

of the included studies consisted of letters (n=4)20,21,25,27, research article (n=2)19,22,

commentary (n=2)23,26, ideas and opinions (n=1)24, discussion (n=1)28, and note (n=1)29.

The majority of the studies described the workplace of the pharmacist in hospitals (n=8)19-

23,25,28,29 following the ambulatory pharmacies (n=4)19,20,28,29, community pharmacies

(n=2)24,26, and clinic (n=1).27 The participants of the included studies were miscellaneous,

including the healthcare professionals (n=7)19-23,28,29, COVID-19 patients

(n=5)19,22,23,28,29, general inpatient (n=2)19,29, general population (n=2)24,26, pediatric

patients (n=1)20, solid organ transplant patients (n=1)21, patients on warfarin therapy

(n=1)25, and myelofibrosis patients (n=1).27



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Table 1. Characteristics of the included studies in the scoping review.

Author Date of publication

(or available online)

Publication

Type

Region Workplace of the

pharmacist

Participants

Arain et al.19 2020 May 18 Research

article

Saudi Arabia Hospital and

ambulatory

pharmacy

Healthcare professionals

and COVID-19 and non-

COVID-19 patients

Elson et al.20 2000 May 5 Letter to the

Editor

United States Hospital and

ambulatory

pharmacy


and pediatric patients

Fan and

Kamath21

2020 May 4 Letter to the

Editor

United States Hospital Healthcare professionals

and solid organ transplant

patients

Hua et al.22 2020 April 10 Research

article

China Hospital Healthcare professionals

and COVID-19 patients

Meng et al.23 2020 April 2 Commentary China Hospital Healthcare professionals


Ou and Yang24 2020 April 13 Ideas and

Opinions

Taiwan Community

pharmacy

Taiwan's population

Tan et al.25 2020 May 13 Letter China Hospital Patients on warfarin

therapy

Ung26 2020 February 12 Commentary Macao Community

pharmacy

Macao's population



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Author Date of publication

(or available online)

Publication

Type

Region Workplace of the

pharmacist

Participants

Yemm et al.27 2020 May 14 Letter to the

Editor

United States Clinic Myelofibrosis patients

Ying et al.28 2020 April 6 Discussion China Hospital

and ambulatory

pharmacy



Zuckerman et

al.29

2020 May 16 Note United States Hospital and

ambulatory

pharmacy


and COVID-19 and non-

COVID-19 patients

Abbreviation: COVID-19 (coronavirus disease 2019)



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Table 2 shows a summary of the results of the included studies. All described actions

taken by the pharmacist. However, only one study evaluated the outcomes associated with

pharmacist intervention.22 Several services were related in these studies, including disease

prevention and infection control19,23,24,28 (e.g., distribution of the masks, develop hygiene

strategies, discard all unused drugs dispensed for COVID-19 patients, and social

distancing), adequate storage and drug supply19,20,22,23,28 (e.g., drug formulary for

treatment of COVID-19 to guide the drug supply and purchase, conversion of intravenous

to oral medications when it was possible, and virtual communication for supply

inventory), and patient care and support for healthcare professionals19-23,25,27-29 (e.g.,

ensure appropriate drug utilization for patients and healthcare professionals, participation

of virtual rounds with interdisciplinary team, review online of the electronic orders,

patient education, virtual medication consultation, and medication reconciliation).



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Table 2. Summary of the results of the included studies in the scoping review.

Author Disease prevention and infection control

Adequate storage and drug

supply

Patient care and support for healthcare professionals

Arain et al.19 Decrease the visits to the pharmacy area by

colleagues from other units, encouraging

them to use phones or in-basket messages

from

the computerized physician order entry

system to communicate; change of staff

plan; implementation of system changes in

perioperative areas; utilization of automation

to reduce traffic of pharmacy staff in the

hospital; discard of all unused medications

dispensed for COVID-19 patients; floor

markings on the ground to section areas of

the pharmacy that patients can stand in

while waiting or being helped.

Switch of intravenous to oral

medications and intravenous

infusion to intravenous push to

prevent drug shortages;

management of drug stocks using

therapeutic interchange;

communication with the supply

team about adequate supplies of

medications.

Participation in the development of a COVID-19

protocol; conduction of clinical interventions; monitoring

and prevention of drug-drug interactions and ADR;

updating pharmacy professionals about new scientific

research

Elson et al.20 NR Contribution with medication

access by making telephone calls to

outside pharmacies, insurance

companies, and patients or families.

Participation in interdisciplinary inpatient rounds using

Microsoft Teams; conduction patient profile reviews to

assess the safety and efficacy of medication therapy using

secure remote access to patient information in the EMR;

providing patient education and counseling via telephone

and Microsoft Teams; continuation of quality

improvement projects, formulary and inventory

management, and research by conference calls, email, and

telephone communication as well as Microsoft Teams and



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supply


other video conferencing platforms; providing ambulatory

care services remotely.

Fan and Kamath21 NR NR Providing medication recommendations during virtual

rounds with HCP; providing remote education for the

patients to assist their learning of medications and

lifestyle choices in discharge or admission.

Hua et al.22 NR Drug formulary and purchase,

storage, and distribution of drugs;

critical care trolleys loaded with all

kinds of critical care drugs.

Online review of 20,000 electronic orders; providing

online medication consultation for 484 patients using

WeChat; providing medication and health education in

the WeChat group; use a module radio station to inform

the patients about the medication, rational nutrition and

diet suggestions for COVID-19, and self-protection and

medication guidance after discharge.

Meng et al.23 Change in mode of drug delivery. Establishing pharmacies from

grounds up, including locating the

ideal pharmacy location and

procuring necessary equipment;

compiling drug formulary;

cataloging and stocking formulary

drugs; resolving drug shortages.

Development of a medicinal dictionary for formulary

drugs to be docked into the CDS to provide prescribing

support; education for patients on medications taken at

the hospital and upon discharge; providing drug

information to physicians especially concerning drugs

that general practitioners are not familiar with a focus on

off-label drug use, and interactions between TCMs and

western medicines; medication reconciliation to ensure

the safe transition of care.

Ou and Yang24 Repacking of bulk packages of masks into

unit packets containing the rationed amount

NR NR



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supply


and distributed them for residents in their

communities; education and consultation on

proper hygiene strategies; disseminating of

accurate information to counter myths and

misinformation; and providing of emotional

support to alleviate public concerns arising

from the COVID-19 crisis.

Tan et al.25 NR NR Managing and providing recommendations on warfarin

dose adjustment to 500 patients via a mobile phone app.

Ung26 Help consumers differentiate surgical masks

from other types of face masks not made for

protection against virus transmission; price

control of surgical masks within reasonable

price range;

and implementing “The Guaranteed Mask

Supply for Macao Residents Scheme” in

response to the new government policy.

NR NR

Yemm et al.27 NR NR Application of MPN-SAF TSS and the DIPSS plus via

telephone and upload this information to the EMR prior

to the patient’s next visit.

Ying et al.28 Designing safety transfer devices to avoid

contacting patients in drugs dispensing;

adjusting the route and time of drug

transportation in the hospital and using

designated elevators and vehicles for drug

Establishing a list of COVID-19

therapeutic drugs to control drug

supply schemes; implementing

online drug procurement; managing

donated medicine.

Monitoring ADR and providing ADR information;

participating in the multidisciplinary diagnosis and

treatment of COVID-19 patients; participating in

multidisciplinary consultations; monitoring drug



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supply


delivery; publicized the prevention and

control of COVID-19 to the public free of

charge online.

interactions, implementing remote pharmaceutical

services; caring out medication review.

Zuckerman et al.29 Staff redeployment and staffing

modifications; sourcing and using of PPE;

installation of hand-sanitizing stations and

plexiglass dividers in pharmacies.

Developing a list of medications

required for treatment of COVID-

19 patients to guide the drug supply

and calculating medication

quantities to purchase; developing

new medication and supply storage

and delivery mechanisms; creation

of a virtual dashboard to clearly

communicate current strategic

supply inventory.

Participating in virtual meetings and inpatient rounds;

patient counseling via smartphones or telehealth visits;

participating of the COVID-19 pharmacotherapy working

group that provided initial treatment recommendations

published weekly on institutions intranet; developing of a

guidance for patients receiving biologics who were at risk

for COVID-19 acquisition due to immunosuppression so

that providers could advise them to suspend therapy if

necessary; coordinated many patients’ transition from

infusions to self-administered medications.

Abbreviation: ADR (adverse drug reaction), CDS (clinical decision support system), COVID-19 (coronavirus disease 2019), DIPSS plus (Dynamic International Prognostic Scoring

System), EMR (Electronic Medical Record), HCP (healthcare professionals), NR (not reported), PPE (personal protective equipment), MPN-SAF TSS (Myeloproliferative Neoplasm

Symptom Assessment Form total symptom score), TCM (traditional chinese medicine).



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Characteristics of pharmacist interventions based on DEPICT 2

Studies were conducted for healthcare professionals and patients (n=7)19-23,28,29 or only

patients (n=2).25,27 Two studies24,26 were conducted for the general population and,

therefore, were classified as “not applicable”. All studies performed one-to-one contact

with the recipients and six studies19-22,28,29 also used the group contact. Different methods

of communication were reported, including face-to-face (n=4)19,24,26,28, written

(n=5)19,20,22,28,29, telephone (n=6)19,20,22,23,27,29, video conference (n=5)20-23,29 and radio

station.22 One study25 did not describe how the communication with the recipient has been

performed. The studies were conducted at different setting of intervention, such as

hospital bedside (n=7)19-23,28,29, hospital pharmacy (n=2)19,29, community pharmacy

(n=2)24,26, ambulatory (n=4)19,20,28,29, and recipient’s home (n=5).20,21,25,27,29

Pharmacists had an important role in taking actions to address during the COVID-19

pandemic, including drug information for healthcare professionals (n=7)19-23,28,29, patient

counseling (n=8)19-23,25,28,29, suggestion for change in therapy (n=3)19,25,29, monitoring

results report (n=1)19, drug supply management (n=6)19,20,22,23,28,29, safety measures for

infection control (n=4)19,24,26,29, and application of tools to evaluated a disease (n=1).27

Regarding the materials that support actions adopted by pharmacists, most studies

(n=7)20-22,24-27 did not report them. Among those that described support resources

provided by the pharmacists, educational materials (n=4)19,23,28,29 were the most reported,

following the protocols (n=2)19,29, discharge letter (n=1)19, and safety alert system

(n=1).19 The description of the pharmacist interventions according to DEPICT version 2

are shown in Table 3.



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Table 3. Description of the pharmacist interventions according to the DEPICT version 2.

Author Recipient Contact with

recipient

Methods of

communication

Setting of the

intervention

Action(s) taken by

pharmacist

Materials that

support action(s)

Arain et al.19 Patient and

HCP

One-to-one (patient

and HCP) and group

(HCP)

Face-to-face

(patient and HCP),

written (patient and

HCP), and

telephone (HCP)

Hospital bedside

(patient and HCP),

hospital pharmacy

(HCP), and ambulatory

setting (patient)

Drug information for

HCP; patient counseling;

suggestion for change in

therapy; monitoring

results report; drug

supply management;

safety measures for

infection control

Discharge letter;

educational materials;

protocol; safety alert

system

Elson et al.20 Patient and

HCP

One-to-one (patient)

and group (HCP)

Written (patient

and HCP),

telephone (patient

and HCP), and

video conference

(patient and HCP)

Hospital bedside

(patients and HCP),

ambulatory setting

(patient), and

recipient’s home

(patient)



drug supply management

NR

Fan and Kamath21 Patient and

HCP

One-to-one (patient)

and group (HCP)

Video conference

(patient and HCP)

Hospital bedside

(patients and HCP) and

recipient’s home

(patient)


HCP; patient counseling

NR



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recipient

Methods of

communication

Setting of the

intervention

Action(s) taken by

pharmacist

Materials that

support action(s)

Hua et al.22 Patient and

HCP

One-to-one (patient

and HCP) and group

(patient)

Written (patient

and HCP),

telephone (patient),

video conference

(patient), and radio

station (patient)

Hospital bedside

(patient and HCP)



drug supply management

NR

Meng et al.23 Patient and

HCP

One-to-one (patient

and HCP)

Telephone and

video conference

(patient and HCP)

Hospital bedside

(patient and HCP)



drug supply

management; safety

measures for infection

control

Educational materials

Ou and Yang24 NA* One-to-one Face-to-face Community pharmacy Safety measures for

infection control

NR

Tan et al.25 Patient One-to-one

NR Recipient’s home Patient counseling;


therapy

NR

Ung26 NA* One-to-one Face-to-face Community pharmacy Safety measures for

infection control

NR

Yemm et al.27 Patient

One-to-one Telephone Recipient’s home Application of tools to

evaluated a disease

NR



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recipient

Methods of

communication

Setting of the

intervention

Action(s) taken by

pharmacist

Materials that

support action(s)

Ying et al.28 Patient and

HPC

One-to-one (patient

and HPC) and group

(HPC)

Face-to-face,

written (patient and

HPC)

Hospital bedside

(patient and HCP) and

ambulatory setting

(patient and HCP)


HPC; patient counseling;

drug supply

management; safety


control

Educational materials

Zuckerman et

al.29

Patient and

HCP

One-to-one (patient

and HCP) and group

(HCP)

Written (patients

and HCP),

telephone

(patients), and

video conference

(HCP)

Hospital bedside

(patient and HCP),

hospital pharmacy

(HCP), ambulatory

setting (patient and

HCP) and recipient’s

home (patient)


HPC; patient counseling;


therapy; drug supply

management; safety


control

Educational materials;

protocols

*Pharmacist interventions were conducted for the general population.

Abbreviation: HCP (healthcare professionals), NA (not applicable), NR (not reported).



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Discussion

Summary of evidence

This scoping review identified 11 relevant studies on the services provided by the

pharmacist during the COVID-19 pandemic. To the best of our knowledge, this is the first

review to discuss this question. These results indicate that there are a reasonable number

of studies on this topic in a short time of the COVID-19 pandemic, although most of them

are letters to the editor and other rapid scientific communications. Moreover, most studies

were conducted in the United States and Asia, particularly in the region of China. These

findings were expected because this region was the first local affected by the SARS-CoV-

2 virus. Diversely, to our surprise, no studies were performed in Europe, especially in the

United Kingdom, Italy and Spain, where the COVID-19 pandemic spread quickly in mid-

March. It is important to note that most studies reported the hospital as the workplace of

pharmacists. Experiences with community pharmacists should be encouraged since most

of the time the community pharmacy is a first point-of-care of the patients.

In light of these findings, researchers must be engaged to design and report future studies

with greater methodological rigor and more detailed description of the pharmacist

interventions, in order to support and guide the actions of the pharmacists in this and-or

other pandemic.

General view of the studies

Most of the studies found in this review were conducted in the United States of America

and China. These countries are the second and first in the scientific publication ranking

worldwide, respectively.30 Moreover, China was the first region affected by the COVID-

19 infection1 and therefore first experiences were felt in this location.

Regarding the type of publication, most studies were letters and other rapid scientific

communications reporting experiences. These publications did not contain details of the

work experiences and are at the lowest level of evidence.31 However, considering the

current pandemic, when there is a need for rapid information for activity guidelines by

the pharmacists need to have quick information to guide their activities, these publications

are convenient and acceptable.



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The hospital was the main workplace of the pharmacist in the included studies, which

was an expected result because the role of pharmacist in hospital pharmacy practice is

one of the most consolidated.32 Pharmacists have a very comprehensive role within the

hospital, performing from administrative activities to clinical services.33 Therefore, they

must be involved with all aspects of medicines use and be accessible as a point of contact

for patients and health care providers.34 As a consequence, it is more than expected that

they would be on the frontline against COVID-19 pandemic and reporting on their

successful experiences.

This review showed that pharmacists may play an important role during the COVID-19

pandemic. The results reported were categorized as “disease prevention and infection

control”, “adequate storage and drug supply” and “patient care and support for healthcare

professionals”. These categories are basically the responsibilities that International

Pharmaceutical Federation (FIP) has stated that it would like pharmacists to have in both

primary care context (i.e. community pharmacies and primary healthcare facilities) and

in hospital settings.12 Other recommendations of the scientific societies are also available

and can help to direct the pharmacist intervention.35-37

According to the key domains of pharmacist interventions, most studies were carried out

for healthcare professionals and patients. Pharmacist-provided interventions with the

recipients have been shown to improve patient outcomes and contribute to substantial

healthcare savings.38 In contrast, two studies did not classify as to the recipient of the

intervention because the DEPICT version 2 did not predict interventions in the general

population. It is important to note that pharmacists can play a role in health education and

disease prevention in various ways for the general population.39-42 Moreover, the level of

pharmacist-recipient interaction varied between studies. Most of them described the use

of telephone, written interaction including web-based, and video conference. Studies

involving the use of these methods of communication have been successful43-45 and these

valuable tools may be applied in a social distancing context. In addition, one study

reported that pharmacists used a hospital's radio station as a communication strategy in

patients who had difficulty in dealing with available technologies, highlighting the

creative character.22 Regarding the setting of intervention, most studies were performed

in hospital bedside, ambulatory, and recipient’s home. Pharmacist interventions were

described in several settings46-48 as to improving the quality of care. Unfortunately, only

two studies related the community pharmacy as the setting of intervention. A recent study



https://doi.org/10.1101/2020.06.30.20143859


discussed the role of community pharmacists during the COVID-19 pandemic, collecting

and summarizing the experience of Chinese community pharmacies.49 It is well known

that community pharmacies are an important setting of care in the COVID-19 pandemic

period and further studies in this context should be encouraged.

Drug information for healthcare professionals and patient counseling were the main

actions provided by the pharmacists identified in this review, similarly with other

studies.48,50 These actions focus on enhancing the problem solving skills of the patient for

the purpose of improving or maintaining the quality of life.18 In addition, other actions

(drug supply management and safety measures for infection control) were also identified

in some studies. Gross and MacDougall51 described these actions (e.g. planning the drug

shortages and antiviral stewardship) as vital during the COVID-19 pandemic period.

Moreover, the key domain “Materials that support actions” has not been reported in most

studies. Among those that described these resources, most of them used educational

materials. These findings are similar to a study that describes the role and impact of

pharmacists in Spain.52 These resources are useful to support the pharmacy services.18

The lack of this information affected the understanding which tools were used by

pharmacists in their actions.

Limitations

This study has some limitations. It is possible that some studies were missed due to not

being indexed in the databases searched or being published in websites of institutions or

scientific societies. Moreover, the number of publications on COVID-19 is rapidly

increasing in a short time and some studies of interest available after the established

search period have not been included. Finally, this review did not analyze the quality of

the studies taking into account the inherent characteristic of the scoping reviews.

Conclusion

A reasonable number of studies that described the role of the pharmacists during the

COVID-19 pandemic were found. Several methods of communication were performed in

different settings of intervention. Moreover, all studies reported actions taken by

pharmacists, mainly drug information and patient counseling, although description was

not satisfactory. Thus, future research with more detailed description and evaluated the

impact of pharmacist intervention is needed in order to guide the actions of the

pharmacists in this and-or other pandemic.



https://doi.org/10.1101/2020.06.30.20143859


Authors' Contributions

MBV and TML identified the reports in the databases and collected data of the studies

included. MBV and TML drafted the manuscript. IVF revised for finalization of the

manuscript. All authors approved the final manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,

authorship, and/or publication of this article.

Source of Funding

The authors received no financial support for the research, authorship, and/or publication

of this article.

Supplemental Files

Appendix 1. Search strategies of the scoping review

Appendix 2. List of excluded studies

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Appendix 1. Search strategies of the scoping review

A. MEDLINE (PubMed)

#1 "COVID-19" [Supplementary Concept] OR (2019 novel coronavirus disease) OR

(COVID19) OR (COVID-19 pandemic) OR (SARS-CoV-2 infection) OR (COVID-19

virus disease) OR (2019 novel coronavirus infection) OR (2019-nCoV infection) OR

(coronavirus disease 2019) OR (coronavirus disease-19) OR (2019-nCoV disease) OR

(COVID-19 virus infection)

#2 "Pharmacists"[Mesh] OR (Pharmacist) OR (Clinical Pharmacists) OR (Clinical

Pharmacist) OR (Pharmacist, Clinical) OR (Pharmacists, Clinical) OR (Community

Pharmacists) OR (Community Pharmacist) OR (Pharmacist, Community) OR

(Pharmacists, Community) OR (Hospital Pharmacists) OR "Pharmacies"[Mesh] OR

(Community Pharmacy) OR (Community Pharmacies) OR "Pharmacy Service,

Hospital"[Mesh] OR (Pharmaceutical Service, Hospital) OR (Service, Hospital

Pharmaceutical) OR (Hospital Pharmacy Services) OR (Pharmacy Services, Hospital)

OR (Services, Hospital Pharmacy) OR (Service, Hospital Pharmaceutic) OR (Hospital

Pharmacy Service) OR (Hospital Pharmaceutic Service) OR (Hospital Pharmaceutic

Services) OR (Pharmaceutic Services, Hospital) OR (Services, Hospital Pharmaceutic)

OR (Pharmaceutic Service, Hospital) OR (Hospital Pharmaceutical Service) OR

(Hospital Pharmaceutical Services) OR (Pharmaceutical Services, Hospital) OR

(Services, Hospital Pharmaceutical) OR (Service, Hospital Pharmacy) OR (Pharmacy

Service, Clinical) OR (Service, Clinical Pharmacy) OR (Clinical Pharmacy Services) OR

(Pharmacy Services, Clinical) OR (Services, Clinical Pharmacy) OR (Clinical Pharmacy

Service) OR "Pharmaceutical Services"[Mesh] OR (Services, Pharmaceutic) OR

(Services, Pharmacy) OR (Pharmaceutic Services) OR (Pharmaceutic Service) OR

(Service, Pharmaceutic) OR (Services, Pharmaceutical) OR (Pharmaceutical Service) OR

(Service, Pharmaceutical) OR (Pharmacy Services) OR (Pharmacy Service) OR (Service,

Pharmacy) OR (Pharmaceutical Care) OR (Care, Pharmaceutical) OR "Medication

Therapy Management"[Mesh] OR (Management, Medication Therapy) OR (Therapy

Management, Medication) OR (Drug Therapy Management) OR (Management, Drug

Therapy) OR (Therapy Management, Drug)

#1 AND #2

Filtrer: publication date from 2019/12/01.

B. Embase

#1 'covid 19'/exp OR 'covid 19' OR 'sars coronavirus'/exp OR 'sars cov 2' OR 'coronavirus

disease 2019'/exp OR coronavirus OR '2019 ncov infection' OR '2019 ncov disease'

#2 'pharmacist'/exp OR pharmacist OR pharmacists OR 'community pharmacist'/exp OR

'community pharmacists' OR 'clinical pharmacist'/exp OR 'clinical pharmacists' OR

'hospital pharmacist'/exp OR 'hospital pharmacists' OR 'hospital pharmacy'/exp OR



https://doi.org/10.1101/2020.06.30.20143859


'hospital pharmacy' OR 'clinical pharmacy'/exp OR 'clinical pharmacy' OR 'pharmacy

(shop)'/exp OR 'community pharmacy' OR pharmacy OR pharmacies OR 'pharmaceutical

care'/exp OR 'pharmaceutical care' OR 'medication therapy management'/exp OR

'medication therapy management' OR 'drug therapy management' OR 'medication

management'

#1 AND #2

Filter: publication date from 2019/12/01

C. Scopus

#1 TITLE-ABS-KEY ( ( covid 19 ) OR ( sars AND cov 2 ) OR coronavirus OR (

2019 ncov AND infection ) OR ( 2019 ncov AND disease ) )

#2 TITLE-ABS-KEY ( pharmacist OR pharmacists OR ( community AND pharmacists

) OR ( clinical AND pharmacists ) OR ( hospital AND pharmacists ) OR ( hospital

AND pharmacy ) OR ( clinical AND pharmacy ) OR ( community AND pharmacy )

OR pharmacy OR pharmacies OR ( pharmaceutical AND care ) OR ( medication

AND therapy AND management ) OR ( drug AND therapy AND management ) OR

( medication AND management ) )

#1 AND #2


D. LILACS

(tw:(covid-19 OR coronavirus OR "sars-Cov-2" OR "2019 ncov infection" OR "2019

ncov disease")) AND (tw:(pharmacist OR pharmacists OR "community pharmacists" OR

"clinical pharmacists" OR "hospital pharmacists" OR "hospital pharmacy" OR "clinical

pharmacy" OR "community pharmacy" OR pharmacy OR pharmacies OR

"pharmaceutical care" OR "medication therapy management" OR "drug therapy

management" OR "medication management"))


E. DOAJ

covid-19 AND pharmacy



https://doi.org/10.1101/2020.06.30.20143859


Appendix 2. List of excluded studies.

Reason for exclusion Authors, year Title Reference

Not described activities and-

or services adopted by the

pharmacist

Shubha B,

Amanuel K

Additional clinical pharmacists roles during COVID-19 J Am Coll Clin Pharm.

2020 Apr 12

Vouri SM, et al. An evaluation of co-use of chloroquine or hydroxychloroquine

plus azithromycin on cardiac outcomes: A

pharmacoepidemiological study to inform use during the

COVID19 pandemic

Res Social Adm Pharm.

2020 Apr 30

Brown JD, et al. Cannabidiol as Prophylaxis for SARS-CoV-2 and COVID-19?

Unfounded Claims Versus Potential Risks of Medications During

the Pandemic


2020 Mar 31;S1551-

7411(20)30300-4.

Carico Jr RR, et

al.

Community Pharmacists and Communication in the Time of

COVID-19: Applying the Health Belief Model


2020 Mar 26;S1551-

7411(20)30293-X



https://doi.org/10.1101/2020.06.30.20143859



Hedima EW,

Adeyemi MS,

Ikunaiye NY

Community Pharmacists: On the frontline of health service against

COVID-19 in LMICs


2020 Apr 17

Khan Z, et al. Coronavirus outbreaks: prevention and management

recommendations

Drugs Ther Perspect.

2020;36:215–217.

Fowler P COVID-19: A chance to be our best J Pharm Pract Res 2020

April 30

Ailabouni NJ,

et al.

COVID-19 Pandemic: Considerations for Safe Medication Use in

Older Adults with Multimorbidity and Polypharmacy

J Gerontol A.

2020;26(6):1-15

Iacobucci G Covid-19: Allow pharmacists to dispense controlled drugs without

prescription, urge specialists

BMJ. 2020 May

7;369:m1868.

Adunlin G,

Murphy PZ,

Manis M.

COVID-19: How Can Rural Community Pharmacies Respond to

the Outbreak?

J Rural Health. 2020 Apr

11.

Zanon D, et al. Data on the stability of darunavir/cobicistat suspension after tablet

manipulation

Data Brief.

2020;30;105552



https://doi.org/10.1101/2020.06.30.20143859



Métayer R Dispositif d’urgence en situation de crise sanitaire: application

d’un régime dérogatoire au pharmacien d’officine

Médecine & Droit. 2020

Apr 17

EHAP EHAP launches COVID-19 resource centre for hospital

pharmacist

https://www.eahp.eu/hp-

practice/hospital-

pharmacy/eahp-covid-19-

resource-centre

Meghana A, et

al.

Emergency preparedness and response (EP&R) by pharmacy

professionals in India: Lessons from the COVID-19 pandemic and

the way forward


2020 Apr 25

Dawoud D Emerging from the other end: Key measures for a successful

COVID-19 lockdown exit strategy and the potential contribution

of pharmacists.


2020 May 13

Wiffen P. Houston we have a problem: coronavirus! Eur J Hosp Pharm. 2020

Mar;27(2):59



https://doi.org/10.1101/2020.06.30.20143859



Amariles P, et

al

How to link patients with suspicious COVID-19 to health system

from the community pharmacies? A route proposal


2020 Mar 23;S1551-

7411(20)30248-5

Kretchy IA,

Asiedu-Danso

M, Kretchyb JP

Medication management and adherence during the COVID-19

pandemic: Perspectives and experiences from low-and middle-

income countries


2020 Apr 15

Cadogan CA,

Hughes CM

On the frontline against COVID-19: Community pharmacists’

contribution during a public health crisis


2020 Mar 31;S1551-

7411(20)30292-8

Alderman C. On the Pharmacy Radar: COViD-19 and Older People Sr Care Pharm.

2020;35(5):190-194.

Green TC,

Bratberg J,

Finnell DS.

Opioid use disorder and the COVID 19 pandemic: A call to sustain

regulatory easements and further expand access to treatment

Subst Abus.

2020;41(2):147-149.

Ha DR, et al. Outpatient hydroxychloroquine prescribing at a large academic

health system during the COVID-19 pandemic

Infect Control Hosp

Epidemiol. 2020 May 15



https://doi.org/10.1101/2020.06.30.20143859



Bahlol M,

Deweyc RS

Pandemic preparedness of community pharmacies for COVID-19 Res Social Adm Pharm.

2020 May 11

Bukhari N, et

al.

Pharmacists at the frontline beating the COVID-19 pandemic J Pharm Policy Pract.

2020;13(8)

Aruru M,

Truong HA,

Clark S.

Pharmacy Emergency Preparedness and Response (PEPR): a

proposed framework for expanding pharmacy professionals' roles

and contributions to emergency preparedness and response during

the COVID-19 pandemic and beyond


2020 Apr 10

Alderman C. Pharmacy Services and the Novel Coronavirus Sr Care Pharm.

2020;35(4):146-147

Mukhatar S. Preparedness and proactive infection control measures of Pakistan

during COVID-19 pandemic outbreak


2020 Apr 11;S1551-

7411(20)30373-9.

Stergachis A Preparing pharmacy for the surge of patients with COVID-19:

Lessons from China

J Am Pharm Assoc. 2020

Apr 10;S1544-

3191(20)30152-7.



https://doi.org/10.1101/2020.06.30.20143859



Zheng SQ, et al. Recommendations and guidance for providing pharmaceutical

care services during COVID-19 pandemic: A China perspective


2020 Mar 26;S1551-

7411(20)30284-9.

Bhat S, et al. Roles of Clinical Pharmacists in Caring for Patients with

Inflammatory Bowel Disease during COVID-19

Gastroenterology. 2020

May 13

Gross AE. Roles of the clinical pharmacist during the COVID-19 pandemic J Am Coll Clin Pharm.

2020 Mar 30

Al-Quteimat

OM, Amer AM.

SARS-CoV-2 outbreak: How can pharmacists help? Res Social Adm Pharm.

2020 Mar 26;S1551-

7411(20)30238-2.

Hasan SS, Kow

CS, Zaidi STR

Social distancing and the use of PPE by community pharmacy

personnel: Does evidence support these measures?


2020 May 1;S1551-

7411(20)30490-3.

Watson KE, et

al.

The evolution of pharmacists’ roles in disasters, from logistics to

assessing and prescribing

Can Pharm J (Ott).

2020;153(3):129-131.



https://doi.org/10.1101/2020.06.30.20143859



Vinci DL,

Polidori C,

Polidori P

The healthcare and pharmaceutical vulnerability emerging from

the new Coronavirus outbreak

Eur J Hosp Pharm.

2020;27(3):129-130.

Chan AHY, et

al.

Together we unite: the role of the Commonwealth in achieving

universal health coverage through pharmaceutical care amidst the

COVID-19 pandemic

J Pharm Policy Pract.

2020;13:13.

Ziegler A. Wenn keiner liefern kann Dtsch Apoth Ztg.

2020;32(10):1-7

Erku DA, et al. When fear and misinformation go viral: Pharmacists' role in

deterring medication misinformation during the 'infodemic'

surrounding COVID-19.


2020 May 1

Reviews, recommendations,

and-or guidelines

Mahmoudjafari

Z, et al.

American Society for Transplantation and Cellular Therapy

Pharmacy Special Interest Group Position Statement on Pharmacy

Practice Management and Clinical Management for COVID-19 in

Hematopoietic Cell Transplantation and Cellular Therapy Patients

in the United States

Biol Blood Marrow

Transplant. 2020

Jun;26(6):1043-1049.



https://doi.org/10.1101/2020.06.30.20143859



Li H, et al. Fighting Against COVID-19: Innovative Strategies for Clinical

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https://doi.org/10.1101/2020.06.30.20143859


Role of pharmacist during the COVID-19 pandemic: a scoping ...€¦ · 30/6/2020 · and reviewing the titles and abstracts, 62 articles were selected for full-text reading. In addition,

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