With COVID-19 leaving the world in disarray, the role of the Community and Hospital Pharmacist has grown and adapted vastly to meet the growing physical and emotional needs of the global population, particularly within the healthcare systems of the United Kingdom and United States. By bridging the gap in mental health, providing additional services like COVID-19 vaccinations and screening and sign-posting patients to name only a few services, the Community Pharmacist has been able to serve an integral role of support to the nation, taking the strain off other healthcare professions and providing a key means of accessibility to clinical expertise and advice.
It is of utmost importance to note that pharmacists across the globe effortlessly continue to directly care for patients and take on frontline responsibilities amidst the COVID-19 pandemic, yet they are often overlooked when other healthcare professionals are proclaimed⁵. Community pharmacists have effectively reduced the strain on the healthcare system by triaging and screening patients, thus re-routing them away from hospitals⁵. In addition, they respond quickly in other ways to such public health issues, for instance by issuing guidance on professional practice, maintaining the medicines supply chain, handling drug shortages, facilitating the remote provision of pharmacy services, warning against self-medication, taking part in clinical trials and educating on the proper use of personal protective equipment (PPE)⁹. Pharmacists across different sectors have adopted rather different roles during this phase of enormous burden on the healthcare system and resource limitations⁵. Especially in low to middle income regions, community pharmacists provide essential services for free, including ensuring access to telehealth services, dispelling misconceptions and running minor ailments consultations⁵. Hospital pharmacists, on the other hand, evaluate COVID-19 protocols through their presence in ward rounds and antimicrobial stewardship schemes, and also by interpretation of test results and identifying new drug therapies⁵. We have learnt from ‘specialty pharmacists’ how to provide the optimal level of coordination and care to patients remotely, given that they have a long track record of treating patients holistically, and feedback has been remarkably positive from both patients and staff ⁶,¹⁷.
Within the UK, a sector of pharmacy which has seen some significant changes is the community pharmacy. Although the ‘pharmacy first’ message has been emphasised and continuously promoted for years, the COVID-19 crisis has led to more patients coming into the pharmacy to treat minor illnesses¹⁷. Additionally, for the majority of patients, the pharmacy acted as their first point of contact, with other healthcare providers, such as GPs being difficult to access, so community pharmacies were presented with more patients, with a wider range of problems¹². Despite the stress that coronavirus has inflicted on society, it has led to pharmacies being more interconnected with other healthcare providers, particularly GPs. Community pharmacists are not only responsible for offering advice and providing treatment, rather they have been adopting a ‘gatekeeper’ role, where they can now cater to a wider variety of patients and refer directly into secondary care¹⁷. Finally, alongside their other roles, community pharmacists have played a huge role in vaccination schemes, by promoting and offering COVID-19 vaccine doses alongside counselling to patients on how to overcome symptoms caused by these vaccines¹⁷. Overall, the pandemic has allowed societies to understand the significance of pharmacies, particularly community pharmacies, as it has given the opportunity for communities to interact more with their local pharmacies and build a new sense of rapport with them¹²,¹⁷.
As a matter of fact, roles of pharmacists vary between countries and states. As a further discussion on the changes of pharmacist roles impacted by the COVID-19 pandemic, we have decided to look into the USA as a comparison to the UK⁷. There are substantial differences of the roles of pharmacists in these two countries despite their similar healthcare responsibilities⁷. One such fundamental difference is that unlike in the UK, in many States (such) authority is shared between pharmacists, authorised doctors and in certain States, other authorised medical practitioners⁷. As a result, in the ‘physician dispensing States’, there is a seemingly competitive relationship between doctors and pharmacists for dispensing revenue⁴. Moreover, while the childhood vaccination programme can only be carried out in GP (family physicians) clinics in the UK, as of 2020, pharmacists from the entire USA have been allowed to provide childhood immunisations without prescription, compared with 28 out of 50 States in 2019¹⁷. This essentially means these vaccinations can be carried out in many other healthcare settings¹¹. This would be one of the essential changes to pharmacist roles in the USA due to the COVID-19 pandemic as such permission was given by the federal Department of Health and Human Services (HHS), using public health emergency powers in 2020¹¹. Similarly, pharmacists in the USA had been authorised by the HHS to provide FDA-approved COVID-19 tests for community testing¹, compared with pharmacies in the UK being centres for distribution of lateral flow test kits⁸. By all means we need to recognise the significant contributions of pharmacists in both countries during the pandemic both by providing accessible healthcare services to the general public and by administering COVID-19 vaccines¹³,².
Whilst life may be returning to a new normal, there is no denying that the COVID-19 pandemic has left its toll on the global population since its emergence in March 2019. Figures from the Office of National Statistics indicate that cases of depression doubled during the pandemic, with those most affected being the unemployed, women, ethnic minorities, the LGBTQ community and the elderly¹⁴,¹⁵. Whilst recent studies have shown an increase in resilience and coping mechanisms since the third lockdown, some groups have seen deteriorations and sustained distress. With the community pharmacist having the most access to the general public than any other healthcare professional, they have played a large role in facilitating the gap in mental health services to help the public process the consequences of their isolation, grief and economic status¹⁴. One of the ways in which this is currently being targeted is through increased vigilance and rapport with the public to identify early signs of mental health issues such as social withdrawal, mood changes and confusion or difficulty concentrating, which are common symptoms in mental health disorders such as depression, schizophrenia, generalised anxiety disorder and bipolar disorder¹⁴. Community pharmacists also increased monitoring of repeated OTC requests particularly that of analgesics, antihistamines or herbal remedies like St John’s Wort, which indicate self-medicating to relieve pain and reduce anxiety respectively¹⁴,³. They also focused on their ability to empathise, refer and sign-post to the GP, specialist mental health services or local support groups, particularly when speaking to a patient who had recently been bereaved or was relapsing or experiencing the worsening of symptoms¹⁴.
The footprint left by pharmacists as a key part of the solution, providing essential healthcare services during the time when they were most needed, will not be forgotten. With the increase in recognition of the role of the Pharmacist during the pandemic and its aftermath, the trust for the pharmacist can only grow as individuals can begin to appreciate their unique clinical knowledge and accessibility to information, advice and services, whether it be COVID-19 related or not.
Authors: Alex Ho, Anika Chamba, Samia Hoque and Sara Bashiri
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