key: cord-281298-qheq9lc8 authors: Merks, Piotr; Jakubowska, Marta; Drelich, Ewelina; Świeczkowski, Damian; Bogusz, Joanna; Bilmin, Krzysztof; Sola, Katarina Fehir; May, Andreas; Majchrowska, Anita; Koziol, Mark; Pawlikowski, Jakub; Jaguszewski, Miłosz; Vaillancourt, Regis title: The legal extension of the role of pharmacists in light of the COVID-19 global pandemic date: 2020-06-12 journal: Res Social Adm Pharm DOI: 10.1016/j.sapharm.2020.05.033 sha: doc_id: 281298 cord_uid: qheq9lc8 BACKGROUND: The COVID-19 epidemic has affected every area of life. The greatest challenge has been to adapt the functioning of the health service to prevent the spread of the epidemic and to help infected patients. This has required the involvement of not only doctors and nurses, but also pharmacists. In the face of this pandemic, governments in many countries have granted pharmacists greater authority. OBJECTIVES: The purpose of this paper is to review the legal extension of the role of pharmacists in light of the COVID-19 pandemic. The review considers recent changes in European countries, Canada, and the United States. METHODS: A literature review was performed to summarise knowledge about the extension of the role of pharmacists during the pandemic period. Key articles were retrieved mainly from PubMed and Google Scholar, using the terms “COVID‐19”, “2019‐nCoV”, “coronavirus”, and “pandemic” in combination with “pharmacist” as keywords for our search. We included scientific publications from February 1, 2019 to May 15, 2020. RESULTS: Pharmacists have been given numerous opportunities so that they can actively join in the fight against the virus. Some of the novel legal extensions aimed at aiding overloaded healthcare systems are as follows: authorisation to prepare hand and surface disinfectants, eligibility to renew chronic treatment prescriptions, as well as filling pro auctore and pro familia prescriptions by pharmacists, performing COVID-19, influenza, and Group A Streptococcus screening tests, and vaccine administration. Moreover, many countries have facilitated Internet services, such as virtual medical consultations, e-prescriptions, and home drug delivery – to promote social distancing among patients. To mitigate drug shortages, the following strategies have been implemented: alternative sourcing, strength, generic, or therapeutic substitution, and preparing compounded formulations at the pharmacy. CONCLUSIONS: Novel legal extensions have allowed exploitation of the full potential ofpharmacists worldwide, aiding the limited resources of overloaded healthcare systems. Pharmaceutical care is focused on the patient pharmacy practice, with the following 31 aims: to protect public health through healthy lifestyle promotion, prevention of diseases, as 32 well as assessment, initiation, and supervision of the proper course of pharmacotherapy in close 33 cooperation with the patient and, if necessary, with other healthcare professionals. In addition, 34 pharmaceutical care aims to ensure the safe and rational use of drugs to optimise the patient's 35 health-related quality of life, achieve positive clinical outcomes, and reduce treatment costs. 1 Over the past four decades, the role of the pharmacist has evolved from that of medicine 37 supplier towards that of a provider of services and information, and finally -to provider of 38 patient care by actively participating in the treatment process. Increasingly, the pharmacist's 39 task is to ensure that a patient's drug therapy is appropriately indicated, the most effective 40 available, the safest possible, and convenient for the patient. By taking direct responsibility for 41 an individual patient's medicine-related needs, pharmacists can make a unique contribution to 42 the outcome of drug therapy. The important role of pharmacies, which form an integral part of 43 the healthcare system, should be emphasised in the daily delivery of medicines, therapeutics, vaccines, and key health services to the public. It is well known that pharmacists are among the most accessible healthcare professionals; in many cases pharmacy staff are available 24 hours a 46 day. The role of pharmacies in a crisis, such as the current pandemic, is of crucial importance because they are often the first and the last point of contact with the health care system for 48 patients who need reliable information and advice. Pharmacists have already confirmed their 49 important role in emergencies, including during the previous pandemics of H1N1 influenza and 50 SARS. [2] [3] [4] Pharmacists play an important role in patient care during a pandemic both in 51 community pharmacies 5, 6 and in the hospital setting. 7 Although the main focus of healthcare 52 services is to respond to COVID-19, people still have other non-COVID-19-related symptoms 53 and conditions that require professional attention. 8 During a time of pandemic pharmacists 54 should concentrate not only on reducing the possibility of virus spread but also on patients' 55 daily needs related to taking medicines. Also, patients requiring special attention, such as after 56 haematopoietic cell transplantation or during cell therapy, can benefit from the involvement of 57 pharmacists in their therapeutic process during the COVID-19 pandemic. 9 The special needs of community pharmacy services during the COVID-19 pandemic should • providing psychological support. Pharmacists should pay attention to patients' 78 emotional and psychological conditions and identify patients with excessive anxiety, 79 concern, or fear; • providing factual and reliable information on the diseases and associated symptoms, e.g. Actions Austria · Implementation of e-prescriptions in Austrian pharmacies. · Major relief concerning the prescribing of narcotics and substitution patients. In March the Federal Ministry of Health created some relief in this area for the duration of the coronavirus crisis. For example, regarding dispensing rules for opioid substitution treatmentpharmacists can dispense larger quantities so the patient does not have to come to the pharmacy every day. 11 Belgium · Permission to denature alcohol by Belgian pharmacists. 12 · Granting exclusive authorisation for pharmacies to sell certain medical devices, individual protective equipment, and biocides, including hydroalcoholic gels and masks, with the following restrictions: -the government reserves the right to request the stocks of all the above-mentioned products at any time to organise possible better distribution between pharmacies. -the delivery of those products to private individuals in the retail trade is subjected to the prescription of a professional care provider, which includes pharmacists. -pharmacists can decide in good conscience who is the priority target group for the distribution of these devices (e.g. family members of an infected person, a patient with immunosuppression or under immunosuppressive treatment, etc.). 13 Canada · Authorisation of pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (e.g. narcotics, controlled drugs, and benzodiazepines), including the following permissions for pharmacists: -to extend and renew prescriptions (for periods beyond the durations prescribed by law); -to transfer prescriptions to other pharmacists; -permit practitioners to verbally prescribe prescriptions with controlled substances; -to deliver controlled substances to patients (at their homes or an alternate location). · Exemption from the obligation to provide information to the doctor aimed at "extending, adjusting, or replacing a medication", unless a doctor requests it. · The prescribing system may use e-mails to communicate prescribing directions to continue providing patient care. 14-16 Croatia · Exception procedure for dispensing medicines in short supply (replacement or substitution). 11,17 · The Red Cross and Croatian Chamber work together to intensify home delivery of drugs to vulnerable people. Drug deliver pharmacist volunteer. · Dispensing haemophilia drugs for two months at once. 18 · Implementation of e-prescription of orthopaedic aids. Czech Republic · Permission to compound antiseptic solutions. 19 Finland · Permission to compound hand disinfectants by pharmacies. 20 France · Authorisation for pharmacies to prepare hydroalcoholic gels, following World Health Organisation (WHO) recommendations, if they are out of stock. 21 · Exceptional renewal of chronic treatment by community pharmacists. 22 · Launching a special code in pharmacies for victims of domestic violence. 23 Germany · Temporary authorisation for pharmacies to prepare hydroalcoholic gels in pharmacies, following WHO recommendations, if they are out of stock. 24 Italy · Decree for pharmacists to give oxygen to patients, also at home. 25 · Introduction of e-prescriptions. 26 · Medicine home delivery service to vulnerable people by Red Cross and Federfarma. 27 · Promoting the preparation of disinfectant products by pharmacies, also to counter speculative prices. 28 Netherlands · Implementing remote consultations with patients (video calling, telephone, e-mail) to ensure continuity of pharmaceutical care, using guidelines provided by The Royal Dutch Pharmacists Association 29 · Taking part in a domestic violence campaign launched specifically during the coronavirus period. Using code word 'mask 19', patients at the pharmacy can say that they are victims of domestic violence. 30 · Developing four preparation instructions for a liquid hand alcohol and a viscous gel: two based on ketone alcohol and two based on isopropyl alcohol, all intended for professional use. 31 Poland · Shorter period for transferring funds to pharmacies from the National Health Fund (at the latest the day after positive verification of the documents sent by the pharmacy). 32 · Permission for pharmacists to prepare ethanol antiseptic solutions for the skin. 30-33 · Patients can get reimbursable medical devices via courier. It is acceptable to receive it without signing appropriate forms by the patient (as is needed when getting reimbursable medical devices directly from the pharmacy). 34 · The possibility of issuing pharmaceutical prescriptions by pharmacists for themselves and some family members ("pro familia prescription") -also reimbursed -and the possibility of writing a pharmaceutical prescription for patients in the event of health endangerment, with 100% payment, with different limitations (for example, not only the smallest pack available at the moment in the pharmacy, but up to 180 days of therapy). · A maximum of three people can be in a pharmacy per cash desk (providing a distance of minimum 2 m). · Only patients aged over 65 years can stay in the pharmacy between 10:00 and 12:00 (except in emergency situations). · All patients in the pharmacy are obliged to wear disposable gloves. 31 Portugal · Extension of the emergency medicine delivery line to the whole country (this free line was only available, due to pilot testing, in the Bragança region and in Loures and Odivelas municipalities). The line, called SAFE, allows patients to know in which pharmacy the medicines they need are available. The pharmacy, after accepting and confirming the availability, is responsible for contacting the patient and defining the delivery and payment methods. With this system, there is a possibility to establish a connection, at a distance, between patients and pharmacies, maintaining the medicine dispensing service. 35 · Establishment of a new protocol for home delivery of medicines -a partnership Associação Nacional das Farmácias (ANF) with the Portuguese post office service, in which it helps pharmacies nationwide to deliver medicines to people's homes. 36 · Protocol for pharmacist screening tests -the ANF has established a protocol with a private company, specialised in laboratory tests, which has implemented drive-thru test sites in several locations in the country. Tests will be extended to anyone with at least one symptom compatible with COVID-19. 37 prescribing. This process is supported by e-health. In this context, it is worth recalling the 158 example of Poland, in which pharmacists' prescriptive authority has been expanded recently. Pharmacists were granted the right to prescribe drugs for themselves and their closest relatives, 160 and those prescriptions are reimbursed from public sources, in the same way as when a similar 161 prescription would be issued by a physician. In different cases, pharmacists can issue a 162 pharmaceutical prescription for patients in the event of a health emergency, not just in life-163 threatening cases, as it was before, but without reimbursement (full patient payment). Moreover, in terms of prescriptive authority, Canadian pharmacists are allowed to prescribe 165 some controlled medications under special circumstances. The different set of new responsibilities is associated with compounding antiseptics. Trade Union of Pharmacy Workers, Poland, Meriana C. Coopera 6B/10 Pharmacy of Bjelovar Employed Pharmacist in Europe (EPhEU) c/o Verband Angestellter Apotheker Österreichs (VAAÖ) Berufliche Interessenvertretung Pharmacy Defence Association, 69 Albion St, B1 3EA Birmingham Children's Hospital of Eastern Ontario, Centre hospitalier pour enfants de l'est de l'Ontario, 401 Smyth Road Ottawa Opportunities and Responsibilities in Pharmaceutical Care. Am 195 Pharmacy Practice in Times of Civil Crisis: The 197 Experience of SARS and the Blackout in Ontario Severe Acute Respiratory Syndrome (SARS): The 200 Pharmacist Role Pandemic H1N1 Influenza Virus: Academy Perspectives on Pharmacy's Critical Role in Treatment, Prevention SARS-CoV-2 Outbreak: How Can Pharmacists Help? Res 205 Community Pharmacists: On the Frontline Hospital Pharmacists' Pharmaceutical Care for 210 Hospitalized Patients With COVID-19: Recommendations and Guidance from Clinical 211 On the frontline against COVID-19: Community pharmacists' 214 contribution during a public health crisis Position Statement on Pharmacy Practice Management and Clinical Management for COVID-219 19 in Hematopoietic Cell Transplantation and Cellular Therapy Patients in the United States Expansion of community pharmacy activties in relation to COVID PGD provider launches video consultations to support social distancing Roles of the clinical pharmacist during the COVID 19 pandemic COVID-19: Times of Crisis Can Bring Out the Best in Pharmacy 366 COVID-19 Update: Pharmacy Meetings Cancelled, New Law Expands Florida Pharmacists' Roles. www.drugtopics.com/latest/covid-19-update-pharmacy-meetings-370 cancelled-new-law-expands-florida-pharmacists-roles Idaho's Broad Practice Laws Allow Pharmacists, Techs to More Quickly Respond to 373 Pharmaceutical Group of European Union -Groupement Pharmaceutique 376 de l'Union Europeenne (PGEU GPUE)