key: cord-0724743-14exeaud
authors: Dawoud, Dalia; Chen, Aleda M.H.; Rossing, Charlotte Verner; Garcia-Cardenas, Victoria; Law, Anandi V.; Aslani, Parisa; Bates, Ian; Babar, Zaheer-Ud-Din; Desselle, Shane
title: Pharmacy practice research priorities during the COVID-19 pandemic: Recommendations of a panel of experts convened by FIP Pharmacy Practice Research Special Interest Group
date: 2020-08-26
journal: Res Social Adm Pharm
DOI: 10.1016/j.sapharm.2020.08.020
sha: 15ba82529f04993af5b22c761caae44c237df128
doc_id: 724743
cord_uid: 14exeaud

Across the globe, pharmacists on the frontline continue to fight COVID-19 and its continuously evolving physical, mental, and economic consequences armed by their knowledge, professionalism, and dedication. Their need for credible scientific evidence to inform their practice has never been more urgent. Despite the exponentially increasing number of publications since the start of the pandemic, questions remain unanswered, and more are created, than have been resolved by the increasing number of publications. A panel of leading journal editors was convened by the International Pharmaceutical Federation (FIP) Pharmacy Practice Research Special Interest Group to discuss the current status of COVID-19 related research, provide their recommendations, and identify focal points for pharmacy practice, social pharmacy, and education research moving forward. Key priorities identified spanned a wide range of topics, reflecting the need for good quality research to inform practice and education. The panel insisted that a foundation in theory and use of rigorous methods should continue forming the basis of inquiry and its resultant papers, regardless of topic area. From assessing the clinical and cost effectiveness of COVID-19 therapies and vaccines to assessing different models of pharmaceutical services and education delivery, these priorities will ensure that our practice is informed by the best quality scientific evidence at this very challenging time.

Information overload might be as problematic as ever during the current pandemic. Since the beginning of 2020, there has been an exponential growth in the volume of COVID-19 related publications, from clinical trials to research papers to commentaries and opinion pieces. 1 The rate at which articles are being published has made it an insurmountable task to keep abreast of the new information. 2 Yet, it is debatable as to whether or not this rapid increase in publications has been borne from quality research. 3 In fact, a recent analysis by Girolamo and Reynders (2020) indicated that much of the research has not led to new knowledge. 3 Pharmacists desire and need evidence to inform practice, and without credible and scientifically sound research studies, partly due to the rush to publish, there is not only a pandemic but an "infodemic". 3, 4 Hence, there is an urgent need to focus our research efforts to provide pharmacists and other healthcare providers with trusted information and evidence to inform patient care, pharmacy practice, and policy changes in the midst of COVID-19.

To address this challenge, methodologically robust, practitioner-led research is needed. It has been argued that "research" is not just for academics but is about authentic issues affecting the public, patients and pharmacists. 5 In many cases, professional organizations are collating information and providing resources for pharmacists in a variety of settings, with some that are more country-or apandemic. The difference is the ability to adapt research and test new models in light of the rapidly changing conditions in which we might be working. Thus, the "best" research continues to be that which is grounded in solid theory, rigorous methods and execution, with a well-constructed plan for streams of research that are cogent and complementary to one another. A well-planned research agenda based in theory and rooted in the literature is not "interrupted" by a sudden pandemic. Rather, the well-planned research agenda can be adapted toward and help meet the needs of an unexpected health crisis.

Most researchers in pharmacy practice were not conducting research on COVID-19, itself, until after it took a hold on an unsuspecting world populace. However, a glance at some of the initial, wellregarded, and highly cited papers published in Research in Social and Administrative Pharmacy (RSAP) and elsewhere reveals carefully executed research strategies and highly instructive commentary by researchers employing strong backbone and adaptation of their existing line of inquiry.

For example, Carico et al. provide insight into how pharmacists can apply the health belief model toward risk mitigation communication with patients. 15 They describe how communication grounded in a well-tested model can assist patients come to their own realization of the benefits of certain behaviors in addition to improving their knowledge of their susceptibility to, and danger posed by, COVID-19 not through paternalistic communication but through guiding the patient in self-discovery.

Research by Park et al. evinced that persons believing they were at less risk of contracting the disease were less likely to take part in risk mitigation strategies. 16 Lam discussed the quick mobilization of pharmacists in Macau in assisting other health professionals and serving on the proverbial front lines of care not only to treat patients but also to bolster mitigation strategies among a public with close geographic and familial ties with those at the original epicenter of the outbreak in Wuhan, China. 17 J o u r n a l P r e -p r o o f This was made possible due to protocols and interdisciplinary mitigation strategies for various type of emergencies that had already been in place and had been constructed through scientific evidence and best practice.

Zheng et al. prepared recommendations for pharmacists' practice in light of the pandemic, again, coming from near its origins in China. 18 While emphasizing the need for flexibility and adaptability in the face of the pandemic, the recommendations were rooted in evidence-based practice from solid research accounting for evolutions in pharmacy practice prior to the pandemic. This group of researchers have long been involved in research proffering roles for pharmacists to ensure patient safety and to advance the roles of clinical pharmacists even prior to the pandemic. 19 Cadogan and Hughes wrote of pharmacists' priorities and shifts in practice during the COVID-19

pandemic, but likewise, basing these on prior research on pharmacists' roles during unexpected emergencies, in a broader sense. 20 

To that end, research in pharmacy practice, while grounded in solid frameworks, must be multifaceted. It takes myriad system factors and people to optimize pharmacists' roles and patient outcomes. Thus, research must examine communication, operations, the interaction of health systems and economic factors, social support, patient and pharmacist/student education, and pharmacological and non-pharmacological aspects of therapy.

Basheti et al. evaluated pharmacists' readiness to engage in these various aspects of practice, including management of actual and potential medicinesshortages and weaknesses in the supply chain. 22 Karasneh evaluated the effect of media coverage of the pandemic on pharmacists' awareness and practice activities finding perhaps an undue influence by lay media, as opposed to relying solely on medical and professional resources. 23 Bahlol and Dewey found pharmacists' preparedness to practice amidst the pandemic to be adequate, but lacking in reporting frequency, mechanisms, and structure. 24 Indeed, if pharmacists are to be more integrated into public health systems, they must participate avidly in reporting of adverse events, triaging of patients, and informing health authorities of suspected health trends.

Dawoud described these and other activities that must be carried out by pharmacists, including adapting to technology, serving as vaccination hubs, and continuously gaining the public trust as critical means in which pharmacists can help society move forward post-lockdown and past the eventual ebb of the pandemic. 25 In a study employing the transtheoretical model of change, Hoti et al.

found pharmacists to outweigh pros versus cons and be in high levels of readiness to engage in risk mitigation strategies related to COVID-19. 26 Austin and Gregory studied resilience of pharmacists during the pandemic and found significant themes in ability to adapt to new technology, provision of personal protective equipment by the organization, and dedicated support staff. 27 As such, future research can leverage these findings to assume that pharmacists want to and are prepared to evolve practice, but might need to adapt to and advocate for change in systems that make this more a reality. Doing so must be placed within the J o u r n a l P r e -p r o o f context of improving patient outcomes, rather than improving pharmacists' "lot in life" for the sake of doing so.

Koster et al. demonstrated that emerging patient-centric pharmacist services have been deleteriously impacted by the pandemic and urged leaders to embrace tele-pharmacy even post-pandemic in a changed world, with all that new models of delivery entail. 28 Amariles et al. worked with researchers outside of pharmacy to project future numbers of cases, morbidity, and hospitalizations not merely to project numbers but for anticipation of their country's needs for pharmacists to continue delivering the necessary care to patients with and without COVID-19 and help ensure adequate supply chain of pharmacological therapies for weeks and even months into the future. 29 Forecasting can and should become an even greater priority for pharmacy practice researchers, and Asia, Europe, the Americas, and Africa during the pandemic. 37 The services provided by pharmacists ranged from essential and extended services, services developed to ensure continuity of care, and supply of essential medicines as well as the responsibilities in emergency care. In another paper, Elbeddini et al emphasized mental health issues impacting pharmacists during COVID-19, highlighting increasing workloads as well as workplace harassment. 38 The pandemic also has pharmacy educators contemplating adaptations and transitions to be made in educating future pharmacists, both in the content of the education and in the logistics, or manner in which it is to be provided. 

COVID-19 has brought a plethora of challenges, as well as opportunities for pharmacists to contribute. The community pharmacy sector is seeing increasing numbers of patients and the public.The current crisis has also seen an impact on medicines supply lines and health systems throughout the globe. This has been seen in high-, middle-and low-income countries. Access to and availability of essential medicines have been impacted, medicinesshortages were noted and there were reports on the use of substandard and falsified medicines. 39, 40 The quality and safety of pharmaceuticals are increasingly important when a large number of people are relying on them.

• As has always been the case, research conducted will be grounded in proven theory and rigorous methods. Undergraduate transition and how we can better support students and early career practitioners, who seem particularly anxious about learning environments and career development support in early years.

Despite the local to global havoc caused by COVID-19, pharmacy practice researchers have made a considerable effort to respond to this global emergency and their research output is starting to inform practice across the world.Reflecting on this output, we should plan carefully for the coming stage to ensure that the impact and value of this research are maximised. The recommendations made by this panel of experts goes some way towards informing pharmacy practice researchers' and research funders'priorities in the next phase of this battle against the most disruptive pandemic that we have witnessed for decades.

Scientists are drowning in COVID-19 papers. Can new tools keep them afloat?

Characteristics of scientific articles on COVID-19 published during the initial 3 months of the pandemic

The Need for an Evidence-Based Encyclopaedia in Health Services Research in Pharmacy

The Pharmaceutical Journal

American Society for Health Systems Pharmacists (ASHP)'s COVID-19 Resource Center

International Pharmaceutical Federation (FIP)COVID-19 Information Hub

Covid-19: Clinical Information and Treatment Guidelines

Covid-19: Frequently Asked Questions and Myth Busting

FIP's response to the COVID-19 pandemic: Global pharmacy rises to the challenge

Responding to the Pandemic Together

Community pharmacists and communication in the time of COVID-19: Applying the Health Belief Model. Res Social Adm Pharm

Optimistic bias and preventive behavioral engagement in the context of COVID-19. Res Social Adm Pharm

Community pharmacist in public health emergencies: Quick to action against the coronavirus 2019-nCOV outbreak. Res Social Adm Pharm

Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective

Fighting against COVID-19: Innovative strategies for clinical pharmacists. Res Social Adm Pharm

On the frontline against COVID-19: Community pharmacists' contribution during a public health crisis. Res Social Adm Pharm

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

Pharmacists' readiness to deal with the coronovirus pandemic: Assessing awareness and perception of roles. Res Social Adm Pharm

Media's effect on shaping knowledge, awareness risk perceptions and communication practices of pandemic COVID-19 among pharmacists. Res Social Adm Pharm

Pandemic preparedness of community pharmacists for COVID-19

Key measures for a successful COVID-19 lockdown exit strategy and the potential contribution of pharmacists

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COVID-19 in Columbia endpoints: Are we different, like Europe? Res Social Adm Pharm

Department of Health & Human Services. HHS Expands Access to Childhood Vaccines during COVID-19 Pandemic

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

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Cannabidiol as prophylaxis for SARS-CoV-2 and COVID-19: Unfounded claims versus potential risks of medications during the pandemic. Res Social Adm Pharm

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