key: cord-0941183-1uen018t authors: Wang, Dongyuan; Liu, Yihui; Zeng, Fang; Shi, Chen; Cheng, Fang; Han, Yong; Zhang, Yu title: Evaluation of the role and usefulness of clinical pharmacists at the Fangcang Hospital during COVID‐19 outbreak date: 2021-05-13 journal: Int J Clin Pract DOI: 10.1111/ijcp.14271 sha: 23ba755ce0ab9d48f3e52c8c6ee99d23bc3effde doc_id: 941183 cord_uid: 1uen018t BACKGROUND: Fangcang Hospitals (cabin hospitals) played a key role in isolation and control of the infection sources during COVID‐19 epidemic. Many patients at Fangcang Hospitals had complications or mental stress. As the doctors, nurses and paramedics presented in the emergency, there was a growing demand for clinical pharmacists to provide pharmaceutical care for the affected patients with chronic diseases via telemedicine. OBJECTIVE: This study was a retrospective study to evaluate the usefulness of clinical prevention and control measures of clinical pharmacists at Jianghan Fangcang Hospital. Besides, this study proposed innovative strategies for developing pharmacy services to ensure the medication compliance, accuracy and cure rates under the epidemic. METHODS: A total of 374 patients filled in the questionnaires and 349 patients were enrolled in this study. Patients who refused to receive pharmaceutical care were not included in this study. The pharmaceutical care included medication education via broadcast station, medication reconciliation, optimisation of drug use, monitor of adverse drug events and psychological comfort via WeChat one‐to‐one service. The data were collected from patients’ interviews and the questionnaires of inpatients and discharged patients. RESULTS: In Jianghan Fangcang Hospital, many patients had complications with hypertension (12.9%), hyperlipidaemia (9.2%), thyroid disease (8.9%), diabetes (7.2%), heart disease (3.4%), nephropathy (1.7%), cancer (1.1%) and other diseases (12.6%). After 35 days’ pharmacy service, about 200 different questions had been solved by our clinical pharmacists, including drug usage (65.38%), medication reconciliation (55.13%), drug precautions (23.1%), adverse drug reactions (35.9%) and psychological counselling (32.05%). Most patients were satisfied with clinical pharmacist service (66.7% great, 18.0% good). CONCLUSION: The results of the retrospective study indicated that clinical pharmacist can effectively reduce and prevent drug‐related, life‐related and COVID‐19‐related problems for COVID‐19 patients, which is important for the disease recovery. This study also demonstrated that clinical pharmacist played a key role for patients’ healthcare during the pandemic. In December, 2019, Wuhan city, the capital of Hubei province in China, became the centre of an outbreak of COVID-19 of unknown cause. 1 Since then, COVID-19 has spread quickly across China and all over the world. 2 On March 11, the World Health Organisation (WHO) has declared the coronavirus a global pandemic. 3 As of June 24, 2020, SARS-CoV-2 has caused 9,239,536 infections and 472,755 deaths worldwide, causing a great threat to global health. 4 The spectrum of COVID-19 ranges from mild to severe and even death. [5] [6] [7] Up to now, more than 80% of the confirmed cases of COVID-19 are mild or common illness. [8] [9] [10] Currently there are no specific antiviral treatment for COVID-19. [8] [9] [10] Since the SARS-CoV-2 is highly infectious, in order to control the spread of the epidemic, Fangcang Hospitals were quickly established for the treatment of patients with mild and moderate COVID-19, which solved the problem of insufficient beds in a short period of time. 11 Until Feb.24th, 2020, there have been 16 Fangcang Hospitals established for more than 12,000 patients with mild and common COVID-19 in China. Over 1 month, most patients were cured and discharged, and only a few patients were transferred to designated hospitals for further treatment because of exacerbations. 12 As a new major public health facility, Fangcang Hospital had large space, multiple beds and possessed multiple functions, including emergency treatment, clinical examination and centralised management. 11, 12 As a requisite functional module of the Fangcang Hospital, the Fangcang pharmacy also played an important role in ensuring the supply and safety of therapeutic drugs for the COVID-19 patients 13 . Thanks for your kind reminding. We have answered this question herein and on the submission form, read as "Due to the high demand of medication consultation for patients, and the non-contact circumstance of Fangcang hospitals, we created a novel work mode for remote pharmaceutical care for 349 patients. This study concluded our work experiences in detail, and also evaluated the role and usefulness of clinical pharmacists at Jianghan Fangcang Hospital. To our knowledge, this kind of study had never been reported". A retrospective study was performed on the patients who were diagnosed with COVID-19 and received pharmaceutical care services at the Jianghan Fangcang Hospital, from February 5th, 2020 to March 10th, 2020. A total of 374 patients filled in the questionnaires and 349 patients were enrolled in this study. Patients who refused to receive pharmaceutical care were not included in this study. Pharmacists played key roles in drug supplies and clinical pharma- Clinical pharmacist team explored the online pharmaceutical care service mode according to the special conditions of the Fangcang Hospitals including telehealth counselling, multimedia health education and no-contact services mainly through WeChat, so as to en- Each item was independently created by the clinical pharmacists taking into consideration of usual pharmaceutical care. The survey included patient basic information, initial symptoms of COVID-19, patient's mental state, comorbidities, the medications including antivirals, antibiotics and other drugs, adverse drug reactions etc as shown in Table 1 . The questionnaire was administered to the patients before they received clinical pharmacist online service. Patients refused to service were excluded from this study. Between February 5th and March 10th 2020, the discharged patients' questionnaire was administered to 78 patients who received pharmaceutical care service at the Jianghan Fangcang Hospital as shown in Table 2 . The survey included the days for antiviral and antibiotic therapy, the usefulness of pharmacist care service on patients' rational medication and mental state, the satisfaction with clinical pharmacist service. Patients who did not receive pharmacist service or unwilling to fill in the questionnaire were excluded. Table 3 . Thus, it was of great significance for clinical pharmacist to provide medication reconciliation and other pharmaceutical care for the patients in Fangcang Hospital to improve medication compliance, accuracy and cure rates. TA B L E 1 Self-reported questionnaire of inpatients at Jianghan Fangcang Hospital Table 4 . Pharmacists should pay close attention to drug reconciliation and optimisation for these patients. Because of the lack of antiviral drugs for COVID-19, many patients took more than one antivirals or antibiotics with the same function overtime, which not only failed to achieve the therapeutic curative efficacy, but also caused a variety of adverse drug reactions. Besides, the drugs for patients' comorbidities may have interactions with antivirals or antibiotics, which may lead to great risks for COVID-19 patients. The ingredients of Traditional Chinese Medicine are complicated which may have antagonistic effect or synergistic effect with western medicine. 14 Many studies have reported that some herbs could influence the activity of specific metabolising enzymes such as cytochrome P450 enzymes or transporters such as ABCB1, ATP-binding cassette, subfamily B member 1, which indeed affect western drug metabolism and deposition and cause various adverse drug reaction. 14 Therefore, drug-related problems need to be paid great attention for clinical pharmacist. Many patients (61.9%) reported that they had adverse drug reactions, including diarrhoea (27.5%), nausea (27.2%), fatigue (24.4%), insomnia (16%), vomiting (11.7%), itchy skin (10.9%), constipation (5.2%), difficulty urinating (4.6%) and other adverse drug reactions (6.9%) as shown in Table 5 . As some adverse drug reactions are similar to the symptoms of COVID-19, clinical pharmacists needed to help patients to understand the concept of adverse drug reactions appropriately, and know how to distinguish minor side effects and severe drug reactions that needs medical intervention using the causality assessment tool of Naranjo Adverse Reaction Probability In recent decades, clinical pharmacists have provided kinds of pharmaceutical care for patients with different diseases. 16 Patients are usually significantly stressed by the big public health emergencies such as SARS. 11 Because of the concern and fear of the COVID-19 epidemic, many patients suffered from severe psychological burden. Before we initiated our pharmaceutical care, we had a preliminary understanding of the patient's psychological status. We found that 59.0% patients had insomnia, 42.3% patients were anxious and 28.2% patients were afraid of disease, 20.5% depressed and 10.3% irritable. We paid more attention to their psychological conditions when communicated with these patients. We also helped the patients to understand the COVID-19 pandemic situation properly and encouraged them to combat with COVID-19 from positive perspectives. Besides, we enhanced the visit frequency to the patients and recorded their emotional changes every day. After 35 days' service, we found our service had positive effect on their mental stress (16.7% great, 43.6% good, 26.9% fair), as shown in Table 7 . In order to evaluate the pharmaceutical care provided by clinical pharmacists, we designed a questionnaire for discharged patients. Many patients joined the pharmaceutical service group on admission, but unwilling to participate in the group after they recovered from hospital, partly because they concerned about the leakage of personal information or the disgust with questionnaire research. Thus, only 78 patients voluntarily completed the questionnaire. According to the survey results, shown in Table 7 , 48.7% patients communicated with the clinical pharmacist at least once a day, 28.2% patients communicate with the clinical pharmacist every 2-3 days. Through 35 days' services, the recognition of clinical pharmacist was greatly improved, from 25.6% to 87.2%, as shown in Table 7 . Most patients were satisfied with clinical pharmacist service (66.7% great, 18.0% good), and they thought pharmaceutical care provided The knowledgement of clinical pharmacists before servicePlease consider changing the word "knowledgement" here and subsequent occurrences. Because of the specificity of the COVID-19 epidemic, most of the patients joined in the pharmaceutical service group at the beginning of treatment, but some of participants were disgusted with the research questionnaire, or unwilling to participate in the research after they recovered from hospitals or transferred to the designated hospital when they got worse. Some of this kind of patients usually had simple or little medication problems and did not continue the service. However, the related data (n = 78) we collected were from the patients we followed up closely and received pharmaceutical care for a long time, thus could somehow reflect the real quality and satisfaction with our pharmaceutical services. All these data indicated that our online mode of novel pharmaceutical care service for patients at Fangcang Hospital was safe, effective and acceptable to COVID-19 patients. Some advices are also provided herein: (1) Online pharmaceutical care service mode should be established not only to COVID-19 patients but also to the general population as necessary; (2) Taken on heavy responsibility of drug safety guardians, pharmaceutical servicer and drug supplier, the clinical pharmacists in preventing the spread of COVID-19 should be strengthened. We performed pharmaceutical care for patients with mild or moderate COVID-19 at Jianghan Fangcang Hospital. A retrospective study was followed to evaluate the usefulness of Clinical pharmacists at This study protocol was approved by the Institutional Review Board of Union Hospital, Tongji Medical College of Huazhong University of Science and Technology (IRB Number: 104). This retrospective study was merely the routine service put in place and data were gathered from existing documents based on routine work. Personal information was protected in the aggregated data. The research reported in this publication was supported by National Chen Shi helped for the revision of the article. The authors have declared no conflict of interest. All data used during the study are available from the corresponding author by request. Yu Zhang https://orcid.org/0000-0003-3630-9002 Clinical features of patients infected with 2019 novel coronavirus in Wuhan COVID-19, a worldwide public health emergency WHO. 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