key: cord-0982930-73bes596
authors: Kassem, Amira B.; Ghoneim, Asser I.; Nounou, Mohamed I.; El‐Bassiouny, Noha A.
title: Community pharmacists’ needs, education, and readiness in facing COVID‐19: Actions & recommendations in Egypt
date: 2021-09-20
journal: Int J Clin Pract
DOI: 10.1111/ijcp.14762
sha: c6bee25f4942d12877e629c8e1be4ac99b731b11
doc_id: 982930
cord_uid: 73bes596

INTRODUCTION: Coronavirus disease 2019 (COVID‐19) outbreak is considered one of the most important public health crises all over the world and in Egypt. Community pharmacists represent the third largest health care professional group after physicians and nurses. Community pharmacists are expected to be fully prepared at the frontline of defending their community needs by limiting the spread of COVID‐19 via different pharmaceutical care services. AIM: This study aimed to evaluate the sources of knowledge and readiness of community pharmacists in facing COVID‐19 early outbreak in Egypt. METHODS: A descriptive cross‐sectional study was performed via a self‐administered online google form questionnaire during the early period from 14 April to 3 June 2020. The questionnaire focused on; evaluating education level, sources of information, and readiness of Egyptian community pharmacists in the COVID‐19 pandemic crisis. RESULTS: A total of 318 community pharmacists from Egypt participated in this questionnaire. About half of the surveyed pharmacists reported that they were frequently consulted and that their patients were seeking consultation regarding COVID‐19 management more than 10 times per day. More than half of the pharmacists reported using social media as a source of information and knew the right social distancing recommendations. Regarding protective measures, only a quarter of pharmacists disclosed the availability of personal protective equipment (PPE). Nevertheless, the majority of pharmacists significantly reported some initial lack of support either inform of recommendations or PPE supply. CONCLUSION: The study revealed the dependence of community pharmacists on social media as the main source of information and the lack of early awareness of evidence‐based practice resources. Community pharmacists were in need of more initial support to achieve better satisfaction, patient counselling and infection control. Corrective measures were promptly undertaken to support and satisfy the Egyptian community pharmacists’ initial awareness and readiness facing COVID‐19.

The study aimed to explore community pharmacists' sources of information in Egypt during the COVID-19 outbreak. In addition, to know how far precautionary measures were applied in community pharmacies and if the community pharmacists were in need of meaningful support from competent authorities. 

Data were analysed, processed and illustrated using IBM SPSS soft- 

A total of 318 community pharmacists from Egypt participated in this questionnaire. 251, 55 and 77 participants located in cities, towns and villages (65.8%, 14.43% and 19.68%), respectively ( Table 1 ). The highest responses were recorded from pharmacists aged from 23 to 30 (56.9%) followed by 31 to 40 (33.33%) and 41 to 50 (7.87%) with only seven pharmacists older than 50 years (2.2%). Female pharmacists' participation in this questionnaire was 86.2%.

When asked about the need for pharmacists' consultation to patients regarding COVID-19 management, 51%, 39%, 4% and 1% of the pharmacists reported that they either frequently, sometimes, rarely, and never consulted by patients, respectively. Also, 40.4% of pharmacists reported that patients were seeking consultation regarding COVID-19 management more than 10 times per day while 23.9% of pharmacists reported that they had never been requested for any consultation related to COVID-19. As reported by the questionnaire, 41.73%, 38.8% and 6.8% of participated community pharmacists were used social media, face to face patient's interaction and printed materials, respectively, to offer COVID-19 awareness.

However, 12.6% of participated pharmacists reported that they had never offered any awareness (Table 1 ).

In response to COVID-19 information resources used by community pharmacists, 58.01%, 19.16%, 13.12% and 8.14% of the pharmacists used social media, media like newspaper and television, WHO website, and the Egyptian ministry of health, respectively, while 1.57% of pharmacists reported not getting information at all ( Figure 1A ).

Concerning the frequency of information updates, 58.79%, 37.01% and 2.62% of pharmacists access information daily, weekly and monthly, respectively ( Figure 1B ).

When asked about the knowledge of community pharmacists regarding ethanol concentration, 97.11% of pharmacists reported that 70% ethanol concentration is an effective concentration ( Figure 1C) and 90.81% of pharmacists discouraged the use of methanol instead of ethanol ( Figure 1D ). Concerning cloth handling, 51.7% of pharmacists washed their clothes after each use daily, 21.52% of pharmacists wore their white lab coats in their pharmacies while 26.77% of pharmacists never altered their normal habits during the COVID-19 pandemic with respect to cleaning and cloth management ( Figure 1E ). Concerning the knowledge of face masks and gloves usage, 55.12% of pharmacists wore their face mask all the time in their pharmacies, 26.77% of pharmacists wore face masks during contact only, while 18.11% did not wear face masks at all ( Figure 1F ). 63.78% and 19.95% of the pharmacists wore gloves either all the time or during contact, respectively, while 16.27% of pharmacists did not use gloves ( Figure 1G ). 16.01%, 9.19%, 14.44%, 17.59%, and 26.51% of pharmacists who used gloves reported the changing of it per patient, hour, two hours, four hours or day, respectively, although 16.27% of pharmacists did not use gloves in their daily practice ( Figure 1H ). Concerning the detergent used 90.29% of the pharmacists used diluted Clorox ® to clean the surfaces in their pharmacies ( Figure 1I ).

For proper social distancing community pharmacists' knowledge, 58.53%, 5.7%, 2.3%, and 0.52% of the surveyed pharmacies suggested 2, 4, 6-m and less than 1 m, respectively, while 32.81% reported that they did not know the proper social distance to combat COVID-19 ( Figure 1J ).

Concerning the community pharmacists' knowledge of using Ibuprofen as a non-steroidal anti-inflammatory in COVID-19 patients, 77.43% of surveyed pharmacists discouraged the use of Ibuprofen ( Figure 1K ). Furthermore, 84.25% of the surveyed pharmacists reported the ineffectiveness of vaccines such as BCG or seasonal influenza vaccines in COVID-19 protection ( Figure 1L ). Figure 1M ). 14.44% of surveyed pharmacists dispensed unreported prophylactic therapy for COVID-19 ( Figure 1N ). 72.18% of surveyed pharmacists communicated proper questions to their patients ( Figure 1O ). Finally concerning community pharmacists' recommendations regarding dealing with the suspicious COVID-19 cases, 23.36%, 71.39% and 5.25% of surveyed pharmacists suggested calling hotlines, 14 days home quarantine, and immediate hospitalisation, respectively ( Figure 1P ). (Figure 2A) . 75.85%

of surveyed pharmacists reported a complete lack of counter shield in their retail sites ( Figure 2B ). For pharmacists' adopted strategies to combat the COVID-19 pandemic spread, 35.43%, 26.25%, 19.95% and 9.97% of pharmacists adopted daily sanitisation, decreased labour, home delivery and social distancing, respectively. 8.4%

of pharmacists adopted no new policies in response to COVID-19

( Figure 2C ).

94.5% of surveyed pharmacists significantly reported that there were no meaningful support provided from competent authorities like the government, Ministry of Health and pharmacy syndicate either in the form of information, regulations or PPE supplies ( Figure 2D ). The study revealed a lack of evidence-based resources among 

Clorox. By asking about proper social distance about 58% of participants had correct answers while the rest had either wrong or did not know. More than 75% of community pharmacists did not support the usage of Ibuprofen, although there was no supporting evidence.

Neither WHO nor the FDA declares withholding ibuprofen in patients with COVID-19. 14, 15 Finally, the study assessed the extent of infection control mea- 

The study was done via an online survey which leads to the collection of data only from pharmacists who were interesting in social media. Such sampling technique leads to selection bias and affecting the validity of our study as the other pharmacists who did not interest in social media lost the chance of participation. This may be explained by the relatively young age of the study participants as elderly pharmacists may either not interesting or unable to use social media. In addition, the study cannot be generalized to all Egyptian community pharmacists, it is mostly covering the west regions in Egypt. The study was done at the beginning of the crisis, so further studies are recommended.

The study revealed the dependence of community pharmacists on social media as the main source of information. The community pharmacists should be provided with evidence-based knowledge regarding infection control measures and how to apply them in their pharmacies. In addition, the community pharmacists were in need of meaningful support from competent authorities to achieve the best health care services during the COVID-19 crisis.

The authors declare that this work complies with the ethical stand- . Participation in the study is voluntary. The submission of the answered questionnaire was considered as consent to participate in the study.

All authors declare that they have no conflict of interest.

All data generated or analysed during this study are included in this published article will be available upon request.

Amira B. Kassem https://orcid.org/0000-0003-4195-6036

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