Prospect of Tele-Pharmacists in Pandemic Situations: Bangladesh Perspective
- Short Communication
- J Health Care and Research. 2020 May 13;1(2):72-77
Mohiuddin AK1*
1Secretary and Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka, Bangladesh
Corresponding Author: Abdul Kader Mohiuddin
Address: Secretary and Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka 1215, Bangladesh; Tel: +8801711885101; E-mail: dr.m.nasirullah.trust@gmail.com
Received date: 08 April 2020; Accepted date: 30 April 2020; Published date: 13 May 2020
Citation: Mohiuddin AK. Prospect of Tele-Pharmacists in Pandemic Situations: Bangladesh Perspective. J Health Care and Research. 2020 May 13;1(2):72-77.
Copyright © 2020 Mohiuddin AK. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: COVID-19, Coronavirus, Tele-Pharmacists
Abstract
Currently, coronavirus COVID-19 has affected 209 countries around the world, killed more than 82,000, and infected more than 1.4 million, according to worldometer, April 08, 2020. Home-care is especially important in these situations because hospitals are not seemingly safe during pandemic outbreaks. Also, the chance to get out of the home during the lockdown period is limited. Telemedicine and telehealth technologies are especially effective during epidemic outbreaks when health authorities recommend implementing social distance systems. Telephone-based measures improve efficiency by linking appropriate information and feedback. In addition to increasing access to healthcare, telemedicine is a fruitful and proactive way to provide a variety of benefits to patients seeking healthcare; diagnose and monitor critical and chronic health conditions; improve healthcare quality and reduce costs.
Introduction
Bangladesh’s health care services are becoming unusually concentrated in a small fraction of costly critical health-demanding patients. A large part of these complex-patients suffers from multiple chronic diseases and are spending a lot of money. Tele-pharmacy includes patient counseling, medication review, and prescription review by a qualified pharmacist for the patients who are located at a far distance from the pharmacy. The most common way to use telemedicine is a responsive model, primarily physician-led with virtual visits stimulated by alerts using interactive services, which facilitates real-time interaction between the patient and provider [1]. It delivers resilience to services and enables pharmacists to work remotely, reducing the need for long journeys and increasing job satisfaction [2]. The rise of pharmacists in epidemic situations has become increasingly popular in developed countries such as the United States, Australia, Canada, and the United Kingdom.
According to information from recently published articles in several ongoing journals, books, newsletters, magazines, etc., the duties, authority, and responsibilities of pharmacists are completely different from doctors and nurses, although there are some similarities. Along with doctors, pharmacists can serve as frontline healthcare workers during epidemics. The profession is developed and highly praised in both developed and underdeveloped countries. Millions of professional pharmacists worldwide work in various organizations, and according to data from the International Pharmaceutical Federation (FIP), nearly 75% of them work inpatient care [3]. Even in the United States, the continued lacking of primary health providers and medical specialists has made it possible for pharmacists to care for ambulatory patients with chronic diseases in a variety of treatment services [4].
Pharmacy Education in Bangladesh
Pharmacy Education in many developing countries, including Bangladesh, is still limited to didactic learning that produces theoretically ‘skilled’ professionals with degrees. Manpower development for community pharmacies in Bangladesh is not systematically regulated and constitutes an important public health issue. Three levels of pharmacy education are currently offered in Bangladesh leading to a university degree, a diploma, or a certificate. Graduates with degrees work in the industry while those with diplomas work in hospitals [5]. Pharmacy is taught in about 100 public and private universities in Bangladesh and about 8000 pharmacy students graduate every year [6]. However, the graduates who pass out do not get employment easily due to their poor training, lack of in-depth knowledge of fundamental concepts and practical skills [7]. Consequently, skilled graduates leave for overseas where they find more prosperous jobs. Alam et.al, 2014 argued that Pharmacy Education can be able to contribute both public and private benefits if a realistic pattern is ensured on its operation [8].
Present State of Pandemic Situation Handling by Bangladeshi Hospitals
More than half of the 88 coronavirus cases detected in Bangladesh have been reported in the capital Dhaka. The virus hit a total of 11 out of the 64 districts in the country until 05.04.2020 after the first known cases were reported around a month ago, according to the government’s disease control agency IEDCR [9]. Many patients with fever, cold, and breathing problems – which are also COVID-19 symptoms – have gone untreated as the hospitals in Dhaka are sending them to the IEDCR for coronavirus test [10]. Many doctors are not providing services fearing the contagion and lab technicians are shunning workplaces halting medical tests, according to the patients.
In some cases, serious patients who are not affected by COVID-19, moved from one hospital to the other but could not receive treatment and finally died, the media reported. In another case, the doctor fled leaving the patient behind [1-14]. Doctors and other healthcare workers say they do not have adequate personal protective equipment and the health system cannot cope with the outbreak [15]. Police have locked down a total of 52 areas of Dhaka after Covid-19 positive patients were found in the localities [16]. Experts say elderly people infected with coronavirus need ICU to support the most. The number of older persons in the country is over 0.8 million [17]. The country’s entire public health system has less than 450 ICU beds, only 110 of which are outside the capital Dhaka [18]. The economic shutdown sparked by COVID-19 threatens millions of livelihoods in the country imminently.
Under Utilization of Hospital Pharmacy
The pharmacy profession is still lagging in developing countries as compared with developed countries in a way that the pharmacy professionals have never been considered as a part of the health care team neither by the community nor by the health care providers. Although hospital pharmacists are recognized for their importance as health care providers in many developed countries, in most developing countries it is still underutilized or underestimated [19-22]. Hospital pharmacy practice is just started in some private modern hospitals in Bangladesh which is inaccessible for the majority of peoples due to high patients cost of these hospitals [23]. Bangladesh is the seventh most populous country in the world and the population of the country is expected to be nearly double by 2050 [24].
According to World Bank data, Bangladesh has 8 hospital beds for every 10,000 people; by way of comparison, the US has 29 while China has 42 [18]. It has been found in Bangladesh that more than 80% of the population seeks care from untrained or poorly trained village doctors and drug shop retailers [25]. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. Licenses are provided to drug sellers by the Directorate General of Drug Administration when they have completed a grade C pharmacy degree (ie, 3 months course) to legally dispense drugs [26] but a grade A pharmacy degree holder, having a B.Pharm or PharmD degree are more equipped to handle these situations if trained properly. Knowledge and helpfulness of pharmacists were identified as two major determinants that could not only satisfy and but also promote a willingness to pay for the service [27]. They can individualize the medications and their dosing according to the needs of the patient, which can minimize the cost of care for the medication.
In Bangladesh, however, graduate pharmacists do not engage directly in-patient care. Here, pharmacies in hospitals are primarily run by non-clinically educated, diploma pharmacists [28]. If the hospital pharmacy is established, patient care, proper dispensing of medications, and other patient-oriented issues can be handled properly. By maintaining a hospital pharmacy quality control program, the health sector can be enriched.
Prospect of Pharmacists in Patient Management Service and Telehealth Care
At present, Hospital Pharmacy has created enormous job opportunities, where graduate pharmacists play a vital role in patient rearing, rehabilitation, and wellness. A professional pharmacist or a pharmacy apprentice at a clinic, hospital, and community care can determine what to do in a given disease situation if guided properly by another medical personnel. The country has a huge opportunity to recruit these pharmacists at Telehealth Care.
In each call, a pharmacist can provide both appropriate and quality information from the most recent medical systems. Studies show that the lack of proper medication management leads to higher healthcare costs, longer hospital stays, morbidity, and mortality. Further, it was reported that one in every five hospitalizations was related to post-discharge complications and about seventy percent were related to proper use of the drug.
In 2017, the World Health Organization committed to minimizing serious, avoidable drug-related harm over the next 5 years. Pharmacists’ interventions to prevent drug-related problems at three community hospitals in California saved approximately 0.8 million USD in a year [29]. The estimated annual cost of medication error-based illnesses and deaths worldwide was USD 500 billion due to non-compliance with the clinical intervention and quantities in 2016. Also, the authors estimate that more than 275,000 people die every year for the same reasons [30]. A pharmacist can use simple and non-medical terminology to set the goal for patients to understand the information as well as to fulfill the prescription by proper request. With chronic conditions such as cardiovascular and respiratory diseases, there is ample evidence of the effectiveness of the tele-pharmacist for remote monitoring, communication, and consultation [31]. In addition, psychotherapy can also be operated through telehealth as part of behavioral health [32]. The pharmacy-related needs of pandemic patients have similarities with the traditional patient population, but with a different emphasis [33].
For example, when providing consulting services to patients, instead of focusing on medications as usual, their queries relate primarily to the knowledge of medical prevention and basic details on COVID-19, such as mask selection and standard COVID-19 signs and symptoms, symptomatic treatment options, breathing difficulties or cough management in comorbid situations, reinforcing behaviors that limit the spread of the pandemic, including social distancing and remaining in the home whenever possible through phone calls/video conferencing [34,35]. Earlier, Student pharmacists served as an effective educational resource for patients regarding the H1N1 pandemic [36].
Conclusion
Overburdened by patient loads and the explosion of new drugs, physicians turned to pharmacists more and more for drug information, especially within institutional settings. They obtain medical and medication history, check medication errors including prescription, dispensing and administration errors, identify drug interactions, monitor ADR, suggest individualization of dosage regimen, provide patient counseling, etc. [37]. Among chronic disease patients, particularly those under quarantine, there is a greater challenge in the supply of drugs and compliance with medications, although the safety and effectiveness of care is still critical for these patients. Stronger data on the effectiveness of this area of pharmacy care, together with a critical assessment of its limitations, can raise awareness among the actors involved about its potential and could contribute to wider dissemination of tele-pharmacy services in the public interest [38].
In the end, it can be said that pharmacists can play a role in both medical aids and regulation. Similarly, in tele-healthcare, professional pharmacists can play an essential role that has not been recognized yet due to a lack of proper initiatives. We hope that policymakers of Bangladesh are aware of its potential and contribute to the wider promotion of tele-pharmacy services in the interest of the citizenry.
Acknowledgment
I’m thankful to Dr. Colin D. Rehm, Clinical Assistant Professor, Department of Epidemiology & Population Health, Alert Einstein College of Medicine, NY, USA for her precious time to review my literature and thoughtful suggestions. Also, I’m grateful to the seminar library of Faculty of Pharmacy, University of Dhaka, and BANSDOC Library, Bangladesh for providing me books, journal, and newsletters.
Conflict of Interest
The author declares that he has no competing interests.
References
[1] Kane-Gill SL, Niznik JD, Kellum JA, Culley CM, Boyce RD, Marcum ZA, He H, Perera S, Handler SM. Use of Telemedicine to Enhance Pharmacist Services in the Nursing Facility. Consult Pharm. 2017 Feb 1;32(2):93-98. [PMID: 28569660]
[2] Pike H. Web therapy: how pharmacists are leading the way on telehealth. The Pharmaceutical Journal; 2018.
[3] Bates I, John C, Seegobin P, Bruno A. An analysis of the global pharmacy workforce capacity trends from 2006 to 2012. Hum Resour Health. 2018 Jan 11;16(1):3. [PMID: 29325554]
[4] Goode JV, Owen J, Page A, Gatewood S. Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States. Pharmacy (Basel). 2019 Aug 4;7(3). pii: E106. [PMID: 31382690]
[5] Alam G, Shahjamal M, Al-Amin A, Azam M. State of Pharmacy Education in Bangladesh. Tropical Journal of Pharmaceutical Research. 2014;12(6):1106.
[6] Mazid MA, Rashid MA. Pharmacy Education and Career Opportunities for Pharmacists in Bangladesh. Bangladesh Pharmaceutical Journal. 2011;14(1):1-9.
[7] AK Mohiuddin. An A-Z Pharmaceutical Industry: Bangladesh Perspective. Asian J. Res. Pharm. Sci. 2019; 9(1):17-28.
[8] Alam GM, Al-Amin AQ. Role of Pharmacy Education in National Development of Bangladesh: A Scope for Public and Private Sectors. Indian Journal of Pharmaceutical Education and Research. 2014;48(4):11-21.
[9] Senior Correspondent. Coronavirus cases detected in 11 districts, more than half of them in Dhaka. bdnews24.com; 2020.
[10] Masum O. Dhaka hospitals turning away patients with fever, cold needing coronavirus tests. bdnews24.com; 2020.
[11] Staff Correspondent. Health minister vows to punish private hospitals for turning away patients. bdnews24.com; 2020.
[12] Islam Z, Mollah S. Admission to Hospitals: Patients left in quandary. The Daily Star; 2020.
[13] Akhter F. COVID-19 and healthcare denial. Newage Opinion; 2020.
[14] UNB. DU student ‘denied treatment by hospitals’ dies. The Financial Express/National; 2020.
[15] Chowdhury T. Poor Bangladeshis being turned away from hospitals. Al Jazeera America News/Bangladesh; 2020.
[16] Tribune Report. Police lock down 52 areas in Dhaka. DhakaTribune; 2020.
[17] Tajmim T. Bangladesh has only 29 ICU beds to fight coronavirus! The Business standard; 2020.
[18] Saleh A. In Bangladesh, COVID-19 threatens to cause a humanitarian crisis. World economic Forum; 2020.
[19] Azhar S, Hassali MA, Ibrahim MI, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health. 2009 Jul 13;7:54. [PMID: 19594916]
[20] Sakeena MHF, Bennett AA, McLachlan AJ. The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives. Pharmacy (Basel). 2019 Jun 5;7(2). pii: E54. [PMID: 31195755]
[21] Rayes IK, Hassali MA, Abduelkarem AR. The role of pharmacists in developing countries: The current scenario in the United Arab Emirates. Saudi Pharm J. 2015 Oct;23(5):470-74. [PMID: 26594111]
[22] Sakeena MHF, Bennett AA, McLachlan AJ. Enhancing pharmacists’ role in developing countries to overcome the challenge of antimicrobial resistance: a narrative review. Antimicrob Resist Infect Control. 2018 May 2;7:63. [PMID: 29744044]
[24] Saha S, Hossain MT. Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh. BMC Health Serv Res. 2017 Feb 13;17(1):136. [PMID: 28193274]
[25] Ahmed SM, Naher N, Hossain T, Rawal LB. Exploring the status of retail private drug shops in Bangladesh and action points for developing an accredited drug shop model: a facility based cross-sectional study. J Pharm Policy Pract. 2017 Jul 11;10:21. [PMID: 28702204]
[26] Chowdhury F, Sturm-Ramirez K, Mamun AA, Iuliano AD, Bhuiyan MU, Chisti MJ, Ahmed M, Haider S, Rahman M, Azziz-Baumgartner E. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh. Patient Prefer Adherence. 2017 Mar 6;11:479-86. [PMID: 28293104]
[27] AlShayban DM, Naqvi AA, Islam MA, Almaskeen M, Almulla A, Alali M, AlQaroos A, Raafat M, Iqbal MS, Haseeb A. Patient Satisfaction and Their Willingness to Pay for a Pharmacist Counseling Session in Hospital and Community Pharmacies in Saudi Healthcare Settings. Front Pharmacol. 2020 Mar 2;11:138. [PMID: 32194400]
[28] Saha T, Bhuiya RH, Masum ZU, Islam MR, Chowdhury JA. Hospital Pharmacy Management System and Future Development Approaches in Bangladeshi Hospital. Bangladesh Pharmaceutical Journal. 2018;20(2):180-87.
[29] Schneider PJ. Evaluating the impact of telepharmacy. Am J Health Syst Pharm. 2013 Dec 1;70(23):2130-35. [PMID: 24249763]
[30] Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep;52(9):829-37. [PMID: 29577766]
[31] Littauer SL, Dixon DL, Mishra VK, Sisson EM, Salgado TM. Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review. Pharm Pract (Granada). 2017 Oct-Dec;15(4):1134. [PMID: 29317927]
[32] Langarizadeh M, Tabatabaei MS, Tavakol K, Naghipour M, Rostami A, Moghbeli F. Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review. Acta Inform Med. 2017 Dec;25(4):240-46. [PMID: 29284913]
[33] Zheng SQ, Yang L, Zhou PX, Li HB, Liu F, Zhao RS. Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective. Res Social Adm Pharm. 2020 Mar 26. pii: S1551-7411(20)30284-9. [PMID: 32249102]
[34] Carico RR Jr, Sheppard J, Thomas CB. Community pharmacists and communication in the time of COVID-19: Applying the health belief model. Res Social Adm Pharm. 2020;S1551-7411(20)30293-X.
[35] Cadogan CA, Hughes CM. On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis. Res Social Adm Pharm. 2020 Mar 31. pii: S1551-7411(20)30292-8. [PMID: 32245691]
[36] Miller S, Patel N, Vadala T, Abrons J, Cerulli J. Defining the pharmacist role in the pandemic outbreak of novel H1N1 influenza. J Am Pharm Assoc (2003). 2012;52(6):763-67. [PMID: 23229962]
[37] Mohiuddin AK. Clinical Pharmacists in Chronic Care. Global Journal of Medical Research. 2019:1-60.
[38] Baldoni S, Amenta F, Ricci G. Telepharmacy Services: Present Status and Future Perspectives: A Review. Medicina (Kaunas). 2019 Jul 1;55(7). pii: E327. [PMID: 31266263]