An emergency plan for management of COVID‐19 patients in rural areas

Abstract

Aims of the study To describe the experience of six hospitals in the management of COVID‐19 patients in rural areas through an assessment of proportions, types and clinical outcomes of remote clinical interventions. Methods This was a prospective observational study conducted in six Egyptian hospitals over a period five months. An emergency response was implemented in each hospital in order to connect clinical pharmacists with COVID‐19 patients living in rural areas. Pharmacists used phone calls and social media applications, such as WhatsApp ® to conduct two types of interventions; (a) Proactive interventions and (b) outcome‐based interventions. IBM SPSS V26 was used for data analysis. Results Of the 418 patients included, 351 (83.97%) recovered, 60 (14.35%) were hospitalised and 7 (1.67%) were deceased. Medication orders per patient, high‐alert medications per patient and prescribing errors per patient were 5.82, 1.45 and 0.74, respectively. Telepharmacy teams conducted 3318 phone calls, 2116 WhatsApp ® chats and 1128 interventions, of which 812 (71.92%) were process‐based and 316 (27.98%) were outcome‐based. Among these interventions, four significant determinants of improvement in clinical outcomes were found: substitution of a prescribed drug (Adjusted odds ratio [AOR] = 4.03; 95% confidence interval [CI], 2.54‐5.87), adding a drug to the prescription (AOR = 3.15; 95% CI, 1.87‐4.76), advice the patient to stop smoking (AOR = 3.53; 95% CI, 1.98‐5.17) and cessation of drug therapy (AOR = 3.11; 95% CI, 1.25‐4.55). The most common medications involved in drug‐related interventions were Hydroxychloroquine, Azithromycin and Paracetamol. Conclusion Our findings demonstrate significant impact of the remote pharmacist interventions on both medicines use and clinical outcomes of COVID‐19 patients in rural areas. Pharmacists in developing countries should be supported to implement remote clinical services to provide patients in rural places with optimal care.

Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services

“…After removing duplicates (n=795), and screening by the title and abstract (n=230) and full text (n=121), 43 articles were included in this review 20–62. Among the included studies were 25 observational studies (including 13 cross-sectional studies,36–39 43–48 54 59 60 5 case series,34 35 49–51 5 retrospective study,40 41 52 53 55 1 prospective study61 and 1 interview study42 and 18 descriptive studies 20–33 56–58 62. The general characteristics of the included studies are summarised in online supplemental table 1.…”

“…The general characteristics of the included studies are summarised in online supplemental table 1. The majority of the studies reported about the use of eHealth by hospital pharmacists,20 21 23 25 29–31 33–35 37–41 43 46–49 52–55 58 59 61 followed by community pharmacists 28 35 45 46 50 51 54 60 62. Patients with chronic diseases27 31 32 34 37 39 40 43 44 48 52 54 57 60–62 were the primary targets populations of PC-eHealth interventions, followed by patients with COVID-1926 34 42 46 49–51 58 and patients with cancer 27 31 37 40…”

“…The purpose of adopting eHealth, the eHealth tools used, the interventions provided by pharmacists with eHealth and the intervention output are illustrated in online supplemental table 2. Considering the lack of official definition or categorisation framework of eHealth applied to PC, the purposes of adopting eHealth in this study were informed by the current literature8 63–65 and thus categorised into: (1) tele-education (educating patients about how to take medicines and adverse drug effects, n=17)20 22 24 25 29 31–33 37–39 42 47 48 56 57 62; (2) tele-consultation (addressing patients’ enquiries about drug-related problems, n=28)20 21 23 25–28 30–33 35–38 44 45 49–51 53 56–62; (3) tele-monitoring (monitor the patients’ use of medications in real time, n=27)20 21 23 25–27 29–33 35 36 38 39 41 44–46 48–51 53–55 57; (4) tele-case-management (continuously manage the patient’s medication regimen according to the patient’s conditions, n=30)22 23 26 27 29 30 32–34 37–42 44 46 48–54 56–61 and (5) tele-mentoring (the use of eHealth by other healthcare workers to seek advice from pharmacists, n=19) 21 25 28 30 31 33 34 38–40 42–44 47 48 53 57 59 62. It is noteworthy that all but five studies22 24 46 52 56 reported the use of eHealth for multiple purposes.…”

“…Phone calls alone in the form of a hotline or as a combination with videoconference, social media and television, mobile applications, websites and/or wearable devices were mostly employed to enable PC-eHealth service mode in the included studies 20 23 25 27 32 35 36 39–43 45 49 50 55–57 59–62…”

Overview of COVID-19 Surveillance in Amuntai Selatan Public Health Center

“…Implementing hospital telepharmaceutical services reduces irrational medicines and improves clinical outcomes for COVID-19 patients in rural areas. 38 Vietnam develops for their rural areas a ‗Rapid Action Team' with the participation of all community stakeholders, including health workers (public and private health staff, retired health professionals), police, soldiers, teachers, community organizations, and communities. This grassroots health system mobilizes and prioritizes all its financial resources from the State budget and contributions from donors and non-governmental organizations to supply medical equipment and supplies.…”