Assessment of Clinical Pharmacists' Assistance for Patients With Established Cardiovascular Diseases During the COVID-19 Pandemic: Insights From Southern India

Abstract

Objectives: We aimed to assess the clinical pharmacist-initiated telephone-based patient education and self-management support for patients with cardiovascular disease during the nationwide lockdown during COVID-19 pandemic.Methods: A prospective single-center telephone-based cross-sectional study was conducted among patients at the Cardiology Department and its speciality clinic at a 1,800-bed tertiary care hospital in Southern India. A validated 8-item clinical pharmacist aided on-call questionnaire with two Domains was administered during and after lockdown (15 March and 8 June 2020). Clinical pharmacist-provided educational assistance on self-management practices were in accordance with the guidelines of Indian Council of Medical Research (ICMR) and World Health Organization. Comparisons was performed using sign test and association of responses were analyzed using the Goodman and Kruskal's gamma test. All the tests were two-tailed, p < 0.05 was considered to be statistically significant.Results: Of the 1,080 patients, 907 consented with a response rate of (83.9%) and 574 (96.36%) patients were analyzed post-intervention. Majority of the patients were male (54.7%) and had Acute Coronary Syndrome [NSTEMI (42.10%), STEMI (33.92%) and Unstable Angina (9.86)]. The majority of subjects had at least two co-morbid conditions [(Type II Diabetes (48.33%), Hypertension (50.11%)] and were rural population (82.5%) as self-employed (43.1%) with a middle-class economy (31.6%). In the Domain-1 of checklist the awareness toward complications caused by COVID-19 in cardiovascular diseases (Z = −19.698, p = 0.000) and the importance of universal safety precautions enhanced after clinical pharmacist assistance [(Z = −8.603, p = 0.000) and (Z = −21.795, p = 0.000)]. In Domain-II of checklist there was a significant improvement in patients awareness toward fatal complications caused by COVID-19 (Z = −20.543, p = 0.000), maintenance of self-hygiene (Z = −19.287, p = 0.000), practice of universal safety precautions (Z = −16.912, p = 0.000) and self-isolation (Z = −19.545, p = 0.000). The results of our study population varied from baseline evaluation (41.7%, n = 907) to post-intervention (95%, n = 574) based on Literacy, employment status and economic status.Conclusions: The proactive role of clinical pharmacists in providing instructional services in collaboration with cardiologist during the pandemic circumstances increased patients understanding and mitigated infection exposure among patients, health care professionals and also assuring the continuity of care in patients with established cardiovascular diseases.

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…”

“…For some patients who had already receiving PC-eHealth interventions, a lack of adherence to the services could negatively impact on the outcome of eHealth service model. 28 For the PC-eHealth tool suppliers, some of the biggest challenges experienced during the COVID-19 pandemic included the unstable network connectivity, 21 49 inadequate interoperability of systems provided by different providers, 21 a lack of standardised platform and technical support within and across the care settings, 33 errors in digital systems, 43 cybersecurity considerations 27 42 and the lack of complete patient data for sharing. 22 To support the adoption of eHealth in PC for better management of patients during the pandemic, several enablers had been suggested.…”