In China, clinical pharmacy services started in 2005 after that the China Ministry of Health issued a series of documentations regarding clinical pharmacists. 1 Since then, a clinical pharmacist system has been established, and the clinical pharmacist has become an essential member of the multi‐disciplinary team providing pharmaceutical care to patients. Chinese clinical pharmacists provide education, medication review, adverse drug reaction (ADR) monitoring services for patients, and sometimes make medication and laboratory recommendations or provide medication consultation for other healthcare providers. 2 The respiratory illness due to SARS‐CoV‐2, termed COVID‐19, is now a worldwide pandemic. Chinese clinical pharmacists actively provide a variety of pharmacy services during the coronavirus pandemic, demonstrating the impact of the clinical pharmacist system. 3 , 4 In this editorial, we describe the roles of the Chinese clinical pharmacists during the COVID‐19 pandemic to share with the international pharmacy community.
1. DRAFTING HOSPITAL TREATMENT PROTOCOLS AND FORMULATING THE COVID‐19 DRUG FORMULARY
COVID‐19 is a newly discovered virus and there are currently no approved drug therapies. The China National Health Commission (NHC) has successively published COVID‐19 diagnostic and treatment guidelines, now in its seventh update. 5 Many of the recommended treatment drugs on the NHC guidelines are off‐label use. They are based on past experiences in the management of the SARS outbreak in China in 2003. To guide physicians and to ensure the safe and efficacious use of these drugs, clinical pharmacists in collaboration with physicians draft treatment protocols and are in charge of developing the COVID‐19 drug formulary at their hospitals. Clinical pharmacists collect evidence‐based drug information for the COVID‐19 formulary drugs concerning indications, dosing, ADRs, drug‐drug interactions, and other precautions. Often there are drug shortages, and pharmacists assist physicians in selecting alternative medicines and adjusting the drug formulary accordingly. With the rapid development of COVID‐19, new studies regarding drug therapy are published continuously. Clinical pharmacists are responsible for providing updates to treatment protocols, drug information resources, and formularies.
2. PROVIDING PHARMACEUTICAL CARE TO COVID‐19 PATIENTS
Providing pharmaceutical care is one of the main tasks of clinical pharmacy. During the pandemic, clinical pharmacists provide event‐driven pharmaceutical care services for COVID‐19 patients. The content of the services is based on the patient's case nature (close contact, suspected diagnosis, confirmed diagnosis) and disease severity (mild‐type/common‐type, critical type), as shown in Table 1. 6 , 7 , 8 Clinical pharmacists pay particular attention to the special patient populations—elderly, 9 pregnant, children, and patients with comorbidities. 10 , 11 Clinical pharmacists also closely monitor drugs/drug classes with more safety concerns, such as lopinavir/ritonavir, 12 ribavirin, 13 interferon, 14 tocilizumab, 15 glucocorticoids, 16 and immunomodulatory drugs. 17
TABLE 1.
Pharmaceutical care to COVID‐19 patients
| Pharmaceutical care activities | Close contact | Suspected diagnosis | Mild‐type/common‐type confirmed patients | Critical‐type confirmed patients a |
|---|---|---|---|---|
| Psychological counseling | √ | √ | √ | — |
| Patient education/counseling b | √ | √ | √ | — |
| Assist in the development of treatment plans | — | √ | √ | √ |
| Monitoring efficacy/ADR | — | √ | √ | √ |
| Medication reconciliation | — | √ | √ | — |
| Pharmacy clinical rounds | — | √ | √ | — |
| Medication review b | — | √ | √ | √ |
| MDT care | — | — | — | √ |
| Discharge counseling | √ | √ | √ | √ |
Abbreviations: ADR, adverse drug reaction; MDT, multi‐disciplinary team.
Minimize patient contact due to isolation.
Maybe provided virtually.
3. MONITORING ADVERSE DRUG REACTIONS AND CONDUCTING PHARMACOVIGILANCE
During the COVID‐19 pandemic prevention and control in China, some drugs were used off‐label or in the context of clinical trials. Due to a lack of clinical use experience and drug safety data, these drugs require close monitoring by clinical pharmacists, and adverse drug reactions need to be promptly documented and reported. At the same time, clinical pharmacists conduct pharmacovigilance research through data mining to provide a reference for the clinical use of drugs. 18 , 19
4. PROVIDING REMOTE INTERNET ACCESS CLINICAL PHARMACY SERVICES
In the daily work of the pharmacy department, there are risks of exposure in many aspects, such as drug dispensing and medication consultation. Internet, remote access services, can prevent and reduce the risk of cross‐infection, ensure the efficient and safe supply of drugs, and improve the efficiency and quality of pharmaceutical care services.
During the pandemic, for particular chronic disease states management, patients may book clinic appointments online and be evaluated by hospital clinic physicians virtually. Prescriptions can be electronically transmitted to hospital pharmacists for review and verification. Medications can then be picked up by patients at hospital outpatient pharmacies or home‐delivered to patients. Through community pharmaceutical care platforms, clinical pharmacists provide drug therapy monitoring, consultation/education to prevent and identify drug‐related problems. 20 The application of smart drug dispensing equipment (automatic vending machines, distribution robots) has also promoted contactless drug distribution services to clinic patients.
5. PROVIDING PUBLIC EDUCATION ON COVID‐19
Due to the risk of infection, traditional face‐to‐face public widespread science dissemination and education are restricted. However, clinical pharmacists promote pandemic‐related knowledge to the public through WeChat (the largest mobile social networking platform in China) and other online platforms, video/recording, and other communication mean. Clinical pharmacists educate the public and answer questions of public concern, such as COVID‐19 transmissions, disease prevention and control, and rational use of drugs. These public education activities improve the general public understanding of the pandemic, eliminate rumors, and stabilize the social order.
6. PARTICIPATING IN THE EVALUATION OF DRUGS USED IN CLINICAL TRIALS
In China, many clinical trials to evaluate the treatment of COVID‐19 have been conducted based on medical ethics principles, including the use of antiviral drugs, biological products, and proprietary Chinese medicines. As of April 18, 2020, there were 591 studies registered in the China Clinical Trials Registry (www.chictr.rg.cn) under the title of COVID‐19, including 299 interventional clinical trials. To assist these clinical trials, clinical pharmacists not only provide and prepare the experimental drugs but also evaluate the effectiveness and safety of relevant trial drugs from a pharmaceutical perspective. 21
7. PROVIDING PHARMACEUTICAL CARE IN THE USE OF TRADITIONAL CHINESE MEDICINE
Traditional Chinese medicine (TCM) has played an essential role in SARS and major historical epidemics in China. In COVID‐19, China NHC recommends applying TCM theories and using TCM drugs in the prevention and treatment of COVID‐19. Because TCM has its unique theoretical system, clinical pharmacists of Chinese medicine are required to provide individualized pharmaceutical care based on the uniqueness of the COVID‐19 patient, especially for patients on the combined western medications and TCM treatments. TCM clinical pharmacists play an active role in the review of TCM prescriptions, prepare TCM decoctions, TCM monitoring, patient education, science popularization, and clinical research. 21
Although clinical pharmacists have played an active role in combating COVID‐19, 22 there is still much room for improvement. One barrier is the number of pharmacists in the epidemic center‐Hubei Province is relatively small. 22 For example, of the tens of thousands of medical personnel across the country in Hubei, there are only 63 pharmacists, 23 which is extremely limited. This barrier forces clinical pharmacists to spend significant time in drug procurement and dispensing, which severely limits their ability to provide direct patients care activities. On the other hand, due to the late start of emergency pharmacy in China, the medical institutions' positioning of pharmacy services is mainly based on drug guarantees. There is relatively limited clinical pharmacy participation in public health emergencies. The priority of utilizing clinical pharmacy and clinical pharmacists in public health emergencies remains low. 23 The role of clinical pharmacists in public health events needs to be further clarified and explored.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
Contributor Information
Feng Qiu, Email: qiufeng.cn@outlook.com.
Shusen Sun, Email: ssun@wne.edu.
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