Table 3.

Community pharmacists and team (CMOCs 5–9)

CMOC 5—receive adequate compensation and resources1 30 32 40 45 93–103	When community pharmacies receive adequate compensation and resource support for COVID-19 vaccines (C), they are more likely to deliver the service (O), because they feel recognised for their service contributions (M).
	‘Pharmacists…have been incredible in supporting patients throughout COVID-19 and rightly deserve recognition for the work they do. We know that teams were already under pressure and that colleagues in community pharmacy are feeling added financial strain.’ (Great Britain).30 ‘In the community, mitigating the impact of COVID-19 has…focused largely on general practitioners (GPs). This is unsurprising to those in the pharmacy profession who have long considered policy makers to overlook them.’ (Great Britain)1
CMOC 6—sustain capacity and facility to adapt essential services16 17 32–34 44 69 71 96 97 104–115	When a community pharmacy has the capacity and permission to manage and adapt existing essential services during COVID-19 (C), they are more likely to effectively deliver and sustain these services (O) because it is feasible for them to do so (M).
	‘Virtual and telephone consultations have become commonplace, particularly to vulnerable patients. Pharmacists have implemented systems to dispense medications in advance of need to minimise wait times and duplicate visits. In case-by-case examples…there has been anticipatory management of medication-related needs.’ (Ireland)115 ‘Pharmacists who had comfort and confidence in managing electronic communication reported feeling greater control over workflow and the ability to triage and queue patients more effectively based on priority and need.’ (Canada)46
CMOC 7—inform users of essential service availability/continuity16 24 25 33–35 45 46 62 97 109 115–124	When community pharmacies have processes in place to inform pharmacy users about the availability of essential services (C), pharmacy users are less likely to become anxious (O), because they feel reassured about access to what they need (M).
	‘Access to medications is a main concern expressed by our patients… The CDC and SAMHSA offer guidance on ways to reduce stress and anxiety in this time of uncertainty.’ 118 ‘As a result of the power dynamics at play, it is ultimately up to pharmacists to be able to reassure patients and provide care, all while taking into account their mental health. Currently, guidelines regarding patient interaction during a pandemic are needed.’ 35 ‘In addition, there is ongoing work in liaison with pharmacists, general practitioners, and state and territory authorities to enable therapeutic substitution by pharmacists in the event of a shortage. This will allow community pharmacists to substitute dose strength or form without prior approval from the prescriber, if a prescribed medicine is not available at the time of dispensing. These measures highlight the important role pharmacists can play in enabling and maintaining access to medicines for people in need throughout the COVID-19 outbreak.’ (Australia)109 ‘Access to medications is a main concern expressed by our patients… The CDC and SAMHSA offer guidance on ways to reduce stress and anxiety in this time of uncertainty.’ (USA)118
CMOC 8—protect the health and safety of staff24 34 35 55 66 97 103 125–130	When community pharmacies have the means to protect the health of pharmacists and staff (C), they are more likely to deliver essential services and COVID-19 vaccination services (O), because they feel safe to do so (M).
	‘…Given high levels of public anxiety and uncertainty regarding the integrity of the drug supply chain in Canada, many participants reported difficult, sometimes frightening, interactions with members of the public and their desire for dedicated security to provide support and conflict management.’ (Canada)24 ‘An additional burden Asian pharmacists face, on top of pharmacist harassment, is the rise of anti-Asian racism that has come about due to COVID-19. Verbal and even physical abuse has been reported to happen in various countries, such as the UK, France, and the USA, to those of Chinese descent…’ (UK, France, USA)35 ‘The survey found that although more than a third (37%) of pharmacists said they felt unsafe at some point working during the pandemic, concerns over PPE have eased. This is due, in part, to the supply problems being eased and community pharmacists being finally allowed to order from the national online PPE portal in an emergency, after calls for access from the RPS.’ (Great Britain)103
CMOC 9—enhance collaboration across services, including IT18 26 33 40 41 82 88 89 104 109 131–135	When systems needed for COVID-19 vaccination, including IT and remuneration, support collaboration by various service providers (eg, general practitioner surgeries and community pharmacies: (C)), a coordinated response is more likely (O), because reduced effort is needed from everyone (M).
	‘Planning and delivery should be undertaken across a consistent, pre-agreed footprint. It may be more efficient and cost effective to provide immunisation across a number of providers, pooling resources and sites to deliver the best service possible, and working in coordination with other local stakeholders such as directors of public health and local government.’ (Great Britain)82 ‘For many community pharmacists, a lack of connected IT is a huge problem. Kieran Eason, who runs an independent pharmacy in Tamworth, Staffordshire, says lack of intra-operability makes it more difficult to do relatively simple things, like sending prescription requests to GPs. “Pharmacy IT is just a complete disaster,” he says, suggesting the COVID-19 crisis has highlighted flaws, such as the number of different systems pharmacists use.’ (Great Britain)40

CDC, Centers for Disease Control and Prevention; CMOC, context-mechanism-outcome configuration; IT, information technology; PPE, personal protective equipment; RPS, Royal Pharmaceutical Society; SAMHSA, Substance Abuse and Mental Health Services Administration.