Pharmacists' Role in Supporting the COVID-19 Response

John Beckner, RPh, Senior Director of Strategic Initiatives at NCPA, discusses the role of the community pharmacy in the age of COVID-19 in supporting current health care efforts, such as continuing immunizations and managing the effects of the pandemic on patients.

Alana Hippensteele: Hi, I'm Alana Hippensteele from Pharmacy Times. Before we get started, one of our top articles today is about the path ahead in reopening community pharmacies as stores open in states across the country. There’s more of that on PharmacyTimes.com.

Today, I’m speaking with John Beckner, the senior director of strategic initiatives at NCPA, on the role of the community pharmacy in the age of COVID-19 in supporting current health care efforts, such as continuing immunizations and managing the effects of the pandemic on patients.

So, John, what is the role of the community pharmacy in supporting patients during the COVID-19 pandemic.

John Beckner: Without question that the COVID-19 pandemic continues to put enormous pressure on the nation's healthcare system. Pharmacists are currently among the health care professionals on the front lines helping to provide care during a very difficult time, and you know, when so doing as frontline providers, pharmacists are really one of the more trusted and highly trained health care professionals and they're really playing a critical role with respect to patient care. And in public health during this crisis, you know, as frontline providers they're serving their communities by providing essential services, and in many cases, they've had to alter their primary way of doing business. And by that I mean some pharmacists are providing curbside delivery, they're helping their patients that have chronic conditions manage those conditions via telephonic consultations, or, you know, Zoom conferences like we're doing today, many of these pharmacists are compounding hand sanitizers and making these available to patients as well as donating to first responders. And they continue to communicate with patients’ physicians. So, just to summarize, they really have been an integral part of the nation's response to the pandemic.

Alana Hippensteele: With rates of immunizations dropping due to the COVID-19 pandemic, what do you see the effects of this being now and in the future, and how can pharmacists support efforts to increase rates of any immunizations?

John Beckner: Well I think vaccine rates are down for a couple of reasons. First of all, patients are not coming into pharmacies, they're not going to position practices with regard to the CDC. The CDC actually came out with guidance in mid-April suggesting that providers pause with respect to preventative type immunizations during the time or until the pandemic subsides. So I think you're definitely seeing vaccine rates drop, so that's going to present a tremendous opportunity for pharmacists moving forward in terms of if a vaccine becomes available this year, and you hear different things: It's either going to be available the end of the year or first quarter next year, and the demand for that's going to be unprecedented. So, I think it's really going to need to be all hands on deck for pharmacists, who are going to play a critical role in that.

Another opportunity for pharmacists is really helping to catch up on vaccines that have not been given for the last two or three months and, you know, I draw attention to the pediatric vaccines that that have elapsed during that time, so I think pharmacists are going to need to play a key role there.

The other thing to keep in mind is I think the COVID-19 pandemic and the increased awareness around the COVID-19 vaccine is really going to increase demand for other vaccines, like the regular flu shot, pneumococcal vaccine. I think some people may equate getting a flu shot to offering some protection against the COVID-19 virus moving forward. So, I think you've got all those things in play. And one of the concerns is that some states currently don't allow pharmacists to administer the COVID-19 vaccine, so they're going to need some regulatory changes, you know, pharmacists have been doing immunizations since the mid-90s. They've been doing so effectively and safely. To restrict access to the COVID-19 vaccine and not allow pharmacists to administer it is really contrary to quality patient care, so lots of things to consider there with regard to immunizations.

Alana Hippensteele: Yeah, absolutely. So, in regard to public health, how do pharmacists support public health by working with local and state health departments?

John Beckner: You know, many community pharmacies or pharmacists to already have an existing relationship with their state or local health department in states that require an immunization protocol. They may have had someone from the health department, the medical director sign the protocol. Those relationships already exist, and just looking ahead to the to the availability of the COVID-19 vaccine, I think the plan is going to be much like H1N1, and the distribution is going to go through state and local health departments. So, it's really important that these community pharmacies, if they don't already have an established relationship with their state or local health department, to go ahead and enforce their relationship, because that's going to play into how the vaccine is distributed once it's available.

Alana Hippensteele: The NACDS issued a recent report urging state and federal to allow community pharmacies to support national COVID-19 testing and contact tracing efforts as well as forthcoming COVID-19 vaccine and treatment distribution. Would you agree that community pharmacies have the potential to play an important role in supporting such efforts?

John Beckner: Yeah, I agree with you 100% on that, in fact any NCPA, my organization, has been very vocal in supporting those same efforts. And certainly clearly there's so much pharmacists can do with respect to immunizations, and in helping to ease the burden on the health care system, so you know, providing increased authority to provide these services, removing barriers that currently exists so pharmacists can provide essential patient care services is very important.

Alana Hippensteele: Yes, absolutely. What is the impact of COVID-19 economic decline on medication adherence and how can pharmacists intervene?

John Beckner: Well, you know I think, obviously, the COVID-19 pandemic has had a negative effect on adherence in terms of patients not getting their refills or not filling new prescriptions because they want to save money. I mentioned earlier patient visits to pharmacies have declined just like patient visits to physician offices have declined. So, another thing in play here is early on many patients with chronic diseases may have tried to stock up on their supply of chronic medications by getting a 90-day supply. And so, while they have an ample supply of medication, that doesn't guarantee they're taking the medication like they need to. It's harder to monitor with a 90-day supply, which has always been a downside of a mail order, which is subscribed to the 90-day supply manager for a long time. So, I think adherence has been negatively affected, and I think pharmacists can play a critical role here.

You know, one of the things to keep in mind is with so much focus on the pandemic, people tend to kind of forget about the chronic disease situations. Pharmacists play a very key role in chronic disease management. They need to continue to work with physicians to help patients manage their condition and, you know, a lot of community pharmacies are offering medication synchronization services. These services are very important to improving adherence, so all of these things are important, particularly during the time of the pandemic.

Alana Hippensteele: Absolutely. So recently, there has been a surge in awareness around the relevance of social determinants of health during the COVID-19 pandemic. Would you say that conducting screenings for social determinants of health would be important for community pharmacies?

John Beckner: Absolutely. I think it's been shown that social determinants of health or social determinants are increasingly important with regard to health, and certainly chronic disease. I think that's really been showcased during the COVID-19 pandemic. I think pharmacists, particularly community pharmacists, are really in an ideal position to be able to screen for social determinants of health, just because of the relationships that they currently enjoy with their patience, the fact that they're trusted. One concept that has really started to gain some traction is the use of community health workers to be involved with assessing a patient's situation. They might go into the home and see that there's no food in the refrigerator, there may be some transportation issues, there may be some health literacy issues. So, I think these community health workers are going to be playing a key role moving forward in terms of identifying problems and trying to get solutions to those problems. So, I think that's one of the things that's going to come out of the COVID-19 pandemic is the importance of social determinants and what role pharmacists and their pharmacy staff can play with that.

Alana Hippensteele: Absolutely. So, adding to that, do you see the role of the pharmacist expanding in the future due to their role in supporting patients during the COVID-19 pandemic?

John Beckner: Yeah, you know, without question I think, you know, the COVID-19 pandemic has made an indelible mark, you know, certainly on society as a whole but in particular the health care system. Pharmacists have been really front and center from the very beginning, and I think I guess one of the silver linings or positive things that has come out of this with regard to pharmacy is that I think it's really shown a light on what pharmacists can do. And you know, just looking ahead I think several things are going to change as a result of what pharmacists have done during the crisis. I think you're going to see scope of practice expansion, and hopefully in accelerated path to provider status for pharmacists. Testing has really been at the forefront of a lot of discussions. Point-of-care testing, you know pharmacists were already doing that, but I think they're going to be doing even more of that moving forward, whether it's testing for COVID-19 testing, for strep or influenza, I think point-of-care testing, the demand for that in the community setting, is going to increase.

We talked about immunizations, I think there's going to be an increased demand for all immunizations, certainly the COVID-19 vaccine, but really all immunizations. And really an opportunity for pharmacist to really look at expanding their vaccine portfolio. I think you're going to see increased demand or increased pharmacist involvement with telehealth. I think particularly in the rural areas, you're going to see an increased online presence and social media advertising by pharmacists and, you know, healthcare moving forward is really going to be about collaboration and team-based care, so I think you're going to see a lot more collaborative practice agreements between physicians and pharmacists. You know, all in all, I think there's just going to be an increased demand for the types of services that pharmacists provide or can't provide in, and again, I think the last two months have really shown to show folks exactly what pharmacists are able to do.

Alana Hippensteele: Absolutely. Well, thank you so much for taking the time to speak with me today. Now let's hear from some of our other MJH Life Sciences brands on their latest headlines.