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

Al Meslamani, Ahmad Z.; Kassem, Amira B.; El‐Bassiouny, Noha A.; Ibrahim, Osama Mohamed

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.