Results
Demographic
1848 patients were hospitalised in Jianghan Fangcang Hospital and 349 patients were willing to add us on WeChat® to receive the pharmaceutical care. Before we performed our service, the patients were allowed to fill in the inpatients’ questionnaire. A total of 349 patients at Fangcang hospital were admitted to this study with an average age of 45.5 ± 10.6 years and 57.6% female. All these patients were diagnosed with mild COVID-19, who had fever(79.7%), cough(60.5%) with 43.6% sputum, pharyngalgia, myalgia, headache(57.3%), shortness of breath (42.7%), chest distress(38.4%), diarrhea(35.8%), nausea and vomiting(24.9%), dyspnea(24.4%), eye symptoms(18.3%), sneeze(17.2%) , rhinobyon (14.0%). Clinical pharmacist need to be more careful with the patients who had more infection symptoms and anxiety in case they got worse. At Fangcang hospital, the patients’ conditions were complicated and many had comorbidities such as hypertension(12.9%), hyperlipidemia (9.2%), thyroid disease(8.9%), diabetes(7.2%), heart disease(3.4%), nephropathy(1.7%), cancer(1.1%) and other diseases(12.6%). Details of patient’s characteristics are summarized in Table1. The complicated patient conditions indicated an urgent need for pharmaceutical care at Fangcang hospital.
Psychological effects of the COVID-19 outbreak
Patients are usually significantly stressed by the big public health emergencies such as SARS11. The patients with COVID-19 could suffer from severe psychological burden during COVID-19 outbreak. Before we initiated our pharmaceutical care for patients, we had a preliminary understanding of the patient’s psychological status. Our study showed that a few people’ spirits were bad (4.6%, 16/349) and 32.09% (120/349) were low. Many patients had low sleep quality(44.12%), and a few (17.91%) had really bad sleep. Most common reported influence factors included anxiety and fear of epidemic situation and clinical outcomes of medications. We performed drug education and psychological comfort for patients with bad spirit and enhanced the visit frequency for them. From the questionnaire for discharged patients(n=78), we found our service had positive effect on their mental stress(16.7%great, 43.6%good, 26.9%fair).
Medication and adverse drug reaction
Patients at Fangcang hospital were treated with various antivirals, antibiotic, traditional Chinese medicine and other symptomatic treatment drugs shown in Table 2. The antivirals taken by patients included Arbidol(70.8%), Oseltamivir(82.5%), Chinese patent medicine of Lianhua Qingwen Granule(92.8%), Chinese herbal decoction(64.8%), Ribavirin(4.9%), Interferon-α(1.7%). With the weakened immune system, few patients were companied with bacterial infection in pneumonia, thus antibiotics were taken. The antibiotics include moxifloxacin(73.1%), cefdinir(36.7%), levofloxacin(32.1%), amoxicillin(6.3%),azithromycin(3.2%). Due to the concerns about outcome of medications and a lack of common medical knowledge, many patients took more than one antivirals or antibiotics with the same function overtime, which not only failed to achieve the therapeutic curative efficacy, but also caused a variety of adverse drug reactions. Besides, many patients also took various treatments for their comorbidities, and these drugs may have interactions with antivirals or antibiotics, which may lead great risk of drug use of COVID-19 patients.
Before the pharmaceutical care provided, many patients reported they had adverse drug reactions(61.9%), including diarrhea (27.5%), nausea (27.2%), fatigue (24.4%), insomnia (16%), vomiting (11.7%), itchy skin (10.9%), constipation (5.2%), difficulty urinating (4.6%), and other adverse drug reactions(6.9%), shown in Table 3. While patients may get confused with these reactions, as some adverse drug reactions were similar with the symptoms of the COVID-19. Thus, these reported adverse drug reactions need to be further confirmed by clinical pharmacists during patients’ consultation.
Online pharmaceutical care service
In recent decades, clinical pharmacist have provided kinds of pharmaceutical care for patients with different diseases12-14. The remote pharmacy service such as telepharmacy have benefited numerous patients in settings the pharmacists are not available15-16. Due to the isolation of Fangcang hospital, and the special nature of COVID-19, a novel service model was developed by clinical pharmacists for the special circumstances of Fangcang hospitals. First, we gave ”Rational Drug Use” science broadcasting programs, including the medical knowledge of antivirals, antibiotics, traditional Chinese medicine, diet of nutrition, precautious after discharge etc, which also make patients get familiar with clinical pharmacist. Second, patients were given ”one-to-one” online pharmaceutical care service through WeChat®. The patients were classified according to their medical conditions from the inpatients’ questionnaire. The clinical pharmacists provided 24-hours online pharmaceutical care in case patients had drug related problems or negative emotions.
After 35 days’ pharmaceutical care, we sifted and got 196 questions from patients which were classified into 5 aspects, including COVID-19 related problems(29.1%), COVID-19 medication related problems(41.8%), basic chronic illness related problem (12.2%),life related problems at Fangcang hospital(7.7%),matters of discharge (9.2%), shown in Table 4. These contents had been compiled into a book which be used as guidelines for patients at other Fangcang hospitals. From this survey we can see the demand for drug consultation by patients. The drug related problems included inappropriate combination of drugs, unclear indication for drugs, drug dosage, time of taking medicine, drug interaction problems and adverse drug reactions etc. Meanwhile, many patients concerned about the sources of infection, the way of transmission, the control of the epidemic situation, the disease recurrence, the possibility of mild patients to severe patients and whether they can be cured. The patients with basic chronic diseases faced the problems with poor disease control due to COVID-19. Most of the proposed advice or explanations were accepted by patients after service of clinical pharmacist.
Satisfaction of pharmaceutical care service
In order to evaluate the pharmaceutical care provided by clinical pharmacists, we designed a questionnaire for discharged patients, and 78 patients voluntarily completed the questionnaire. According to the survey results, shown in Table 5, 48.7% patients communicate with the clinical pharmacist at least once a day, 28.2 % patients communicate with the clinical pharmacist every 2-3 days. The pharmaceutical care service included drug usage (65.38%), medication reconciliation (55.13%), drug precautions (23.1%), adverse drug reactions (35.9%), and psychological counseling (32.05%). We also found that 59.0% patients had insomnia, 42.3% patients were anxious, and 28.2% patients were afraid of disease, 20.5% depressed and 10.3% irritable. These results indicated that our clinical pharmacists did play an important role for pharmaceutical care in Fangcang Cabin hospitals.
Through 35 days’ services, the recognition of clinical pharmacist was greatly improved, from 25.6% to 87.2%, shown in Table 5. Most patients were satisfied with clinical pharmacist service(66.7%great, 18.0%good), and they thought pharmaceutical care provided by clinical pharmacist was necessary for treatment and rehabilitation at Fangcang hospital(62.8%great, 32.1%good). Besides, most patients thought the service had positive effect on their mental stress(16.7%great, 43.6%good, 26.9%fair).
This study indicated that most patients need clinical pharmaceutical care services. The online pharmaceutical care service can not only help patients to use drugs rationally, but also relieve the patient’s negative emotions and anxiety during the COVID-19 outbreak.