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.