Developing and validating a pharmacist post-acute Covid-19 counseling tool

Abstract

Coronavirus-19 (COVID-19) has led to a serious threat globally with risk of multi-organ complications and occurrence of post-acute COVID-19. Pharmacists serving as front-liners in the community, play key role in providing patient care to those presenting with these symptoms despite the absence of a guide. The main objective of this study is to develop and validate a counseling guide for pharmacists in post-acute COVID-19. The objective of the first study was to determine symptoms, dyspnea, quality of life (QOL) and well-being during, and six months after initial COVID-19 infection. This was a cohort study involving 388 patients admitted for COVID-19 followed up monthly for six months. Symptoms seen comprised of respiratory (n=333, 85.5%), non-specific symptoms (n=295, 76%), gastrointestinal (n=117, 30.2%), musculoskeletal (n=76, 19.6%), neuropsychiatric (n=47, 12.1%), and cardiovascular (n=20, 5.2%) symptoms during infection which recover gradually. Improvement was seen in dyspnea (mMRC=-5.14, p=0.00) and pain (Z=-3.41, p=0.00) within three months while mobility (Z=- 3.05, p=0.002), self-care (Z=-2.53, p=0.01), usual activities (Z=-3.47, p=0.00), anxiety (Z=- 3.49, p=0.00) and well-being (Z=15.1, p=0.00) over six months. Subsequently, a survey was carried out on 405 pharmacists which aimed to determine knowledge, attitude and practice of pharmacists in COVID-19, knowledge in post-acute COVID-19 as well as to identify barriers and facilitators in providing support to post-acute COVID-19 patients. Average score of knowledge, attitude and practice in COVID-19 was 5.69 (±0.78) (maximum=7), 3.56 (±0.63) (maximum=4) and 3.38 (±0.61) (maximum=4). However, the knowledge in post-acute COVID- 19 was 12.93 (±2.44) (maximum=20). Knowledge of pharmacists in COVID-19 was 81% and 64% for post-acute COVID-19. Following this, the third study was undertaken to develop a counseling guide for pharmacists for post-acute COVID-19 based on the previous two studies. Symptoms incidence graph, medications, mechanism of symptoms and medication as well as side effects was included into the tool. The tool was finalized after two-rounds of Delphimethod and was validated by face (n=10, 100%) and content validity (S-CVI-UA: 0.89; S-CVIAve: 0.98; i-CVI:>0.79). The validated tool was acceptable when tested for system usability scale among 152 pharmacists (score of 70.3%, acceptable score>70). The tool provides input for pharmacists during post-acute COVID-19 patient encounters and ensures improved and continuous standard patient-centered care.