Reflections on the COVID-19 Pandemic Response by North Carolina Ambulatory Care Pharmacists Kimberly L. Nealy, PharmD, BCPS, CDCES, CPP Wingate University School of Pharmacy Jennifer A. Wilson, PharmD, BCACP Wingate University School of Pharmacy
North Carolina Ambulatory Care Pharmacists have been pioneers in the specialty for decades. Additionally, pharmacists practicing in this area have a berth of sub-specialties, protocols, and patient populations, resulting in rich service provision. It comes as no surprise that in 2020, during the global SARS-CoV-2 pandemic, the outpatient clinical pharmacists’ responses were varied and diverse. In the spring of 2020, pharmacists pivoted to develop innovative ways to continue providing optimal patient care, which now including protecting themselves, their patients, and the community from contracting the novel Coronavirus. We set out to explore strategies and barriers experienced by ambulatory care pharmacists during the first year of the pandemic and to garner information about plans for the foreseeable future.
A questionnaire sent to NCAP Ambulatory Care Academy members revealed that most of the responders were providing both in office (88%) and tele-
phonic patient care (100%) going into the fall of 2020. Additionally, several responders reported they were also providing video visits (55%) for their patients at that time. Barriers of new care models ranged from patient apprehension of coming in to clinics for visits or lab work to frustration over the transition from office-based to virtual care. Technology challenges associated with working virtually included the use of personal or unlisted phones by providers, which often resulted in confusion or concerns from patients. In some cases, phone and virtual visits have resulted in more difficulty providing hands-on, directly observed device training for products like injectables, inhalers, and self-monitoring. Unsurprisingly, patients may have limited access to or comfort with the technology required for video visits and telephonic visits limit non-verbal communication. There have also been several factors which have indirectly affected routine ambulatory care pharmacy practice, such as a decrease in access to pharmaceutiPage 33
cal samples as well as copay and trial cards.
Despite the challenges and downfalls during the pandemic, there have been some positive outcomes of the changes in practice. The increased provision of telephonic and virtual health offerings has given alternative avenues for care for patients who may have previously had barriers to transportation or time for appointments. By the nature of these visits, time commitment to the visit is usually decreased for the patient, as they aren’t required to drive to and from the clinic setting. This may allow for more visits in a day with various providers and an increased time available overall. Additionally, when patients are at home, they are more likely to be able to access medications, self-monitoring devices and logs, and food labels more readily. While clinics are now mostly back to allowing in-person appointments, many are still offering these expanded opportunities, which can potentially reach a broader patient
