Engagement of hospital pharmacists in evaluation of drug utilisation, management of antimicrobial programmes and shortages during COVID -19 pandemic in the Republic of North Macedonia

Introduction: As part of an interdisciplinary team, hospital pharmacists (HPs) are kay factors in implementation of healthcare services and are responsible for evaluation of drug utilisation, management of antimicrobial programmes and shortages. During the COVID-19 pandemic pharmacists were engaged in additional activities in order to obtain the best care in hospitals that were overloaded with patients.

Aim: The aim of this study was to evaluate attitudes and consequences of COVID-19 pandemic on everyday practice of HPs and to assign their engagement as front-line workers in this period in the Republic of North Macedonia.

Methods:Questionnaire based research was performed among HPs in the RN Macedonia during July 2022. Obtained data were computed and consequently evaluated using statistical software STATGRAPHICS Centurion XVI evaluation (StatPoint technologies Inc., USA).

Results: The survey was completed by 35 HPs (representing almost 50%) of whom 96% were females. The average age was 45.4±12.9 years, more than 40% have over 20 years practical experience and almost 70% of the respondents are working in public hospitals. Over 50% of the respondents have been working in hospitals with 101-250 beds, and 32% in hospitals with over 250 beds that were transformed in COVID centers during the pandemic. More than 64% of the facilities (hospitals) have 24/7 available pharmacist and in 24% only 1 HP was employed. Evaluation of the engagement of HPs in COVID-19 pandemic presented that 13% strongly agreed, 21.7% agreed, 26.1% partly agreed, and 34.8% disagreed that were actively engaged in treatment of hospitalised COVID-19 patients. Additionally, 22.7% strongly agreed and 28.7% agreed that they were asked for guidelines for off-label use of drugs. This survey has also confirmed that HPs were not fully engaged and only 21.7% strongly agreed that they participated in antimicrobial treatment management and 13% were referred for the use of the antibiotics during pandemic. Additionally, only 8.7% strongly agreed that were consulted for advice on replacing intravenous with oral antibiotics and 17.4% participated in the education or advising for rational use of antibiotics. More the 52% of the respondents confirmed that have faced shortage of antibiotics during pandemic, and 40% strongly agreed that were consulted for appropriate replacement of a certain antibiotic when shortage occurred. The respondents have confirmed the shortages of personal protective equipment (PPE), antiseptics, antiviral drugs, corticosteroids, as well as monoclonal antibodies. Conducted study confirmed high engagement of HPs in estimating the quantity and preparation of plans for availability of essential medicines, materials, equipment and PPE needed during the pandemic (almost 70% strongly agreed), and more than 50% of them strongly agreed that they have participated in creating lists of alternative suppliers for essential medicines and medical devices.

Conclusion: Obtained results confirmed the pivotal role of HPs, in the RN Macedonia during the COVID 19 pandemic, in management of drug, medical devices and PPT shortages, but their expertise in rational drug utilisation as well as conducting of antimicrobial programmes should be recognised by other healthcare professionals in order to obtain best patient care in hospitals