Pharmacist Role in Telehealth Practice in Pakistan During 2019 Novel Coronavirus Pandemic: The Neglected Link for Patient Safety

Telehealth services have been working for decades to offer health advice at the point of treatment care. The usage of this innovative modern communication technology for the general public is still in its infancy in developing countries including Pakistan. The communities are advised to practice social distancing for safe survival during the corona pandemic. The role of a pharmacist is well recognized Worldwide in the practicing telemedicine models of drug information centers and poison control centers. Telemedicine centers were established by different hospitals and medical universities to provide telephonic consultation regarding any ailment during the 2019 Novel Coronavirus pandemic in Pakistan. The pharmacist’s potential and professional expertise are neglected and unexplored as drug information experts in hospitals and community pharmacies, antidote specialists in poison control centers, patient counselor for treatment compliance in Pakistan. The telemedicine practice in the institutions ensures the inclusion of trained pharmacists for better patient care. Telepharmacy initiation at the community level by the government will also reduce the burden on the hospital level. Short Communication Rehman AU and Hani U; JPRI, 34(22B): 1-4, 2022; Article no.JPRI.81108 2


INTRODUCTION
Telemedicine is used as a means of health care delivery to meet the needs of the clients at a considerable distance globally. Telehealth services have been working for decades to offer health advice at the point of treatment care. Telemedicine is classified into teleconsultation by patients, televisits through videoconference, telesupervision by experts, telemonitoring of patients, teleinterpretation of the lab and radiological data [1]. Most telemedicine models demonstrated strong health advantages for the patients but few of them were unable to show clear health benefits [2]. The aerospace sector and armed forces have been utilizing telemedicine services through audio and video technology since the last century [3]. The usage of this innovative modern communication technology for the general public is still in infancy in developing countries.
The 2019 Novel Coronavirus (COVID-19), first time detected in Wuhan, China in December 2019 was declared a pandemic by the World health organization on 11 March 2020 [4]. The importance of telemedicine has increased significantly during the corona pandemic [5]. The governing bodies at the national level are trying to control the morbidity of 2019 Novel Coronavirus (COVID-19) by implementing lockdowns in the infected territories [6]. Corona pandemic severity can be minimized by restrictive contact with the infected carriers in the lockdown. The communities are advised to practice social distancing for safe survival. Telehealthcare services are needed in the corona pandemic to provide outpatient department consultations to the patients as well as to address the unmet needs of the general population correlated to 2019 Novel coronavirus awareness, stress counseling and preventive measures advice. The role of a pharmacist is well recognized Worldwide in the practicing telemedicine models of drug information centers and poison control centers [7].

ROLE OF COMMUNITY PHARMACIES IN CORONA PANDEMIC
Community pharmacies are the easiest accessible health contact points for selfmedication, prescription filling, and health accessories acquisition. The general public and patients depend on their neighborhood pharmacies to get sufficient stock of their everyday use medicines. The demand for health accessories has been increased in pharmacies due to the extensive use of face masks and hand sanitizers by the population during the corona pandemic [8,9]. Community pharmacies must follow national and international guidelines for safe and effective working. Environmental control of pharmacy must also be maintained by frequent use of disinfectants, dispensing counters prepared at six feet distance, use of personal protective equipment by the staff members and handwashing or sanitizer facility for visitors at the main entrance. The training of pharmacy staff on COVID-19 equipped the staff with adequate knowledge related to coronavirus treatment. testing and prevention. The initiation of telepharmacy and online pharmaceutical care services to facilitate the community in medication consultation, brand selection, online or telephonic order of prescription to avoid maximum exposure, patient counseling and referral to a health care facility.

THE NEGLECTED ROLE OF PHARMACIST IN PAKISTAN
Pharmacists are the frontline unrecognized combatants against the 2019 novel coronavirus disease fight globally. The pharmacist's potential and professional expertise are neglected and unexplored as drug information experts in hospitals and community pharmacies, antidote specialists in poison control centers, patient counselor for treatment compliance in Pakistan [10]. The reason is a lack of acceptance of the pharmacist role in direct pharmaceutical care by the other health care professionals and retail pharmacy business owners [11]. The domain in hospitals is limited to stock management and dispensing of drugs. The World Health Organization standard of one pharmacist for fifty beds in the hospital settings remained unnoticed by the health authorities in Pakistan. Just one pharmacist serves in hospitals with around 1200 beds in Pakistan [10]. The professional relationship between physicians and hospital pharmacists faces a lot of constraints in health communication. The business owners of community pharmacies are acquiring a pharmacist license to practice at a nominal rate. They are not willing to hire pharmacists on attractive salaries [12]. This resulted in the brain drain of qualified professionals to the countries of developed community and hospital pharmacy practice [13]. The majority of available professionals are service providers in the production and marketing departments of the pharmaceutical industries. The services of clinical pharmacists are not utilized by any of the government hospitals in Pakistan [14]. The unemployment rate is high in the profession with around 15,000 pharmacists are in search of jobs [10].

TELEMEDICINE PRACTICE IN PAKISTAN DURING CORONA PANDEMIC
Telemedicine is the best model for therapeutic consultation in the corona epidemic when the practice of social distance among the population was endorsed by the World health organization [15]. The government of Pakistan has created a COVID-19 resource center and helpline, available to the public on their website. Telemedicine centers were established by different hospitals and medical universities to provide telephonic consultation regarding any ailment including COVID-19 [16]. Some of the universities in their telemedicine response team included pharmacists while the remaining included only physicians.

POTENTIAL OF PHARMACISTS TO BE UTILIZED DURING CORONA PANDEMIC
The effective public health communication of the community pharmacists during the corona pandemic will provide health awareness. There is a need for inclusion and active pharmacist participation in the telehealth programs in Pakistan. The potential of the pharmacist at community pharmacies may be utilized for patient safety in the following ways:  Provide active consultation to common diseases as well as COVID-19 while avoiding close contact with customers and staff members.  Promote preventive measures through counseling and also guide the method of adoption, frequency, and timing for particular precautions.  Maintain a clean environment of the pharmacy by frequent use of disinfectants.  Ensure the use of personal protection equipment by the staff members including gatekeepers.
 Suspected cases should be referred to corona designated hospitals for testing  Initiate telepharmacy services for self and community protection.  Maintain up to date knowledge regarding COVID-19 using e-learning resources.

CONCLUSION
The telemedicine practice in the institutions ensures the inclusion of trained pharmacists for better patient care. Telepharmacy initiation at the community level by the government will also reduce the burden on the hospital level

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.