Rapid realist review of the role of community pharmacy in the public health response to COVID-19

  1. Ian Maidment
  2. Emma Young
  3. Maura MacPhee
  4. Andrew Booth
  5. Hadar Zaman
  6. Juanita Breen
  7. Andrea Hilton
  8. Tony Kelly
  9. Geoff Wong

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Abstract

Community pharmacists and their teams have remained accessible to the public providing essential services despite immense pressures during the COVID-19 pandemic. They have successfully expanded the influenza vaccination programme and are now supporting the delivery of the COVID-19 vaccination roll-out.

Aim

This rapid realist review aims to understand how community pharmacy can most effectively deliver essential and advanced services, with a focus on vaccination, during the pandemic and in the future.

Method

An embryonic programme theory was generated using four diverse and complementary documents along with the expertise of the project team. Academic databases, preprint services and grey literature were searched and screened for documents meeting our inclusion criteria. The data were extracted from 103 documents to develop and refine a programme theory using a realist logic of analysis. Our analysis generated 13 context-mechanism-outcome configurations explaining when, why and how community pharmacy can support public health vaccination campaigns, maintain essential services during pandemics and capitalise on opportunities for expanded, sustainable public health service roles. The views of stakeholders including pharmacy users, pharmacists, pharmacy teams and other healthcare professionals were sought throughout to refine the 13 explanatory configurations.

Results

The 13 context-mechanism-outcome configurations are organised according to decision makers, community pharmacy teams and community pharmacy users as key actors. Review findings include: supporting a clear role for community pharmacies in public health; clarifying pharmacists’ legal and professional liabilities; involving pharmacy teams in service specification design; providing suitable guidance, adequate compensation and resources; and leveraging accessible, convenient locations of community pharmacy.

Discussion

Community pharmacy has been able to offer key services during the pandemic. Decision makers must endorse, articulate and support a clear public health role for community pharmacy. We provide key recommendations for decision makers to optimise such a role during these unprecedented times and in the future.

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  1. Version published to 10.1136/bmjopen-2021-050043
  2. ScreenIT

    SciScore for 10.1101/2021.02.01.21250765: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Stage 2: Literature Searching: Searches were conducted (July-August 2020) using MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus for search concepts relating to Pharmacy and COVID by AB (see Appendix 1 for search strategy).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    Reference checking and citation searching of all included references on Google Scholar (using the Publish or Perish tool) were also carried out.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, limitations continue to surround the direct policy relevance of much of the community pharmacy evidence base146. Study strengths and limitations: The realist approach uses diverse data, including grey literature. This feature is especially important given a novel and rapidly evolving topic area, such as COVID-19. Multiple researchers with subject matter expertise participated in screening the literature and extracting and coding data, which maximised opportunities to discuss and debate the plausibility of the inferences made. The CMOCs were developed and refined through regular discussions within a team with varied academic and clinical backgrounds. Professional and public stakeholder consultation further refined the CMOCs. All rapid reviews operationalise coverage versus expediency. Other sources of evidence could have informed the review; however, potential gaps were mitigated by stakeholder engagement and expertise within the team. The evidence supporting the CMOCs was based on available time for document review, and during the review period, research, directives and policy related to COVID-19 vaccination rapidly evolved. The programme theory and its CMOCs, however, are expressed in such a way that they can be further confirmed, refuted or refined in the future using additional data. Meaning of the study: possible explanations and implications for decision makers: Although there are multiple actors involved in pandemic response, for brevity, recommendations (Table...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.01.21250765v1 on medRxiv