SMART Pharmacists Serving the New Needs of the Post-COVID Patients, Leaving No-One Behind 2023 Šipetić et al

Abstract

This study aims to demonstrate the improvements in clinical symptoms in patients with post-COVID syndrome after a community pharmacy-based intervention in Serbia. The Pharmaceutical Chamber of Serbia (“Chamber”) invited pharmacists to deliver post-COVID patient care counselling, supported by the SMART Pharmacist Program, offering education and guidance. Present symptoms, duration and patient self-reported severity of symptoms on a scale of 1–5 on the first visit were recorded. After the counselling and proposed self-medication treatment, the time of the follow-up visit and the severity of the recorded symptoms were also recorded. The prospective data collection lasted from December 2021 to September 2022.

In total, 871 patients with post-COVID symptoms were included in the study, served by 53 pharmacists. The most frequently reported post-COVID symptoms coincided with the literature, mostly related to the respiratory system (51.2%), immunity status (32.2%), fatigue and exhaustion (30.7%), skin, hair and nails (27.4%) and cognitive functions (27.9%). A total of 26.5% of patients were referred to their family physician (general practitioner), and 69.5% returned to the pharmacist for a follow-up visit. On the first visit, the median severity of patients’ symptoms was three, while on the second visit it dropped to one. The pharmacists’ intervention led to a significant improvement in the post-COVID patients’ condition.

Open access, https://www.mdpi.com/2226-4787/11/2/61

 

I remember this post-covid counselling program in pharmacies in Serbia. Here is a short article about it in the News from Southeastern Europe thread.

 

Only possible explanation. There is literally no other possible explanation for this change. It's the magical healing presence of those strong professional hands.

All of this actually shows how the "white lab coat" effect was manufactured by simply saying so and, somehow, believing in it. This is why people need oversight. Everyone needs it, all the time. No one is above self-grading themselves as 10/10 regardless of merit. Especially not with stakes dealing in life and death.

If this "placebo" thing were anything real, we could just employ actors to do the same and it would work just as well. And, actually, it does "work" just as well. Alternative medicine would be highly effective. It's not, we know this. Even when dispensed by MDs. It's all BS. All of this nonsense is narcissistic delusion. It's the same thing behind kings who declared that the sun rises in the morning because of their rule. It's just primitive nonsense.

 

In the last few years I have gone to my GP surgery and been treated by GPs, nurses, pharmacists, and paramedics. In each case they were prescribing things for me.

How can I tell when the person prescribing for me is acting outside their competence level, if they aren't a GP?

Edit : This is a serious question, I'm not trying to be snide.

 

Is this becoming a thing where not fit for purpose medical institutions are dumping more and more work on pharmacists who are also understaffed and over worked .

 

Nothing new. Psychiatry has long been used as dump. NIMBY (not in my back yard) is always very strong when no one is responsible for something. It's someone's else responsibility. Surely. Probably. One thing they know for sure, it isn't there, and everyone agrees.

 

I'm slightly divided in that if you have a good pharmacist then I have little issue with them being able to prescribe things that might well be of use and make a difference. Particularly when they might be given freedom to refer - I'm imagining things like sinus issues, but also where for example you have a muscle injury.

One of the huge benefits is that you don't need to pre-book in the same way, and it tends to avoid that issue where the problem disappears and the mind goes just for the moment you go into the appointment.

And as they have your records [certainly of current meds?] then am I correct in thinking they could flag if there were potential contra-indications anyway even if prescribed by someone else.

What I do get wary of oddly enough (and I know sthis will be a point of debate) is the rigid pathwaying that became such a problem for GPs. It is a good idea when offering ideas. But it became about rationing (to silly points where people were sent away for 2weeks for some things just as process - whether they were the type who'd have waited until they were really sure anyway, and the second appt costs a lot more than any meds would have).

I don't mind data collection, which makes sense, but worry with these conditions about lowest-common denominator tail-wags-dog. ie medications working for 70% means that the 30% aren't talking nonsense when they don't. That is no indication on their personality etc. And what you are measuring probably needs some more common sense than the throw everything at the wall or be really generic stuff we often see. It needs 'primary issue' and then 'potential comorbid/added' vs 'secondary issue' rather than the 3 symptoms to one. Sorting someone's sinus will no doubt be very worth doing, might even take a bit of added load off the underlying condition to give that a chance of not getting worse, but it isn't necessarily curing the main condition etc

So I think my point is that I don't have an issue with pharmacists being involved, good ones, as good GPs or good other relevant professionals. But if it means something is 'off the list' based on an arbitrary averaged-out judgement of 'this gets better after 3 pharm appts' when the picture actually varies hugely and some will need referrals which are made more difficult by such pathways or data collected in a way which muddies the picture then not great.

And I'm most concerned about where the seriously ill might have that will do further necessary tests, adjustments and so on, and making sure these new staff get training that gets rid of any 'residue' from the Gerada/Chalder old-school videos type things biasing their view of people before they walk in the door, and just being straightforward as per any other illness. If they can be fresher pairs of eyes, and can start speaking for that more freely (saying it's like flu patients, and then they get worse over time) maybe that is a good thing.

 

If they have to get someone else to sign the prescription. A GP can print off, sign and hand it over there and then or send to chemist. If recommendation from the others needs a second check from a GP then they will say something like that/you can ask when it will be sent, or sometimes you find out when it takes longer than expected to get to chemist.