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The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.
To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.
There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).
Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.
This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.
Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.
To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.
Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.
The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.
Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.
Cyclones are expected to increase in frequency and intensity, significantly impacting communities and healthcare services. During these times, those with chronic diseases such as opioid dependence are at an increased risk of disease exacerbation due to treatment regimen interruptions. Disruptions to the continuity of the opioid replacement therapy (ORT) service can be detrimental to both clients and the community which can potentially lead to relapse, withdrawal, and risky behaviors.
To explore the impacts of cyclones on opioid treatment programs within community and hospital pharmacies in Queensland.
Qualitative research methods were used in this study with two methods of data analysis employed: the text analytics software, Leximancer®, and manual coding. Interviews were conducted with five hospital and five community pharmacists and four Queensland opioid treatment program (QOTP) employees. Participants worked in Mackay, Rockhampton, Townsville, and Yeppoon in a community impacted by a cyclone and involved with ORT supply.
The themes developed in the manual coding were “impact on essential services,” “human experience,” “healthcare infrastructure,” “preparedness,” and “interprofessional networks.” These themes were aligned with those identified in the Leximancer® analysis. The community pharmacists focused on client stability, whereas, the hospital pharmacists and QOTP employees focused on the need for disaster plans to be implemented.
The greatest concern for participants was maintaining the stability of their clients. Communication amongst the dosing sites and ORT stakeholders was most concerning. This led to a lack of dosing information in a timely manner with pharmacists being hesitant to provide doses and takeaways due to legislative restrictions. A review of coordinated efforts and the legislative constraints is recommended to ensure continuity of ORT supply during cyclones.
In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers.
The aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters.
Delegates at the World Association for Disaster and Emergency Medicine’s (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists’ roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded.
Of the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of “Agree” or “Strongly Agree” by 72.4% or more of the participants. Lack of understanding of a pharmacist’s roles and capabilities was the highest described barrier to pharmacists’ roles in disaster management.
This multi-disciplinary disaster health “community” agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.
WatsonKE, TippettV, SingletonJA, NissenLM. Disaster Health Management: Do Pharmacists Fit in the Team?Prehosp Disaster Med. 2019;34(1):30–37.
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