It is the middle of summer, and our attention should be focused on upcoming vacations, extended trips to spend time with family, or even spending time at the lake/pool/beach (you pick) this weekend. Instead, we continue to live with the ongoing effects of the coronavirus pandemic. As states loosen and then reinstate restrictions, people are certainly taking different approaches to the pandemic. Some are still in strict “lockdown” mode with their immediate families, while others are loosening the quarantine’s grip. In Auburn, Ala., which is the epitome of a small college town, we are actively planning for the upcoming academic semester. As small numbers of students are also returning for brief summer terms, we wonder if the recent news of a local bartender and 24 students testing positive for coronavirus is a precursor of the fall semester. We hope not.
Telepharmacy during the pandemic was the topic of our previous column. Telepharmacy provides a clear example of the value of information technology during unusual circumstances. Patients need to connect with their pharmacists, and pharmacists need tools to support their medication management activities — from afar. We acknowledge the existence of learning curves in telepharmacy (and other information technology) activities implemented in a short time frame due to the pandemic. However, if we are honest with ourselves, patients need to connect with their pharmacists, and pharmacists need tools to support their medication management activities regardless of the pandemic. This reality prompted us to consider what the future might hold.
It is our sincere desire that this experience will bring about positive change for the healthcare system and those it serves.
A few weeks ago, one of your authors was asked if he was over 65 when he tried to enter a pet store. Surely his mask “masked” his youthful appearance. After regaining his composure, the reason for the question was apparent. Many businesses have implemented “senior shopping” hours to allow seniors and other potentially at-risk populations to shop when crowds are small. All pharmacies we have encountered have implemented similar hours, including grocery stores. The rationale behind these designated hours seems reasonable and is probably appreciated by the customers.
Patients need to connect with their pharmacists, and pharmacists need tools to support their medication management activities regardless
of the pandemic. This reality
prompted us to consider what the future might hold.
Could this stick? Might the designation of specific times for specific subgroups of the population be so attractive that patients demand it beyond the pandemic? We can envision patient demand for senior shopping hours continuing, but we also see challenges in selecting which group(s) has designated shopping times. This is one change that we are interested in monitoring when the pandemic is behind us.
One of the earliest policy changes during the pandemic was actually not a federal policy change. It was a request from the secretary of Health & Human Services (HHS) encouraging governors to loosen requirements and allow healthcare professionals to practice across state lines. As you know, healthcare professionals’ licenses are granted at the state level. In March, when it became apparent that the demands of the pandemic could potentially exceed healthcare workforce capacity at local levels, HHS identified cross-border practice as an important tool in addressing the impending capacity challenges. This request was intended to support care delivered over distance (i.e., telehealth) as well as in-person care. According to our sources, 49 states and Washington, D.C., allow some form of cross-border practice. The current challenge with cross-border practice is the lack of standardization of regulations. For long-term cross-border practice to be practical, a common approach will be necessary to avoid the inevitable confusion that exists when each state controls healthcare professional licensure. We anticipate a return to pre-pandemic licensure practices.
Prior to the pandemic, vaccine administration was one of the most visible examples of successful advocacy for pharmacists’ services. As pharmacists, we believe it makes sense that the most accessible healthcare professional would provide this service. We are certainly glad to see pharmacists’ role as immunizers continue to grow. We fully believe that pharmacists must play a major role in administering the COVID-19 vaccine when it becomes available. While the time frame for vaccine availability is not completely known, the impending demand is easy to anticipate. Millions of doses will need to be administered in a short time period. Various pharmacy organizations are currently advocating for authorization allowing pharmacists to administer the COVID-19 vaccine when it becomes available. In fact, New York state recently passed legislation adding the COVID-19 vaccination to the list of vaccines that pharmacists can administer. This is a good thing for patients and for pharmacy.
However, we believe this may bring to light a challenge faced in community practice, especially in independent pharmacies. Reporting rates to immunization registries among community pharmacies are low. Is it likely that the COVID-19 vaccination will be added to the list of vaccines children must receive prior to attending school? Documentation will be necessary. Is it possible that, at least in the short term, some employers may require proof of COVID-19 vaccination prior to employees returning to work? If this happens, documentation will be necessary. Workflow integration will be key to ensuring efficient and timely reporting to immunization registries.
Related to this, pharmacists have now been authorized to order and administer COVID-19 tests approved by the FDA. This is significant, due to the accessibility of community pharmacies. It is important to note that this authorization addresses the liability associated with testing but does not address reimbursement. As a result, several pharmacy organizations are working to grant pharmacists emergency status as providers under Medicare Part B. Regardless of provider status, we ask ourselves, if pharmacists can administer COVID-19 tests, why not tests for the flu or step throat? Why not initiate treatment for these conditions when tests results are positive?
Hope for Positive Change
Finally, several restrictions related to pain management medications were lifted due to COVID-19. The rationale for these changes makes sense. However, history has shown us that some people will take advantage of others’ good intentions. We believe that community pharmacists will need to give heightened attention to the PDMP (prescription drug monitoring program) and to their interactions with patients who need help with pain management.
Regardless of provider status, we ask ourselves, if pharmacists can administer COVID-19 tests, why not tests for the flu or step throat?
Why not initiate treatment for these conditions when tests results
We continue to monitor the impact of the coronavirus pandemic, both locally and nationally. It has been inspiring to read stories of those who have sacrificed to help others, including pharmacists who have rapidly adapted to changing rules and regulations to ensure their patients receive the care they need. As a profession, we face an evolving reality that will likely not reach a sense of normalcy until a vaccination is widely available. It is our sincere desire that this experience will bring about positive change for the healthcare system and those it serves. Please let us know your thoughts. CT
Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, and Joshua C. Hollingsworth, Pharm.D., Ph.D., is an assistant professor, Pharmacology and Biomedical Sciences, Edward Via College of Osteopathic Medicine, Auburn Campus, Auburn University. The authors can be reached at firstname.lastname@example.org and email@example.com.