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COVID-19 impact on skills and professional perceptions of the hospital pharmacist during the first outbreak wave

The first COVID-19 outbreak wave has deeply destabilised the global health system, causing sudden changes at different levels and affecting the ordinary activities and skills of hospital pharmacies. To better understand the consequences of these changes, we carried out a webbased survey collecting information from Italian pharmacist members of SIFaCT (Società Italiana di Farmacia Clinica e Terapia) on the impact of the pandemic on their routine activity. Data were collected between May and June 2020 and were compared in two different groups according to the geographical spread of the infection: pharmacists who worked in severely affected pandemic areas, named ‘Highspread Regions’ (HSR, which included Lombardia, Piemonte, Veneto and EmiliaRomagna) and ‘Lowspread Regions’ (LSR, including all the other regions). The identification of HSR and LSR was performed according to National Health Institute epidemiological data. The main changes in ordinary work settings reflect the return to a traditional role in logistics, management of drugs, MDs and personal protective equipment shortages and nonsterile galenic. The reduction in clinical activities has been counterbalanced by the enhancement in drug supplies, adopting or extending the use of dematerialised prescription or delivery channels through the Italian Red Cross and National Civil Protection. The purpose of this letter is to describe how hospital pharmacists perceived their role during the pandemic, how they felt they were considered by national authorities and healthcare professionals, and which goals they would aspire to improve their performance during an emergency. A total of 113 participants completed the webbased questionnaire (57.5% HSR vs 42.5% LSR); the results confirmed a statistically higher mortality rate in HSR compared with LSR. 55% of participants felt that the role of the hospital pharmacist was not substantially changed during the pandemic and 22% felt their work was underestimated. The negative perception was more frequently reported in HSR than in LSR. Nonetheless, 43% of participants reported better consideration of their role, although they were mostly appreciated for efficiency in supplying medical products. Respondents believe their work may be improved by updating prevention and specific intervention measures for pandemics, and by learning how to quickly adapt daily working activities to new needs. The pharmacists were also asked to rate the support received by national institutions and healthcare authorities during the early phase of the pandemic. The Italian Medicine Agency (AIFA), the Ministry of Health and Scientific Societies received the best ratings with assigned scores of 6.6±1.8, 6.4±1.9 and 6.3±2.2/10, respectively, while regional/local institutions and National Civil Protection were graded with lower scores. An overall positive opinion on how the pandemic has been managed was expressed by 43% of participants; 55% felt they should have been more involved by local institutions in the decisionmaking process. A greater difference emerged regarding the role played by regional governments, which were more active in HSR in potentiating homecare prevention, treatment and centralised medical product supply. Taken together, these results enhance the importance of hospital pharmacists and should promote their ability to team up with other professionals to continuously improve health outcomes during emergency conditions.

The first COVID-19 outbreak wave has deeply destabilised the global health system, causing sudden changes at different levels and affecting the ordinary activities and skills of hospital pharmacies. 1 To better understand the consequences of these changes, we carried out a webbased survey collecting information from Italian pharmacist members of SIFaCT (Società Italiana di Farmacia Clinica e Terapia) on the impact of the pandemic on their routine activity. Data were collected between May and June 2020 and were compared in two different groups according to the geographical spread of the infection: pharmacists who worked in severely affected pandemic areas, named 'High-spread Regions' (HSR, which included Lombardia, Piemonte, Veneto and Emilia-Romagna) and 'Low-spread Regions' (LSR, including all the other regions). The identification of HSR and LSR was performed according to National Health Institute epidemiological data. 2 The main changes in ordinary work settings reflect the return to a traditional role in logistics, management of drugs, MDs and personal protective equipment shortages and non-sterile galenic. The reduction in clinical activities has been counterbalanced by the enhancement in drug supplies, adopting or extending the use of dematerialised prescription or delivery channels through the Italian Red Cross and National Civil Protection. 3 The purpose of this letter is to describe how hospital pharmacists perceived their role during the pandemic, how they felt they were considered by national authorities and healthcare professionals, and which goals they would aspire to improve their performance during an emergency.
A total of 113 participants completed the web-based questionnaire (57.5% HSR vs 42.5% LSR); the results confirmed a statistically higher mortality rate in HSR compared with LSR. 4 55% of participants felt that the role of the hospital pharmacist was not substantially changed during the pandemic and 22% felt their work was underestimated. The negative perception was more frequently reported in HSR than in LSR. Nonetheless, 43% of participants reported better consideration of their role, although they were mostly appreciated for efficiency in supplying medical products. Respondents believe their work may be improved by updating prevention and specific intervention measures for pandemics, and by learning how to quickly adapt daily working activities to new needs.
The pharmacists were also asked to rate the support received by national institutions and healthcare authorities during the early phase of the pandemic. The Italian Medicine Agency (AIFA), the Ministry of Health and Scientific Societies received the best ratings with assigned scores of 6.6±1.8, 6.4±1.9 and 6.3±2.2/10, respectively, while regional/local institutions and National Civil Protection were graded with lower scores. An overall positive opinion on how the pandemic has been managed was expressed by 43% of participants; 55% felt they should have been more involved by local institutions in the decision-making process.
A greater difference emerged regarding the role played by regional governments, which were more active in HSR in potentiating homecare prevention, treatment and centralised medical product supply.
Taken together, these results enhance the importance of hospital pharmacists and should promote their ability to team up with other professionals to continuously improve health outcomes during emergency conditions. Contributors ACP, DM and MC conceived and planned the web-based survey. DM and MC collected all the results. VD, RB, DM and ACP contributed to the analysis and interpretation of the results. VD carried out the statistical analysis. RB and MR took the lead in writing the manuscript and DM and VD revised the manuscript critically for intellectual content. All authors provided critical feedback and helped shape the research, analysis and final version of the manuscript.

Funding
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.