The challenges and solutions faced by rural pharmacies in a Covid-19 era

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​The challenges of rural pharmacies are well documented. They often struggle to find appropriate health care professionals to staff the facilities, which can significantly reduce the quality of care delivered. Covid-19 has posed new challenges for health care systems globally, and specifically for community pharmacies.

As they must remain open, pharmacies in rural areas must adapt to the pandemic’s ever-changing reality. Standard precautions like social distancing, restriction of patient numbers, and implementing delivery services have been recommended and implemented extensively. But more importantly, community pharmacies have also upgraded work practices to match the times. Some of these include working in teams and shifts to limit the risks of cross infections and implementing workflows to accept prescriptions from the temporary Telehealth extensions.

Read: Locum Pharmacist shares stress of Melbourne lockdown

However, these are small problems in the grand scheme as rural pharmacies have to contend with the challenge associated with prescription drugs. Patient groups who need continuous care face additional risks. For example, individuals who rely on medication delivery may feel the pain of a decreased resource availability. They may also miss out on the opportunity to discuss their medication-related problems. Pharmacies also need to balance the risks of regular hospital visits with increasing drug supplies to monthly doses.

In addition to all these, rural pharmacies must prepare themselves for the reception of the covid-19 vaccine. They are well-placed to implement delivery of the vaccine, ensuring that everyone gets a dose.

A subtle but real challenge also poses a threat in the dissemination of the vaccine. A study published on the 20th of January shows that an increasing number of the Australian population is uncertain about their willingness to accept the covid-19 vaccine. It’s too soon to tell, but it may fall to rural health care systems to ensure penetration in their communities.

Indeed, community pharmacies have their work cut out for them. But the pharmacy profession is known for swift action and quick responses in the face of medical emergencies.

The solutions: Workflow and regulation changes

Multiple regulatory changes have been implemented over the past months that affect how pharmacies handle patients and prescribe medication. These changes are in response to the challenges listed above, and they are as exhaustive as they are effective.

The Pharmaceutical Society of Australia published a summary of the Covid-19 regulation. Here are some critical highlights.

Image-based prescriptions (Digital image prescriptions)

Digital or image-based prescriptions are transferable from the prescribing practitioner to a pharmacist electronically, without a paper trail. It is a temporary measure implemented to facilitate drug dispensation without the associated sluggishness present in pre-Covid times.

The measure is supported by existing territory regulation, temporary state regulations amendments, and a PBS special arrangement. Prescriptions that don’t qualify to be supplied as digital image prescriptions may be supplied under existing territorial regulations.

Continued dispensing (Supply of essential prescriptions only medicine without prescription in an emergency)

The supply of essential prescriptions only medicine is also known as continued dispensing. It is the supply of essential prescriptions only medication without prescriptions in an emergency. However, the measure is subject to professional and regulatory requirements, as well as existing territorial regulations.

Continued dispensing was limited to statins and oral contraceptives before Covid-19. The measure will probably be lifted when the pandemic passes. But for now, it’s here to stay.

Urgent prescriptions over the phone/fax (owing prescriptions)

Phone orders are used to communicate prescription details to pharmacists via means like phone calls, emails, and faxes. The prescriber may then follow up with a hard-copy prescription to the pharmacist. The ‘delayed paperwork’ is why they are called owing prescriptions.

Owing prescriptions need to be reconciled before new prescriptions can be made via the same means of communication. Unlike the other measures highlighted above, owing prescriptions existed before Covid-19. However, they’ve become more relevant in the pandemic, especially for prescriptions not eligible for digital image prescriptions.

The 3-day rule of emergency supply

Emergency supply gives pharmacists the leverage to prescribe small quantities of prescription only medications, usually a 3-day supply, without a prescription. It’s used when the prescriber cannot be reached, and it requires no follow-up prescription or reconciliation. Medicines supplied under the 3-day rule cannot be changed into full quantity dispensing at a later date.

Provisions under the 3-day rule existed before Covid-19 and may be supplied if the relevant drugs cannot be dispensed under other temporary provisions like the expanded continued dispensing.

The bottom line

The supply of workers remains a major concern for rural communities, and there are certainly rural support programs and opportunities for willing workers.

Read: Eligibility to claim the Intern Incentive Allowance for Rural Pharmacies

In addition to these, pharmacists looking to take up employment in these areas can look forward to a smoother workflow filled with useful adaptations and improved working policies. These include digital image prescriptions, continued dispensing of essential drugs, and owing prescriptions.