Patient care and customer services during the COVID-19 pandemic at accredited pharmacies: Pharmacists and patients' perspectives

Abstract

Background
Community pharmacists are now the most accessible healthcare professionals, providing advice, information, drugs, and devices across the globe during the COVID-19 pandemic. In Thailand, accredited community pharmacies meet higher standards than qualified community pharmacies, but little is known about the perspectives of accredited community pharmacists and patients in this emergency situation. This study aimed to assess pharmacists' and patients' perspectives on the challenges and opportunities they faced in providing or receiving patient care and services during the COVID-19 pandemic.

Methods
A cross-sectional study was conducted in March–August 2022 in a province located in the eastern part of Thailand. Participants of the study were full-time pharmacists and patients at accredited community pharmacies. A convergent mixed methods design was used and involved quantitative data about the perspectives of participants measured by online self-administered surveys and qualitative open-ended questions.

Results
Twenty pharmacists and 416 patients provided complete responses. The meta-inferences were expansive in three standards including physical evidence, quality management, and good pharmacy practices/services for both groups of participants. For the social/community involvement standard, pharmacists' and patients' opinions (free-text responses) confirmed their perspective scores.

Conclusions
This study highlights community pharmacy's crucial role in maintaining essential healthcare services during the pandemic, with patients acknowledging and appreciating the dedication of community pharmacists. The mixed methods findings provide valuable insights into pharmacists' and patients' perspectives, facilitating a deeper understanding and exploration of the potential roles community pharmacists can play in a post-pandemic world, embracing new technologies for improved systems.

Full text

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
Available online 21 September 2023
2667-2766/© 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Patient care and customer services during the COVID-19 pandemic at
accredited pharmacies: Pharmacists and patients’ perspectives
Chamipa Phanudulkitti
a
,
*
, Surangkana Puengrung
b
, Karen Bell Farris
c
a
Faculty of Pharmaceutical Sciences, Burapha University, 169 Long Had Bangsaen Rd, Saen Suk, Chon Buri District, Chon Buri 20131, Thailand
b
Independent Researcher, 502 Charunsanitwong 79, Bangphlat District, Bangkok 10700, Thailand
c
University of Michigan College of Pharmacy, 428 Church Street, 3569 NUB, Ann Arbor, MI 48109-1065, United States of America
ARTICLE INFO
Keywords:
Accredited pharmacy
Community pharmacy
COVID-19 pandemic
New Normal pharmaceutical care services
Telepharmacy
ABSTRACT
Background: Community pharmacists are now the most accessible healthcare professionals, providing advice,
information, drugs, and devices across the globe during the COVID-19 pandemic. In Thailand, accredited
community pharmacies meet higher standards than qualied community pharmacies, but little is known about
the perspectives of accredited community pharmacists and patients in this emergency situation. This study aimed
to assess pharmacists’ and patients’ perspectives on the challenges and opportunities they faced in providing or
receiving patient care and services during the COVID-19 pandemic.
Methods: A cross-sectional study was conducted in March–August 2022 in a province located in the eastern part
of Thailand. Participants of the study were full-time pharmacists and patients at accredited community phar-
macies. A convergent mixed methods design was used and involved quantitative data about the perspectives of
participants measured by online self-administered surveys and qualitative open-ended questions.
Results: Twenty pharmacists and 416 patients provided complete responses. The meta-inferences were expansive
in three standards including physical evidence, quality management, and good pharmacy practices/services for
both groups of participants. For the social/community involvement standard, pharmacists’ and patients’ opin-
ions (free-text responses) conrmed their perspective scores.
Conclusions: This study highlights community pharmacy’s crucial role in maintaining essential healthcare ser-
vices during the pandemic, with patients acknowledging and appreciating the dedication of community phar-
macists. The mixed methods ndings provide valuable insights into pharmacists’ and patients’ perspectives,
facilitating a deeper understanding and exploration of the potential roles community pharmacists can play in a
post-pandemic world, embracing new technologies for improved systems.
1. Introduction
Coronaviruses (CoV) are a large family of respiratory viruses causing
mild to severe symptoms of respiratory diseases.
1
Since the rst cases of
Corona Virus Disease 2019 (COVID-19) were detected in China (Wuhan)
in late 2019,
2
community pharmacies were among the few essential
services that kept their activities ongoing during the emergency and the
lockdown.
3
They have become the frontline healthcare professionals
with the most accessible point of care providing advice, information,
drugs, and devices to the entire population.
3,4
Several studies explored the perspectives of community pharmacists
and patients during the pandemic. A number of community pharmacists
faced difculties in providing their best pharmaceutical care services
including shortages of essential pharmaceutical products,
5
pharmacists’
job-related stress, long hours, and burn-out,
4
as well as impacts of the
pandemic on vulnerable populations.
6
Taking patients’ perspectives into
account, it was necessary for pharmacies to prioritize the maintenance,
adjustment, or adaptation of their services in conjunction with the
development of information technology (IT) infrastructure, alongside
the coordination of primary care services.
7
In Thailand, community pharmacies are categorized into two groups,
Good Pharmacy Practice (GPP) community pharmacies, and accredited
community pharmacies. All community pharmacies are obligated to
adhere to the Good Pharmacy Practice (GPP) standards, which serve as
the minimum requirement for pharmacies. However, obtaining certi-
cation as an ‘accredited pharmacy’ was optional.
8
The Thai GPP
* Corresponding author.
E-mail addresses: chamipa@go.buu.ac.th (C. Phanudulkitti), kfarris@med.umich.edu (K.B. Farris).
Contents lists available at ScienceDirect
Exploratory Research in Clinical and Social Pharmacy
journal homepage: www.elsevier.com/locate/rcsop
https://doi.org/10.1016/j.rcsop.2023.100336
Received 17 August 2023; Received in revised form 20 September 2023; Accepted 20 September 2023

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
2
standards encompass four domains that pharmacies must adhere to: (1)
places and equipment, (2) personnel, (3) quality control, and (4) phar-
macy services.
9
With higher standards, accredited pharmacies are sub-
ject to a more comprehensive set of ve standards, which include
physical evidence, quality management, good pharmacy practice/ser-
vices, law and ethics, and social/community involvement. Furthermore,
accredited pharmacies require the continuous presence of pharmacists
throughout their business hours, whereas GPP pharmacies permit
pharmacists to be present for a specic portion of their operating hours.
This study primarily centered on accredited pharmacies due to their
elevated standards and the consistent availability of full-time pharma-
cists. Across the country, there were over 1600 accredited community
pharmacies offering healthcare services, such as the Near-home Medi-
cine Pick-up Project (aimed at patients enrolled in Universal Health
Coverage (UHC) programs, with well-managed non-complicated con-
ditions, enabling them to personally collect prescribed medications from
pharmacies situated near their residences), and actively participating in
various COVID-19-related campaigns, including home isolation and the
distribution of free Antigen Test Kits (ATK), all authorized by the Min-
ister of Public Health (MoPH) of Thailand.
10
At the present time, there is limited available information regarding
the perspectives of pharmacists employed at accredited community
pharmacies and of patients who have received patient services from
these pharmacies in the context of the emergency situation. This
research focused on accredited pharmacies located in Chonburi prov-
ince, Thailand, with a particular emphasis on four selected standards
known for their relevance to patient care and services. These standards
encompass physical evidence, quality management, good pharmacy
practices/services, and social/community involvement. The study in-
cludes participation from full-time pharmacists at each accredited
pharmacy and patients served by these pharmacies. The ndings of this
study could be shared with other pharmacies across the country as well
as other countries so that they can prepare themselves for any further
uncertain situations in the future. This study aimed to (1) assess phar-
macists’ perspectives on the challenges and opportunities they faced in
providing patient care and services during the COVID-19 pandemic,
with a focus on the four standards, and (2) assess patients’ perspectives
on the challenges and opportunities they faced in receiving patient care
and services during the COVID-19 pandemic, in relation to the four
standards.
2. Methods
A convergent mixed-methods design (Fig. 1) was employed to capi-
talize on the strengths of quantitative data obtained from surveys with
complementary qualitative data. Mixed-methods research refers to an
approach in which researchers collect, analyze, and integrate both
quantitative and qualitative data, enabling them to draw interpretations
based on the combined merits of these data types. In the present study, a
convergent design was adopted, wherein both types of data were
collected and analyzed concurrently. Separate analyses were conducted
for pharmacists and patients to ensure a comprehensive understanding
of their attitudes toward patient care and services during the COVID-19
pandemic. The cross-sectional survey was conducted between March
and August 2022. All research materials and protocols were approved by
the Institutional Review Board committee, Burapha University (Project
No. HS013/2565; Approval No. IRB1–023/2565; approved on February
25, 2022). An electronic informed consent from anonymous participants
was added as an initial cover page before their online survey started with
emphasis on voluntary participation and withdrawal withoutproviding
a reason.
Fig. 1. Mixed methods convergent design.
C. Phanudulkitti et al.

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
3
2.1. Participants
Based on preliminary calls, 20 out of the 33 accredited community
pharmacies in Chonburi province (61%) agreed to participate in this
study. Patient sample size determination was aided by Open-source
Epidemiologic Statistics for Public Health version 3 (OpenEpi), acces-
sible at https://www.openepi.com. This tool facilitated the computation
of sample size using parameters based on a 95% condence level, a 5%
margin of error, a hypothesized response distribution of 50%, design
effect, and population size. As a result, the calculated minimum sample
size requirement was 385 patients. Each participating pharmacy enlisted
a full-time pharmacist and approximately 20 patients, resulting in a total
of 20 pharmacists and around 400 patients as study participants,
employing a convenience sampling method. The survey itself took
approximately 10–15 min to complete.
2.2. Study instruments
Two sets of questionnaires were created, one tailored for pharmacists
and another specically designed for patients, drawing upon the four
standards outlined in the Ofce of Community Pharmacy Accredita-
tion’s guideline for pharmacy accreditation.
11
The face validity of these
questionnaires was reviewed by three experts. Content validity of the
questionnaires was assessed by three experts in accredited community
pharmacies, education, and survey development. The content validity
index (CVI) values for these two instruments were both 1.00, indicating
good content validity.
The pharmacist questionnaire (Appendix A) consisted of 22 items in
two sections; the rst had 18 items focused on the four standards,
physical evidences, quality management, good pharmacy practices/
services, and social/community involvement, and the second section
had four items focused on demographic information. A 4-point Likert
scale (4 =strongly agree to 1 =strongly disagree) was used for 12 items
in Section 1, and six were open-ended questions. To evaluate the reli-
ability of the questionnaire, the authors calculated Cronbach’s alpha
coefcients for each dimension. The resulting coefcients were as fol-
lows: 0.74 for physical evidences, 0.81 for quality management, 0.87 for
good pharmacy practices/services, and 0.71 for social/community
involvement. These values indicated good internal consistency within
each dimension, afrming the questionnaire’s reliability.
The patient questionnaire (Appendix B) consisted of 21 items that
was divided into two sections. Section one had 13 items asking level of
agreement about the four standards, physical evidence, quality man-
agement, good pharmacy practices/services, and social/community
involvement. Five open-ended questions were included. Section two
asked 3 demographic questions. To assess the questionnaire’s reliability,
the authors computed Cronbach’s alpha coefcients for each dimension.
The obtained coefcients were as follows: 0.71 for physical evidence,
0.85 for quality management, 0.88 for good pharmacy practices/ser-
vices, and 0.81 for social/community involvement. These values
demonstrate strong internal consistency within each dimension, con-
rming the questionnaire’s reliability.
2.3. Data collection
The study brochure invitations and surveys, which included essential
participant information in Google form links and QR codes, were
distributed to the full-time pharmacist of each pharmacy via their con-
tact email. Each pharmacy received unique links and QR codes. Two sets
of surveys were provided for each pharmacy: one for the full-time
pharmacist and another for patients. Pharmacists assisted in the print-
ing of the patient survey’s link and QR code, making them available on
the counter for interested patients to access. Researchers consistently
monitored the online responses. Once the expected number of re-
spondents was reached, the researcher exported the data from Google
Forms, conducted completeness checks, and performed the analysis.
2.4. Data analysis
Descriptive statistics were used to determine means and standard
deviations. The analysis was conducted using SPSS version 24 (SPSS
Inc., Chicago, Illinois). Qualitative components of the surveys were
analyzed by using content analysis. Coding written data was done by
two researchers (CP and SP) by identifying and dening themes, and
grouping written data into a specic theme/domain using Microsoft
Excel. Consensus between the two coders was obtained. Results from the
qualitative and quantitative analyses were explicitly merged through a
side-by-side comparison to assess for conrmation, expansion, or
discordance between the results and to draw meta-inferences. Pharma-
cist and patient responses were 19 and 127, respectively. Integration at
the reporting level occurred through weaving (matched construct-by-
theme descriptions) and joint displays. Conrmation occurred if the
ndings from both types of results reinforced each other. Expansion
occurred when the ndings from the two datasets overlapped and
additional insights of attitude changes were identied as different or
complementary aspects. Discordance occurred if the results were
inconsistent, contradictory, or disagreed with each other.
3. Results
3.1. Participant characteristics
Of the 20 accredited pharmacies, 80% (n =16/20) were chain stores,
while 15% (n =3/20) and 5% (n =1/20) were stand-alone pharmacies
and faculty-owned, respectively. The majority of these pharmacies
(40%, n =8/20) had been in business for 11–15 years. Most (90%, n =
18/20) allowed customers to enter the pharmacy during the COVID-19
pandemic. Of the 20 pharmacists, 70% (n =14/20) were female and
55% (11/20) were between 26 and 35 year-old. Fifty percent of the
pharmacists (n =10/20) had worked in pharmacies for 5–10 years. The
characteristics of each pharmacist (n =19/20) who provided open-
ended responses are displayed in Table 1. Of the 416 patients, 72.35%
(n =301/416) were female. Majority of respondents were aged between
26 and 35 year-old (34.86%, n =145/416) and had visited the phar-
macies for about 1–3 years (45.91%, n =191/416). Among the patients
who provided open-ended responses (n =127/416), 67.70% (n =86/
127) were female. Additionally, 35.40% (n =45/127) of these open-
ended responders were between 26 and 35 years, while 36.20% (n =
46/127) had visited the pharmacies for about 1–3 years.
Table 1
Characteristics of informants – Pharmacists (n =19).
Informant
code
Gender Age Experience in
community
pharmacy (years)
Duration of the
community pharmacy’s
operation (years)
P01 Male 26–35 5–10 11–15
P02 Female 26–35 5–10 11–15
P03 Female 46–55 5–10 11–15
P04 Female 26–35 5–10 11–15
P05 Female 36–45 11–15 5–10
P06 Female 26–35 5–10 5–10
P07 Female 26–35 5–10 5–10
P08 Female 26–35 <5 5–10
P09 Male 20–25 <5 <5
P10 Female 26–35 5–10 <5
P11 Male 20–25 <5 >20
P12 Female 36–45 11–15 11–15
P13 Female >55 >20 16–20
P14 Male 26–35 5–10 11–15
P15 Female 36–45 11–15 11–15
P16 Male 36–45 5–10 5–10
P17 Female 26–35 <5 >20
P18 Male 26–35 <5 >20
P19 Female 26–35 <5 5–10
C. Phanudulkitti et al.

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
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3.2. Pharmacists’ perspectives
The results showed that mean agreement scores regarding the four
standards, physical evidence, quality management, good pharmacy
practices/services, and social/community involvement, of accredited
pharmacies were 2.55 (0.84), 2.28 (0.78), 2.42 (0.79), and 1.92 (0.76),
respectively. The mean scores of physical evidence, quality manage-
ment, good pharmacy practices/services standards were rated ‘Moder-
ate’ (2.01–3.00) whereas the mean score of social/community
involvement standard was considered ‘Low’ (1.00–2.00).
12
3.3. Patients’ perspectives
The results showed that the mean agreement scores regarding the
four standards, physical evidence, quality management, good pharmacy
practices/services, and social/community involvement, of accredited
pharmacies were 2.22 (0.99), 2.24 (1.00), 2.18 (1.01), and 3.11 (0.91),
respectively. The mean scores of physical evidence, quality manage-
ment, good pharmacy practices/services standards were rated ‘Moder-
ate’ (2.01–3.00) whereas the mean score of social/community
involvement standard was considered ‘High’ (3.01–4.00).
12
3.4. Qualitative ndings
Content analysis of the qualitative data was completed, and exem-
plary quotes were provided for each theme that was relevant to the
specic standards – physical evidence, quality management, good
pharmacy practices/services, and social/community involvement (Ta-
bles 2, 3, 4, and 5). Physical evidence was focused on limited access,
using partitions, queuing, and sanitation. Quality management included
personal health and hygiene, patient referral system, and patient history
taking. Good pharmacy practices/services were illustrated by good in-
ventory management, communication between patients and pharma-
cists, and patient counseling. Social/community involvement was
focused on providing healthcare and medicine information to people
living in communities, and supporting governmental healthcare cam-
paigns. Qualitative ndings reported by pharmacists and patients for
physical evidence, quality management, and good pharmacy practices/
services standards elaborated their consideration and suggestions on the
particular standards.
Overall feedback was also obtained related to possibilities for com-
munity pharmacy service improvement. The outstanding theme
emerging from general comments by pharmacists and patients was
about increasing online services. For pharmacists, the theme named
increasing online and technological services covered “continuously
support the use of technology”, and “a pharmacy should have online
channels for customers to access information and counsel with phar-
macists in order to reduce the risk of COVID-19 infection. Also, tele-
pharmacy is highly recommended to implement in pharmacies with
good consideration of legal and ethics”. More online services was also a
theme included in patients’ overall feedback. They mentioned “Please
consider implementing new technology and innovation in pharmacies
for more convenience”, “More service options such as application for
medication counseling or healthcare product information”, and “Due to
specic and limited service hours of pharmacies, please consider having
online channels so that customers can access anytime”. Other themes
pharmacists suggested for improvement included governmental
healthcare projects; “All accredited pharmacies should participate in
Table 2
Joint display of quantitative, qualitative, and mixed methods meta-inferences of physical evidence.
“Physical evidence”
Pharmacists Patients
Perspective
M (SD)
Qualitative Sources/ Related themes Meta-Inferences Perspective
M (SD)
Qualitative Sources/
Related themes
Meta-Inferences
2.6 (0.8) Sanitation concern
“I adopted vigilant measures against
the spread of COVID-19 infection by
cleaning service areas with alcohol,
managing social distance, having
partition, and cleaning more
frequently.” [P17]
“It was important to continuously
arrange and clean service areas to
protect the spread of pandemic.”
[P01]
New normal service consideration
“Due to the pandemic, new
communication channels like
telemedicine or social media could be
considered as they can decrease
contamination/infection. However,
these new normal ways were not quite
well-known and widely adopted.”
[P03]
“There were various new channels
and options in selling healthcare
products including providing
pharmacy services especially via
online platforms which have been
increasingly used by people.” [P19]
Expansion
Participants described their
understanding of the situation and
concerned about the sanitation of
service areas. They also suggested for
new selling and communication
channels such as online/social
platforms.
2.2 (1.0) No/Little effect
“There was no problem
because it was a part of
social distance.” [C091]
“No effect. I can talk with
pharmacists as usual”
[C088]
Appreciating with
social distance and
hygiene service
processes
“The vigilant measures
were good as they made
us safe.” [C044]
“Very appropriate”
[C010]
Long queue/ social
distance
“I spent longer time”
[C093]
“I faced difculties in a
long queue” [C098]
Difculties in having
partitions
“Due to limited access and
having partition, patients
and pharmacists had less
counseling time” [C099]
“It was difcult to see
medical products through
partitions.” [C105]
Expansion
Participants described their
understanding of the situation
and appreciate the prevention
measures. Some were
uncomfortable with queuing and
partitions.
C. Phanudulkitti et al.

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
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Table 3
Joint display of quantitative, qualitative, and mixed methods meta-inferences of quality management.
“Quality management”
Pharmacists Patients
Perspective
M (SD)
Qualitative Sources/ Related themes Meta-Inferences Perspective
M (SD)
Qualitative Sources/ Related
themes
Meta-Inferences
2.3 (0.8) Sanitation concern
“It was sort of increasing workload of
pharmacies in term of personal hygiene,
wearing gloves, providing alcohol gel,
and cleaning service areas contacted
with infected patients.” [P14]
“Always consider about hygiene, and
social distancing. I had to modify or
adjust the ways of services to protect
infection.” [P01]
Patient referral concern
“Pharmacies should make more efforts in
collaboration with hospitals to facilitate
patients.” [P03]
“During the pandemic, referring patients
to hospitals was difcult due to limited
access and full occupancy of inpatient
rooms. Collaboration and
communication between pharmacies and
hospitals should be easier in the future.”
[P07]
Expansion
Participants understood about the
importance of pharmacies’ quality
management especially personal
hygiene and health. They also
considered if collaboration processes
of patient referrals could be more
efcient.
2.2 (1.0) No/Little effects “Not at all”
[C059]
“Little effects” [C085]
Communication on health
problems/Needs
“Overall, I understood what a
pharmacist suggested.
However, I preferred faster
processes.” [C120]
“Not clearly heard and it
could make misunderstood”
[C078]
Expansion
Participants considered if
the communication
processes can be clearer
and faster.
Table 4
Joint display of quantitative, qualitative, and mixed methods meta-inferences of good pharmacy practices/services.
“Good pharmacy practices/services”
Pharmacists Patients
Perspective
M (SD)
Qualitative Sources/ Related themes Meta-Inferences Perspective
M (SD)
Qualitative Sources/
Related themes
Meta-Inferences
2.4 (0.8) Medical supply concern
“Inventory management during the over
demand situation was very challenging
for me.” [P03]
“During the pandemic, it was difcult to
order healthcare products related to
COVID-19 symptoms. They were also
overpriced. We should have the control
on this.” [P07]
Patient counseling concern
“Have to study more on the new diseases
and medicines. Moreover,
communication and counseling skills
with patients have to be enhanced.”
[P16]
“I have to study more about the new
disease including prevention processes
in order to share them with my patients.
I should keep update on new healthcare
products and treatment guideline.”
[P17]
Expansion
Participants expressed their
concerns about challenges in
inventory management and
knowledge updates during the
pandemic.
2.2 (1.0) No/Little effects
“Little effect. We should
support and understand
roles of pharmacists”
[C090]
“No effect” [C117]
Good pharmacist service
“Very good services. Please
continue.” [C015]
“I got clear, accurate, and
trustworthy information.”
[C039]
Medical supply concern
“It was difcult to buy
some medicines. Also, they
were more expensive than
usual situation.” [C101]
“Face masks and alcohol
were sometime out of stock
because of hoarding the
supplies.” [C056]
Patient counseling
concern
“unmet needs for some
essential medical supplies
and less patient
counseling.” [C099]
“may receive uncomplete
medical suggestions from
pharmacists.” [C026]
Expansion
Participants describe their
understanding of their pharmacies’
GPP. However, there were some
challenges in shortage of health
products and limited counseling
time.
C. Phanudulkitti et al.

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
6
National Health Security Ofce (NHSO) projects”, “Pharmacy universal
precaution practices can be considered as a good example of healthcare
practice for communities”, and “A connecting system between phar-
macies and hospitals should be more practical and efcient so that it can
ease crowd of patients at hospitals”. Many patients thought that they
had received good pharmacy services - “Pharmacists and pharmacist
assistants provided great advices”, and “This pharmacy provided very
good services particularly proactive prevention information and helpful
recommendation”.
3.5. Mixed method ndings
The mixed method results (Meta-inferences) of each standard
(physical evidence, quality management, good pharmacy practices/
services, and social/community involvement) were presented in Ta-
bles 2, 3, 4, and 5, respectively. The meta-inferences were expansive in
three standards including physical evidence, quality management, and
good pharmacy practices/services. For example, the pharmacists’
consideration of physical evidence was neither supportive nor discor-
dant with the quantitative ndings. Rather, the qualitative results
expanded the understanding of the concept of physical evidence and
suggested effective ways of practice.
4. Discussion
Among the four selected standards for accredited pharmacies, social/
community involvement emerged as the most prominent standard. Both
pharmacists and patients acknowledged the pharmacies’ remarkable
contributions in maintaining essential healthcare services throughout
the pandemic. Patients expressed deep appreciation for the dedication
that pharmacists demonstrated to their communities.
For the social/community involvement standard, pharmacists and
patients agreed that this standard was outstanding during the COVID-19
crisis and the qualitative ndings conrmed their perspectives. When
considering the social/community involvement standard, both phar-
macists and patients found it to be particularly important during the
COVID-19 crisis, and qualitative ndings supported their perspectives.
Pharmacists rated the mean agreement scores for this standard as “Low,”
indicating that they were unlikely to encounter difculties in providing
patient care and services according to this standard. Conversely, patients
Table 5
Joint display of quantitative, qualitative, and mixed methods meta-inferences of social/community involvement.
“Social/community involvement”
Pharmacists Patients
Perspective
M (SD)
Qualitative Sources/ Related themes Meta-Inferences Perspective
M (SD)
Qualitative Sources/ Related
themes
Meta-Inferences
1.9 (0.8) Healthcare information provider
“… pharmacies were the rst line
healthcare services including
providing information and better
understanding about the COVID-19
infection to people.” [P02]
“… people in communities will get
better knowledge, access to
medicine, and health information
rather than getting these from social
media.” [P03]
Community support
“During the pandemic, I
collaborated with National Health
Security Ofce (NHSO), supported
communities, and provided care to
patients more than usual…” [P01]
“There was an increase of number of
people in the community visited
pharmacies during the pandemic.
They contacted pharmacists via Line
application, and asked to reported
their ATK results via Mohpromt
application…” [P08]
Challenges in participating with
governmental healthcare
campaigns
“There were several and complex
working processes of NHSO projects
including payment processes….”
[P04]
“I have been participated with many
NHSO projects…… I faced with
some challenges in stock
management such as lacks of
medicines and healthcare products
at the beginning period of projects
and overstocking at later periods…”
[P18]
Conrmation
Participants highly
understood about their roles
in community involvement
especially health
information support.
Expansion
Participants faced some
difculties in participating
with NHSO projects due to
the complex and time-
consuming working
processes.
3.1 (0.9) No/Little effects “Not affect me”
[C076]
“No problem” [C063]
Support health care/service
during COVID-19
“Apart from medical selling and
counseling, I just have known that
there were various community
projects supported by pharmacies.
Please continue having new
projects.” [C104]
“I participated in COVID-19 home
isolation with this pharmacy and I
got very helpful information and
good care. I also known that there
were other useful services.”
[C108]
“This pharmacy has a very good
contribution. They gave ATK for
free for low-income people.”
[C013]
Health information services
“The community gained better
health knowledge from this
pharmacy.” [C086]
“Provided useful information
about basic knowledge of some
diseases” [C110]
Conrmation
Participants conrmed that their
pharmacies supported
communities in term of providing
health information and distributing
essential medicine and healthcare
products to COVID-19 infected
patients.
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Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
7
rated the mean agreement scores as “High,” underlining their recogni-
tion of the pharmacies’ dedication to delivering patient care and ser-
vices. They both recognized important roles of accredited community
pharmacists especially in providing information related to health and
supporting primary patient care such as home isolation, COVID-19
testing with antigen test kits, and other self-care consultation. Several
studies supported this nding that one of the most crucial roles of
community pharmacists during the COVID-19 outbreak was providing
reliable information on several health-related and drug-related aspects
or serving as an information hub, and served as a means to debunk fake
news.
3,13,14
Facilitating self-isolation, supporting point-of-care testing
(i.e., COVID-19 antigen test kits), and empowering people, families, and
communities were considered crucial roles of community pharmacists in
the aspect of social/community involvement during the pandemic.
2,14,15
Although there were a number of governmental healthcare projects and
campaigns during the pandemic in Thailand, the COVID-19 vaccine
administration was not yet available at the accredited community
pharmacies. This was different from many countries such as the USA,
Canada, England, Jordan, and Switzerland, where community phar-
macists were responsible for the vaccine administration.
16–18
This study
revealed that the pharmacists understood their social involvement roles
and were willing to support their communities. However, they faced
some difculties in participating in the governmental healthcare cam-
paigns, as their qualitative results expanded the perspectives of social/
community involvement. They experienced more workload, complex,
and time-consuming processes. A couple of studies found similar trends
in terms of a high inux of patients into the pharmacy, working for
extended hours, and more complicated activities.
2,7,15
Pharmacists’ and patients’ perspectives on the other three standards
were moderate. This might be because the scope of work for these three
standards was not as crucial as the social/community involvement
during the COVID-19 pandemic. Moreover, it may relate to the timing of
data collection of this study which was in mid-2022, when people were
less scared and less critical. If we collected data during the middle of the
pandemic, the results could be different. However, the mixed-method
analyses provided additional insights to expand perspectives on these
three standards with mostly recommendations for improvement. For
instance, pharmacists suggested using more online platforms and social
media to provide services whereas patients described their appreciation
of preventive measures but felt uncomfortable with queuing and parti-
tions for the standard of ‘physical evidence’.
Apart from the four standards of accredited community pharmacies
in Thailand, pharmacists and patients raised the same general comment
emphasizing the importance of information technology (IT) including
telepharmacy, online consultation, mobile application, and social media
during the pandemic. This nding was echoed by several studies. Dat
and colleagues (2022) in Vietnam revealed that 87.2% of participating
pharmacists were willing to apply telepharmacy in their practice.
19
In
Northern Ireland, there was a call for investment in better IT systems and
a strong support for a change to IT pharmaceutical services by com-
munity pharmacists who worked in the periods of the COVID-19
pandemic.
7
Nearly 90% of general population excluding pharmacists,
physicians, and pharmacy students in Arabic countries supported the
idea of creating a website provision of telemedicine and pharmaceutical
care services.
20
The importance of these technologies during the crisis
situation included remote pharmaceutical services with respect to home
quarantined patients with chronic diseases, continuity of care for high-
risk groups while allowing for social distancing and minimizing the risk
of infection, and managing multiple healthcare services by integrating
diverse eHealth components and collaboration with all
stakeholders.
14,15,20
From the pharmacists’ and patients’ perspectives, this study rec-
ommends maintaining social and community involvement between
community pharmacists and patients, and increasing the use of tech-
nology in pharmacy services. Policy- and decision-makers should pri-
oritize comprehensive national guidelines for community pharmacists to
prepare for future public health crises. These should cover Standard
Operating Procedures (SOPs), safety and training programs, health-
related information dissemination, and collaboration with other
healthcare professionals. Examples include creating patient interaction
protocols and managing increased medication and PPE demand, estab-
lishing emergency preparedness initiatives, ensuring access to reliable
health information for the public, and fostering effective communication
among interdisciplinary teams. IT infrastructure and online platforms
should be also effectively implemented in community pharmacies with
appropriate and practical regulations. Lastly, compensation to recognize
increased workload and stress are crucial aspects for consideration in
response to these heavy and costly contributions of community phar-
macists to society.
The strength of this study is the integration of the quantitative and
qualitative analyses from pharmacists and patients at the accredited
pharmacies that resulted in meta-inferential ndings. There are, how-
ever, some limitations. The generalizability of this study is limited by the
small number of accredited pharmacies which mostly were chain stores
from one province, Chonburi. Some of the qualitative comments sug-
gested improvements that could be pursued. Furthermore, it’s important
to note that the evaluation did not cover all aspects of accredited
pharmacy standards. Yet, these results quantify the value of national
health policies for accredited pharmacy initiatives during the pandemic
and raise some issues for future study. Future work should expand this
healthcare concept to other qualied community pharmacies or clinics
and invest in technologies and innovation supports.
5. Conclusion
In conclusion, pharmacists’ and patients’ recognized community
pharmacies contributions to maintain essential healthcare services
during the pandemic and patients appreciated what community phar-
macists had devoted to society. This leads to a consideration of the roles
community pharmacists can play in the post-pandemic world with new
normal lifestyle and better systems of online technologies.
Financial disclosure
This work was nancially supported by the Research Grant of the
Faculty of Pharmaceutical Sciences, aBurapha University (Grant no.
Rx7/2565).
Author contribution
All authors (CP, SP, and KF) contributed to the study’s conception
and design. Material preparation and data collection were performed by
CP. Data analyses were performed by SP and CP. The rst draft of the
manuscript was written by CP and reviewed and edited by KF. All au-
thors read and approved the nal manuscript.
Funding
This work was nancially supported by the Research Grant of the
Faculty of Pharmaceutical Sciences, Burapha University (Grant no.
Rx.7/2565).
Ethical disclosure
All research materials and protocols were approved by the Institu-
tional Review Board committee, Burapha University (Project No.
HS013/2565; Approval No. IRB1–023/2565; approved on February 25,
2022).
Declaration of Competing Interest
The authors declare that they have no known competing nancial
C. Phanudulkitti et al.

Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
8
interests or personal relationships that could have appeared to inuence
the work reported in this paper.
Data availability
The datasets used and analyzed during the current study are avail-
able from the corresponding author on reasonable request.
Appendix A. Pharmacist survey
Please answer the following questions based on your experiences during the COVID-19 pandemic in Thailand.
A.1. Section 1: Standards
A.1.1. Physical evidence
 
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
A.1.2. Quality management
    
    
’
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
A.1.3. Good pharmacy practices/services
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Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
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’
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
Q1: I faced difculties procuring COVID-19-related medications and medical supplies to meet my
A.1.4. Social/community involvement
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
A.1.5. General comments/suggestions
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
A.2. Section 2: Demographic
  
  
 
  
 
  
 
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Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
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Appendix B. Patient survey
Please answer the following questions based on your experiences during the COVID-19 pandemic in Thailand.
B.1. Section 1: Standards
B.1.1. Physical evidence
    
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
B.1.2. Quality management
’
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
B.1.3. Good pharmacy practices/services
    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
B.1.4. Social/community involvement
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Exploratory Research in Clinical and Social Pharmacy 12 (2023) 100336
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    
    
    
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
B.1.5. General comments/suggestions
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
B.2. Section 2: Demographic
  
  
  
  
 
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