Research in Social & Administrative Pharmacy Elsevier Res Social Adm Pharm. 2020 Apr 15 doi: 10.1016/j.sapharm.2020.04.007 [Epub ahead of print] PMCID: PMC7158799 Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from LMICs Irene A. Kretchy,a,∗ Michelle Asiedu-Danso,a and James-Paul Kretchyb Author information Article notes Copyright and License information Disclaimer Associated Data Supplementary Materials Go to: Abstract The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities in managing chronic conditions and promoting medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases. during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries. Keywords: COVID-19, Chronic diseases, Medication adherence, Community pharmacists, Pharmaceutical care, LMICs Go to: Introduction The coronavirus disease 2019 (COVID-19) pandemic is putting a huge strain on healthcare systems worldwide.1 Several developed countries such as the United States of America, United Kingdom, Italy and Spain have had to recruit retired health personnel to help battle the infections. Countries like the United States have contracted car and weapon manufacturers to provide ventilators for affected patients in need of them and to help fight the pandemic in the nation. Hospitals in many affected countries are overburdened and in Italy for example, it was projected that approximately 80% of ICU beds was going to be occupied by patients affected by COVID-19 before April 2020.2 In line with the challenge that this pandemic poses on healthcare systems worldwide, the WHO in recognizing how fragile many of the world's health systems and services were, proposed guidelines for countries to maintain essential health services throughout the pandemic period.3 Healthcare systems in low-and middle-income countries (LMICs) are especially challenged because of the effect this pandemic will have on the already weak health systems in these countries. Before the COVID-19 pandemic, healthcare systems in LMICs faced considerable challenges in providing high-quality, affordable and universally accessible care.4 , 5 These health systems had limited financial resources, inadequate health personnel and unavailable medications.6, 7, 8, 9 Again, inequitable health access within LMICs may be further widened by the COVID-19 pandemic. The socio-economic gap together with poor quality access to health care has become even more glaring in these times. Persons of higher socio-economic standing are more likely to have access to quality health information and medications for chronic health management, given the current challenges with health care personnel, facilities and essential medicines. Chronic diseases which are often managed poorly in persons of low socio-economic standing is going to be further poorly managed and health outcomes can be projected to get worse. For patients who prior to the pandemic could not afford prescription refills and healthy lifestyle adjustments, a deterioration of their condition as a result of poor health accessibility may be imminent. Thus in the face of this global COVID-19 pandemic, although some persons with high socio-economic standing may struggle with keeping up good health behaviors and medication adherence, the projection for persons with low socio-economic status may be rather dire.10
