The role of primary care pharmacists in the response to the Zika epidemic

Keywords: Zika Virus Infection, Zika Virus, Epidemics, Pharmacists, Pharmaceutical Services, Professional Role, Counseling, Infant, Pregnant Women, Public Health, Primary Health Care, Qualitative Research, Brazil

Abstract

Background: Zika virus (ZIKV) infection emerged in Brazil in 2015, leading to the declaration of a national public health emergency, mainly due to its consequences for pregnant women and newborn babies. The Zika epidemic demanded major efforts from the public health system to address the full range of disease consequences.

Objective: The objective of this study was to investigate the role of Primary Health Care pharmacists working in the city of Campo Grande in the State of Mato Grosso do Sul.

Methods: A qualitative cross-sectional interview-based study with pharmacists working in municipal Primary Health Care services was carried out to investigate knowledge about the disease and involvement in the response to the health emergency. Informed consent was obtained. After coding, the corpus underwent thematic analysis.

Results: The data show that few professionals had received specific training in public health. Knowledge largely encompassed disease transmission by the mosquito and collective and individual preventive measures. Findings highlight knowledge gaps relating to signs and symptoms, diagnosis, consequences of infection, and the role of epidemiological surveillance. Most professionals mentioned at least one of the recommendations on the use of medicines in symptom management protocols. The practical implications surrounding knowledge gaps and misconceptions were reflected in pharmacists´ role in response, restricted to counselling on preventive measures. Few respondents participated in institutional groups and committees or in multiprofessional teams involving case management.

Conclusions: The study identified important knowledge gaps and showed that the involvement of pharmacy professionals in the response to the Zika epidemic was timid or inadequate. The results also suggest that pharmacists failed to recognize their role in interventions related to the ZIKV epidemic. Findings highlight the need to increase the involvement of primary care pharmacists in community-based actions, for communication and reduction of health risks, and emergency preparedness and response.

Downloads

Download data is not yet available.

References

Brazilian Ministry of Health. Ministry of Health announces end of Public Health Emergency for Zika. http://portalarquivos.saude.gov.br/images/pdf/2017/maio/11/11.05.2017_Coletiva%20Zika.pdf (accessed Jan 11, 2019).

World Health Organization. Zika: Then, now, and tomorrow. https://www.who.int/emergencies/zika-virus/articles/then-now-hugonnet/en/ (accessed Nov 7, 2019).

Brazilian Ministry of Health. [Congenital syndrome associated with Zika virus infection: epidemiological situation, actions developed and challenges, 2015 a 2019]. Bol Epidemiol Secretriat Health Surveillance. 2019;50(esp):1-31.

Miranda ES, Fitzgerald JF, Osorio-de-Castro CG. A methodological approach for the evaluation of preparedness of pharmaceutical services. Rev Panam Salud Publica. 2013;34(5):312-320.

Pimenta-de-Souza P, Miranda ES, Osorio-de-Castro CG. Preparação da assistência farmacêutica para desastres: um estudo em cinco municípios brasileiros [Preparedness of pharmaceutical assistance for disasters: a study in five Brazilian municipalities]. Cien Saude Colet. 2014;19(9):3731-3742. https://doi.org/10.1590/1413-81232014199.01412014

Brazilian Ministry of Health. Protocol for surveillance and response to the occurrence of microcephaly and / or changes in the central nervous system (CNS). http://www.saude.gov.br/images/pdf/2016/marco/24/Microcefalia-Protocolo-vigil--ncia-resposta-versao2.1.pdf (accessed Sep 27, 2019).

Municipal Health Department. [With the expansion of UBSFS, assistance totals almost 1 million in 2018]. http://www.campogrande.ms.gov.br/cgnoticias/noticias/com-expansao-das-ubsfs-atendimentos-somam-quase-1-milhao-em-2018/ (accessed Sep 27, 2019).

National Health Council. [Resolution Nº 338, May 6, 2004. Approves the Brazilian Pharmaceutical Services Policy]. https://bvsms.saude.gov.br/bvs/saudelegis/cns/2004/res0338_06_05_2004.html (accessed Sep 27, 2019).

Regional Pharmacy Council (CRF-MS). [Campo Grande City Hall expands clinical pharmacy services in health units]. https://www.crfms.org.br/noticias/farmacia/4228-prefeitura-de-campo-grande-amplia-atendimento-de-farmacia-clinica-nas-unidades-de-saude (accessed Oct 10, 2019).

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. https://doi.org/10.1093/intqhc/mzm042

Brazilian Ministry of Health. [Ministry of Health announces end of Zika Public Health Emergency]. http://portalarquivos.saude.gov.br/images/pdf/2017/maio/11/11.05.2017_Coletiva%20Zika.pdf (accessed Nov 1, 2019).

Brazilian Society of Infectious Diseases. [Zika virus management guide]. http://www.epi.uff.br/wp-content/uploads/2013/10/Guia_Manejo_Zika_SBI.pdf (accessed Mar 13, 2020).

Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-1907. https://doi.org/10.1007/s11135-017-0574-8

Municipal Health Department. [City Hall calls 499 approved candidates]. http://www.campogrande.ms.gov.br/cgnoticias/noticias/prefeitura-convoca-499-candidatos-aprovados-em-concursos-dos-anos-de-2013-e-2016/ (accessed Oct 22, 2019).

Junqueira Tda S, Cotta RM, Gomes RC, et al. As relações laborais no âmbito da municipalização da gestão em saúde e os dilemas da relação expansão/precarização do trabalho no contexto do SUS [Labor relations under decentralized health management and dilemmas in the relationship between work expansion and casualization in the Brazilian Unified National Health System]. Cad Saude Publica. 2010;26(5):918-928. https://doi.org/10.1590/s0102-311x2010000500014

Fiocruz Mato Grosso do Sul. [Specialization in Primary Care and Family Health]. http://www.matogrossodosul.fiocruz.br/educacao/especializacao (accessed Dez 6, 2019).

Mato Grosso do Sul State Health Department. [Specialization Course in Public Health]. https://www.esp.ms.gov.br/curso-de-especializacao-em-saude-publica/ (accessed Jan 18, 2020).

Barberato LC, Scherer MDDA, Lacourt RMC. The pharmacist in the Brazilian Primary Health Care: insertion under construction. O farmacêutico na atenção primária no Brasil: uma inserção em construção. Cien Saude Colet. 2019;24(10):3717-3726. https://doi.org/10.1590/1413-812320182410.30772017

Aruru M, Truong HA, Clark S. Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond. Res Social Adm Pharm. 2021;17(1):1967-1977. https://doi.org/10.1016/j.sapharm.2020.04.002

Rajiah K, Maharajan MK, Yin PY, Yee YW, Lin WW, Kean CH. Zika Outbreak Emergency Preparedness and Response of Malaysian Private Healthcare Professionals: Are They Ready?. Microorganisms. 2019;7(3):87. https://doi.org/10.3390/microorganisms7030087

Oster AM, Brooks JT, Stryker JE, et al. Interim Guidelines for Prevention of Sexual Transmission of Zika Virus - United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(5):120-121. https://doi.org/10.15585/mmwr.mm6505e1

Custódio JMO, Nogueira LMS, Souza DA, et al. Abiotic factors and population dynamic of Aedes aegypti and Aedes albopictus in an endemic area of dengue in Brazil. Rev Inst Med Trop Sao Paulo. 2019;61:e18. https://doi.org/10.1590/s1678-9946201961018

Mato Grosso do Sul State Health Department. [Epidemiological Bulletin of Dengue]. https://www.vs.saude.ms.gov.br/boletins-epidemiologicos-de-dengue/ (accessed Jul 16, 2020).

Costa EM, Rabelo ARM, Lima JG. Evaluation of pharmacist's role in health promotion and disease prevention in primary care. Rev Ciênc Farm Básica Apl. 2014;35(1):81-88.

Rocha MS, Bartholomay P, Cavalcante MV, et al. Notifiable Diseases Information System (SINAN): main features of tuberculosis notification and data analysis. Sistema de Informação de Agravos de Notificação (Sinan): principais características da notificação e da análise de dados relacionada à tuberculose. Epidemiol Serv Saude. 2020;29(1):e2019017. https://doi.org/10.5123/s1679-49742020000100009

Freitas CF, Osorio-de-Castro CG, Shoaf KI, Silva RS, Miranda ES. Preparedness for the Rio 2016 Olympic Games: hospital treatment capacity in georeferenced areas. Cad Saude Publica. 2016;32(7):S0102-311X2016000705010. https://doi.org/10.1590/0102-311x00087116

Assis SS, Pimenta DN, Schall VT. Printed materials about dengue: critical analysis and opinions of health and education professionals of its use. Revista Brasileira de Pesquisa em Educação em Ciências. 2014;13(3):25-51.

Bueno FTC, García M, Moya J, et al. Zika and Aedes aegypti: new and old challenges. Zika e Aedes aegypti: antigos e novos desafios. Hist Cienc Saude Manguinhos. 2017;24(4):1161-1180. https://doi.org/10.1590/s0104-59702017000500017

Erku DA, Belachew SA, Abrha S, et al. When fear and misinformation go viral: Pharmacists' role in deterring medication misinformation during the 'infodemic' surrounding COVID-19. Res Social Adm Pharm. 2021;17(1):1954-1963. https://doi.org/10.1016/j.sapharm.2020.04.032

Bueno FTC, García M, Moya J, et al. Zika and Aedes aegypti: new and old challenges. Zika e Aedes aegypti: antigos e novos desafios. Hist Cienc Saude Manguinhos. 2017;24(4):1161-1180. https://doi.org/10.1590/s0104-59702017000500017

Pan American Health Organization. Zika virus infection: step by step guide on Risk Communications and Community Engagement. https://iris.paho.org/bitstream/handle/10665.2/18599/zikavirusinfection_2016_eng.pdf?sequence=1&isAllowed=y (accessed Aug 14, 2020).

Rodrigues RRN, Grisotti M. Communicating on Zika: prevention recommendations in contexts of uncertainties. Interface (Botucatu). 2019; 23: e190140. https://doi.org/10.1590/Interface.190140

Baldon JP, Correr CJ, Melchiors AC, Rossignoli P, Fernandez-Llimos F, Pontarolo R. Community pharmacists’ attitudes and knowledge on dispensing drugs to pregnant women. Pharm Pract (Granada). 2006;4(1):38-43.

Pan American Health Organization. WHO recommends that people consider avoiding pregnancy in areas of local Zika circulation. https://www.paho.org/bra/index.php?option=com_content&view=article&id=5135:oms-recomenda-que-pessoas-considerem-evitar-gravidez-em-areas-de-circulacao-local-do-zika&Itemid=812 (accessed Jun 24, 2020).

Castro MC, Han QC, Carvalho LR, Victora CG, França GVA. Implications of Zika virus and congenital Zika syndrome for the number of live births in Brazil. Proc Natl Acad Sci U S A. 2018;115(24):6177-6182. https://doi.org/10.1073/pnas.1718476115

Diniz D, Gumieri S, Bevilacqua BG, Cook RJ, Dickens BM. Zika virus infection in Brazil and human rights obligations. Int J Gynaecol Obstet. 2017;136(1):105-110. https://doi.org/10.1002/ijgo.12018

Silva AG, Lima JG, Lira AC. [Pharmacist role in the Family Health Support Centers: a contribution to the strengthening of the Family Health Strategy]. Revista de Atencao Primaria a Saude. 2016;19(1):14-23.

Rego S, Palácios M. Ethics, global health and Zika virus infection: a view from Brazil. Rev Bioét. 2016;24(3):430-434. https://doi.org/10.1590/1983-80422016243141

Sobral MFF, Sobral AIGDP. Casos de dengue e coleta de lixo urbano: um estudo na Cidade do Recife, Brasil [Cases of dengue and urban waste collection: a study in the City of Recife]. Cien Saude Colet. 2019;24(3):1075-1082. https://doi.org/10.1590/1413-81232018243.10702017

Zara AL, Santos SM, Fernandes-Oliveira ES, Carvalho RG, Coelho GE. Estratégias de controle do Aedes aegypti: uma revisão [Aedes aegypti control strategies: a review]. Epidemiol Serv Saude. 2016;25(2):391-404. https://doi.org/10.5123/s1679-49742016000200017

Municipal Health Department. [Primary Care Medicines Campo Grande]. http://www.campogrande.ms.gov.br/sesau/downloads/medicamentos-da-atencao-basica/ (accessed Jun 24, 2020).

Federal Pharmacy Council. [Resolution 596]. http://www.cff.org.br/userfiles/file/%20resolucoes/596.pdf (accessed Oct 12, 2019).

Federal Pharmacy Council. [Decree 85878]. http://www.cff.org.br/userfiles/file/decretos/858%2078.pdf (accessed Oct 19, 2019).

Federal Govenment. Law 13.021]. http://www.planalto.gov.br/ccivil_03/_Ato20112014%20/2014/Lei/L13021 accessed Oct 12, 2019).

Brazilian Ministry of Health. [Resolution RDC 4]. [http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2009/res0004_10_02_2009.html#:~:text=Disp%C3%B5e%20sobre%20as%20normas%20de,de%20medicamentos%20de%20uso%20humano (accessed Nov 17, 2019).

Federal Pharmacy Council. [Resolution 296]. Available from: https://www.cff.org.br/userfiles/file/resolucoes/296.pdf (accessed Nov 17, 2019).

Federal Pharmacy Council. [Resolution 499]. Available from: http://www.crf-rj.org.br/arquivos/fiscalizacao/resolucoes/ResolucaoCFF499.pdf (accessed Nov 17, 2019).

Federal Pharmacy Council. [Resolution 509]. http://www.crf-rj.org.br/arquivos/fiscalizacao/resolucoes/ResolucaoCFF509.pdf (accessed Mar 30, 2020).

Federal Pharmacy Council. [Resolution 585]. https://www.cff.org.br/userfiles/file/resolucoes/585.pdf (accessed Apr 13, 2020).

Brazilian Ministry of Health. [Resolution RDC 44]. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2009/rdc0044_17_08_2009.html (accessed Sep 17, 2019).

Brazilian Ministry of Health. [Resolution RDC 17]. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2010/res0017_16_04_2010.html (accessed Mar 30, 2020).

Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010.

Published
2021-06-16
How to Cite
1.
Santos-Pinto CB, Osorio-de-Castro CS, Ferreira LM, Miranda ES. The role of primary care pharmacists in the response to the Zika epidemic. Pharm Pract (Granada) [Internet]. 2021Jun.16 [cited 2021Jul.27];19(2):2290. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2290
Section
Original Research