Public’s Perception of Pharmacy Services during Coronavirus (COVID-19) in Saudi Arabia

Yousef Ahmed Alomi*, Bsc. Pharm, Msc. Clin pharm, BCPS, BCNSP, DiBA, CDE Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, P.O.BOX 100, Riyadh 11392, Riyadh, SAUDI ARABIA Sultan Mohammed Al-Jarallah, Head, Ambulatory Care Pharmacy, Oncology and Haematology Clinical Pharmacist, Pharmaceutical Care Department, Security Forces Hospital, Riyadh, SAUDI ARABIA. Dona Abdullah Alajmah, Pharm. D, Batterjee Medical College, Jeddah, SAUDI ARABIA. Shatha Alhassan Alnami, Pharm. D, Jazan University, Jazan, SAUDI ARABIA.


INTRODUCTION
New viral diseases confronted the countries in the world developed pandemic situations. The World Health Organization called the new virus SARS-2 or coronary viral infection in 2019 or COVID-19. [1,2] All countries were under emergency public health circumstances. Each country offers various health care services nonehealth services to their citizens. Saudi Arabia was one of the perfect countries that delivered differently for their citizens and residents. [3] For health care services, the government has formulated a higher national committee toward this pandemic, organize controlling room buildings to deal with pandemic situations hour by hour and day by day through the Saudi centre for disease control. [3] The command and control administration of Ministry of Health had received all health information about new cases of infection by COVID-19, recovery cases, follow-up cases, hospital admission, critical or death cases. [3] All those cases were familiar through the dashboard and various applications. They were a daily report issued about all previous claims and decisions made accordingly. [3] There were lengthened hospital beds and additional temporary hospitals when needed. Besides, they delivered various COVID-19 vaccines to cover all populations in Saudi Arabia. Numerous pharmacy services are presented through pharmacies by governmental or privates sectors. [1,2] The Saudi Food Drug Authority (SFDA) organized the mask, hand sanitizer with community pharmacies and showed by internet website and application (Sehhaty). Thus, the community pharmacies brought medications and associated products, emphasizing hand sanitizer or alcohol swab through regular dispensing or home delivery services through the internet and mobile applications. [4] Community pharmacies bring medications and associated products, emphasizing hand sanitizer or alcohol swab through regular dispensing or home delivery services through the internet and mobile applications. [4] Recently, the community pharmacy affords immunization services (COVID-19 vaccines) to the patient. The hospital pharmacy applied the home delivery and mail pharmacy systems to give the patient medicines. [1] Besides, all pharmacists follow the Ministry of Health guidelines to prevent COVID- 19 and international organizations guidelines. [4] Moreover, the pharmacist played an active role in providing enough medication supply at the hospitals or primary care centres, recognised therapeutic management guidelines, and patient education about medications like other countries. [1,2,4,5] Various instruction provided by the local pharmacy society and local investigators encourages the pharmacist to implement the operational activities role during COVID-19. [1,2,5,6] In all the earlier pharmacy services, the patient was the foundation of receiving the benefits. However, patients' perception about pharmacy services during COVID-19, accentuating medication delivery service and drug information inquiry was critical. Few studies were directed about the patient perception of pharmacy services during a pandemic situation of COVID-19 worldwide. [7] However, few or nil studies were conducted about patient's perception of pharmacy services during COVID-19 locally or in Gulf and Arabic countries.

METHODS
It is a two-month cross-sectional study of the public's perception of pharmacy services during COVID-19 in Saudi Arabia. It was a selfreported electronic survey for the population in the king of Saudi Arabia. It incorporated all citizens who lived in Saudi with age more than 18 years and above. Any incomplete reports or locations outside of Saudi Arabia will be omitted from the study. The survey entailed of demographic data, including locations, gender, material status, age, responder qualifications, occupational status, and monthly income. Further, it includes the second part of the patient's perception of medication delivery service during COVID-19. Besides, the patient's experiences of drug information inquiries were communicated with the pharmacist during COVID-19. The 5-point Likert response scale system was used. The sample was intended according to the previous literature with unlimited population size, a population percentage of 50%, a confidence level of 95% with z score of 1.96, margin of error of 5%, and a drop-out rate of 10%. As a result, the sample size will equal 251 to 432 with a power of study of 80%. [8][9][10] The response rate mandatory of calculated sample size at least 60-70% and above. [10,11] The survey was dispersed through social media and telegram during July and August 2020. The reminder message had been sent every 2-3 weeks. The survey was authenticated through the revision of expert reviewers and pilot testing. Besides, the reliability tests McDonald's ω, Cronbach's α, Guttmann's2, and Guttmann's 6 had been completed with the study. The data analysis is finished through the survey monkey system, the Statistical Package of Social Sciences (SPSS), and Jeffery's Amazing Statistics Program (JASP). Besides, the Microsoft excel sheet version 16 with description and frequency analysis, good of fitness analysis, correlation analysis, inferential analysis of factors marks pharmacist ' s perceptions of forensic pharmacy. The STROBE (Strengthening the reporting of observational studies in epidemiology statement: guidelines for reporting observational studies) steered the reporting of the contemporary study. [12,13]

RESULTS
The total number of responding pharmacists was 461, with most of them coming from the south area 211 (45.77%), and west area 154 (33.41%) with statistically important among the regions (p<0.001). Of those, 440(95.44%) were Saudi, and 344 (74.62%) were female, with statistical significance between nationality or gender answers (p<0.001). Most of the responders were in age (18)(19)(20)(21)(22)(23)(24) years 174 (39.19%) with statistically momentous between all ages level (p<0.001). Almost two-thirds of the responders had bachelor's degrees 319 (69.20%) with statistically significant between among all academic qualifications (p<0.001). Most responders were students 186 (40.35%) and employees 144 (31.24%), and monthly income less than 3,000 SR was 197 (46.14%) statistically significant between among the remaining answers (p<0.001). Most of the responders were non-healthcare professionals 338 (74.45%), and physicians and nurses illustrative high percentages 37 (35.92%) and 31 (30.10%), respectively, with statistically significant among the remaining answers (p<0.001). The majority of responders contacted with community pharmacies 282 (62.81%) or hospital pharmacies 115 (25.61%) more frequently, while rarely 171 (37.92%) or sometimes 119 (26.39%) communicate with pharmacist statistically significant between among the answers (p<0.001). There is a medium positive association between Age (years) and monthly income Kendall's tau_b (0.563) or Spearman's rho (0.677) with statistically significant difference (p>0.05) as discovered in Table 1 and 2. The total average scores of patient's perception of medication delivery service during COVID-19 were 2.50. The high scores element was answering drug information inquiries (3.30), medications home delivery (2.80), and requesting medications through a mobile application (2.78). On the contrary, the lowest score was mail medications deliver (1.86). requesting medical devices and instruments through online internet (2.19), screening blood pressure and blood glucose (2.20), and medical apparatus and instruments home delivery (2.22) with statistically significant between answers (p<0.001) as explored in Table 3. The total average scores of patient's experiences of drug information inquiries communicated with a pharmacist during COVID-19 were 2.76 with high scores element was the drug administration inquiries (3.37). In addition, dosage/schedule inquiries (3.29), pharmacoeconomics/medications cost inquiries (3.18), and drug indications inquiries (3.13). On the contrary, the lowest score aspect of the patient's experiences of drug information inquiries was the medication's wastage inquiries (2.09) and alternative medicine inquiries (2.26). Besides, the herbal medicine inquiries (2.33) with statistically significant between answers (p<0.001) as reconnoitred in Table 4. The reliability test of McDonald's ω, 0.954, Cronbach alpha 0.954, Guttmann's λ2, 0.958, and Guttmann's λ6, 0.978. Factors persuading the perception of patient's perception of medication delivery service during COVID-19 and patient's experiences of drug information inquiries communicated with a pharmacist during COVID-19. Using independent samples Kruskal-Wallis test and the Bonferroni correction for multiple tests have adjusted significant values, the results showed as follows. The various factors (location, employment, age (years), nationality, gender, educational level, monthly income, and the responders from healthcare professionals) might bearing the patient's perception of pharmacy services or the patient's experiences of drug information inquiries. However, there are no statically significant differences in influencing the patient's perception of pharmacy services or the patient's experiences of drug information inquiries and those factors (p>0.05). Except, five employment classes affected the patient's experiences of drug information inquiries with the unemployed average score was 2.6500, and students average score was 3.3109 with statically momentous differences (p=0.000) as explored in Table 5. The relationship between the patient's perception of medication delivery service during COVID-19 or the patient's experiences of drug information inquiries interconnected with a pharmacist during COVID-19 and factors location, employment, age (years), nationality, gender, educational level, monthly income, and does the responders from a healthcare professional. It confirmed through applications. As a result, the current study is to to examine the patient's perception of pharmacy services during COVID-19. The existing electronic legalized with a highreliability survey, dispersed to patients in the south and west region in Saudi Arabia. Most responders came from two areas because the author was working their distribution mainly at their locations. Most of the responders were young females same gender as an author, which is very easy to interaction females than males. Three-quarter of responders was non-healthcare providers, which was our target. However, knowledge of healthcare professionals is desirable to compare with the public one. Most responders communicated with community pharmacies more than hospitals because it was easier to contact and safer during pandemic situations than healthcare institutions. The average score of patients' perception of pharmacy services did not influence an acceptable level. The patients had a higher perception of pharmacy providing drug information services, medications home delivery, and applications in requesting medications during the COVID-19 period. However, not all community pharmacies carry those services at the same level. It is highly suggested that all community pharmacies apply home delivery with mobile applications for requesting medications or devices. The patients had a poor perception of mail medications delivery because most of the community did not exploit mail pharmacy services. Recently, the MOH using mail pharmacy services during COVID-19 to deliver the medication to the patient home through Saudi post. [26] The patients had a poor perception of screening of blood glucose or blood pressure done by the pharmacy. Besides, the public responders had a poor perception of home delivery of the medications device or instruments, and community pharmacies did not afford the services for unknown reasons. Recently, the updated pharmacy law permits the community to deliver essential examinations or basic blood glucose or blood pressure, medical devices, public education, and immunization services. [27] Thus, the new approved services will surge patient outcomes, patient satisfaction and declare the role of pharmacists at the community pharmacies. The existing examination results displayed the patients' experiences of drug information were not good, although all electronic facilities are available. It might be linked to community pharmacy services provided to the patients. Patients during pandemic situations are highly desirable for many healthcare inquiries, and it is up-front for them to contact the community  Table 6 and 7.

DISCUSSION
The pharmacy services are snaky in the hospital and community pharmacies in Saudi Arabia and away in the world. [14][15][16][17][18] The hospital pharmacy is increasing in the drug distribution system services and clinical pharmacy services. [17,19,20] However, the community pharmacy is snowballing in the drug distribution system, not in clinical pharmacy services. During COVID-19, numerous drug distribution and clinical pharmacy services variations were altered from a traditional face-to-face delivery system to a fully online system. The drug distribution change to home or might mail delivery. [21][22][23][24][25] The changes encompassed regular prescribing with paper or electronic systems to online internet or  [28,29] However, the community pharmacy is highly commended to provide drug information services and answering drug information inquiries supporting the MOH services. The cost of drug information services is high. However, the community pharmacy can distribute drug information services through applications or point of sale places. Besides, the patients might use the community pharmacy commutation to answer their inquiries or use the 973 instead of the community pharmacy. [28,29] Most of type drug information inquiries do not variation from the pandemic and regular days. [28] The most common type was drug administration and dosing schedule, while the most minor types of drug information inquiries were drug wastage and herbal or alternative medications because most of public using regular drugs and do not use the herbal drug.
Various factors might move the patient's perception of pharmacy services or the patient's experiences of drug information inquiries during COVID-19 including location, employment, age, gender, nationality, education level, monthly income, and public or healthcare professionals. Not all those factors exaggerated the patient's perception of pharmacy services or experiences of drug information inquiries. There is no statistically significant difference between public or healthcare professionals. There is only redundancy and student more  perception of drug information inquiries than other occupational types, which differed from the previous study. [7] It is related to demand for drug information during pandemic situations COVID-19. The pharmacy services should be upgraded, emphasizing community pharmacy, including all prescribed or over-the-counter medications or devices, cosmetics, and herbal medications. [24,[30][31][32][33] It also includes the new implementation of mail pharmacy and using applications or internet drug information during pandemic situations.

Limitations
Although very informatics information had been reconnoitred from the patient's perception of pharmacy services, numerous limitations encompassed the responder's un-equal distribution in the locations, age, gender, academic qualifications, employment, and monthly income. Besides, the age levels came from females and a young age with student qualifications. Therefore, further studies are necessitated with equal distribution of previous elements.

CONCLUSION
The public's perception of pharmacy services during COVID-19 in Saudi Arabia highlights the patient's perception of medication delivery. The patient's experiences of drug information inquiries communicated with the pharmacist were insufficient. There are no differences in the perception between public or healthcare providers in the perception. Therefore, no factors affect the responders of Patient's perception of pharmacy services. More pharmacy applications with drug consultation, medication and devices requesting, and home or mail delivery systems are highly suggested during pandemic situations or emergency public health in Saudi Arabia.

CONFLICT OF INTEREST
The Authors declare that there is no Conflict of Interest.

Funding
Non.

Consent for Publications
Informed consent was obtained from all the participants.

Ethical Approval
This research was exempted from research and ethical committee or an institutional review board (IRB) approval.