Performances and Activities of Virtual Pediatrics Medication Counselling Clinic in Riyadh City, Saudi Arabia

Objectives: To explore the activities and performances of a virtual pediatrics medication counseling clinic in Riyadh City, Saudi Arabia. Methods: it was a retrospective analysis of activities and performances of a virtual pediatric medicine counseling clinic operated by the pharmacist at a public pediatric and maternity hospital. The pharmacist documented all the activities, including demographic information of patients visiting the clinic, the reason for the counseling, medication requirements to be counseled, and patient counseling items based on international guidelines. The data analysis was done through SPSS version 20 and Microsoft Excel version 2021; descriptive analysis and logistic regression of factors associated with the reason for counseling. Results: The total number of patients who visited the virtual pediatric medicine clinic through 20 months was 1955, with (97.75) per month. The majority of patients were female in the year 2021, 204 (63.55%) vs. female 900 (61.19%) in 2021, compared to male 117 (36.46%) vs. males in year 2022 628 (38.81%) with non-significant differences ( p =0.149). The majority of patients were diagnosed as Diabetic Miletus in both years, 145 (45.17%) vs 884 (54.47%), with statistical significance differences between two 2021 and 2022 ( p =0.000). The majority of patients counseled due to high alert medication was 230 (71.65%) in 2021 vs. 1198 (73.32%) in 2022, with non-statistically significant difference between them ( p =0.539), and chronic diseases such as diabetes and asthma 224 (69.78%) vs. 901 (55.14%) in the year 2021 and 2022 respectively with statistical significance differences between both years ( p =0.000). Most medication counseled was Insulin Aspart in both years, 121 (21.72%) vs. 909 (31.92%), insulin Glargine 104 (18.67%) in 2021 vs. 555 (19.49%) in 2022, and Enoxaparin in both years 40 (7.18%) vs. 205 (7.20%). Conclusion: The virtual pediatric medicine counseling clinic served many patients, emphasizing pediatric chronic diseases such as Diabetes and Asthma. Future studies are highly recommended to measure the clinical and economic outcomes and patient satisfaction.


INTRODUCTION
The pharmacist provides pharmaceutical care nationwide and locally through principles of international guidelines. [1,2]He or she distributes medication to different types of patients and information requirements for those medications.[3][4][5] Patient counseling might reduce drug-related problems and avoid unnecessary economic burdens on the healthcare system. [6,7]Besides, it improves patient compliance with their medication.During the previous coronavirus pandemic in 2020, healthcare providers changed regular patient care to telemedicine and virtual patient care. [8]That is to reduce direct contact with the patients and prevent infection from disseminating throughout society.Various publications should show that healthcare professionals provide patient care through telemedicine and virtually and excellent subsequent patient outcomes and satisfaction. [8][11][12][13][14] Some clinical pharmacy services become virtual through telepharmacy.The ambulatory care clinic operated by a pharmacist provides virtual pharmacy activities and is called a virtual pharmacy clinic. [13,15],15,16] The virtual pharmacy clinic has advantages, such as more convenience and patient satisfaction. [8]esides, there is a more significant coverage number of patients.Therefore, the virtual pharmacy clinic continued after the pandemic, such as the pharmacy clinic for patient medication counseling.The public pediatric and maternity hospital in Riyadh City, Saudi Arabia, provides those services through comprehensive pharmaceutical care to patients virtually called the virtual pediatric medicine counseling clinic. [15]An expert pharmacist operates the clinic and provides extensive patient counseling through telepharmacy procedures. [15]Over more than one year, the experience needs to be assessed and evaluated to improve the services.The virtual pediatric medication counseling clinic is seldom published nationwide and internationally.Therefore, activity and performance need to be explored, which was the aim of the current study.

METHODS
It is a retrospective analysis of the activities and performance of the virtual medicationcounseling clinic operated by a pharmacist at Pediatrics and Maternity Public Hospital in Riyadh City, Saudi Arabia.The analysis includes the addressograph of patients visiting the clinical virtually and documentation of the pharmacist counseling activities involved in the reasons for counseling, medication reconciliation, and medication counseling for patients.Besides, if necessary, patient instructions include dosing information, therapy duration, consideration during pregnancy and breastfeeding, adverse drug reactions, medication storage conditions, and medication administration during the holy month of Ramadan.The pharmacist documents all previous information on a Microsoft Excel sheet and sends the report monthly to the pharmacy director.Full details about policy and procedures were discussed in the previous report. [15]The Pharmaceutical Care Department is meant to provide care jointly related to patients and physicians.Supervise all pharmacy functions to ensure that all relevant elements and human resources are available to suit patients' needs through direct administrative and technical supervision and distribution of tasks to all pharmacists and technicians in the pharmaceutical care department.They were establishing pharmacy services based on the Standards of Practice guide by the Ministry of Health (MOH), the Saudi Central Board for Accreditation of Health Institutions (CBAHI), the Food and Drug Administration (FDA) and Saudi Food and Drug Administrations (SFDA).It consisted of an inpatient pharmacy section, emergency pharmacy, outpatient pharmacy, intravenous injections, clinical services, and drug information services, besides the Extemporaneous Preparation Unit, Medication safety services, and Patient Counseling Clinic.The pharmacy services are provided through public pediatrics and maternity hospitals in Riyadh, Saudi Arabia.The hospital has 300 beds with various specialties such as pediatric infectious, pediatric neurology, pediatrics endocrinology, neonatal critical care, and critical maternity sections. [17]he descriptive and frequency analysis used the Statistical Package of Social Sciences (SPSS) and Microsoft Excel sheet version 2020.Chi-Square was used to determine the difference between categorical variables.The logistic regression multinomial analysis with odds was used for correlation analysis.A p-value of 0.005 was set as statistical significance at a 95% confidence interval.The STROBE (Strengthening the reporting of observational studies in epidemiology statement: guidelines for reporting observational studies) guided the reporting of the current study. [18]

DISCUSSION
Virtual pharmacy services have been expanding since the coronavirus crisis until now. [9]][21] One of the critical services founded in Riyadh City is The virtual pediatric medicine counseling clinic, one of the virtual pharmacy services at public pediatric and maternity hospitals. [15]The current study is to determine the activity and performance of the clinic.The total number of patients visiting tremendously increased from the first to the second year, which transferred from physician and ambulatory care pharmacy to the clinic, higher than in the previous study. [8]That was not documented before to demonstrate the high demand of the clinic because they were facing a high number of patients not aware of their medication and a high need for basic information about their medication.Thus, over time, there were more transfers from outpatient pharmacies than physician's clinic transfers in the second year.The pharmacy staff became more aware of the patient's status and needed education about their medications.No statistically significant differences existed between all patients' demographic information, including gender and age.That is related to equal demand for counseling regardless of gender or age level.Despite that, most patients were children, which was expected because it was a pediatric hospital; subsequently, most of the recipient's information was caregivers on behalf of children.That is a regular situation for pediatric patients.The common diseases visited the clinic during the research period are Diabetes Multitudes, Epilepsy, and Asthma.That is expected because those diseases highly demand medication counseling, and the impact of counseling was well established.
Most patients receive counseling due to highalert medication or medication for chronic illness, as discussed before, besides specific concerns about DM and medication devices.
That is expected of chronic illness, and medication device counseling is rarely available for patients, which was a beneficial candidate to be counseled and prevent drug-related misadventures. [6,7]Besides, the anticoagulation medication or medication for asthma is prescribed adequately to pregnant women while visiting the clinic.[24] Using telepharmacy technology, the pharmacist provided various information such as drug information, dosing instructions, administration, drug storage, drugs during pregnancy, and breastfeeding.There were specific items such as medication and pregnancy medication side effects and medication reconciliation.[27][28] Emphasis on those items is highly recommended.The results showed that logistic regression was a non-significant relation of reasoning and association factors such as diagnosis, gender, and gender.All patients need almost the same basic understanding of medication and necessary basic knowledge of counseling of medications such as DM, Asthma, and Epilepsy.There is no existing study on the same topic to compare the results.We assumed that it was the first publication.

CONCLUSION
The new technology serves the pharmacy practice to provide patients care with high efficiency and productivity.Telepharmacy is used for various purposes through the preparation and distribution of medicine.Besides, patients were counseled for their medication.The foundation of virtual pharmacy services is the new digital pharmacy era.Virtual clinical pharmacy services emphasize that virtual pediatric medicine counseling clinics offer new services to the pediatric and related caregivers. [15,21]t can handle a high number of patients very quickly and more conveniently.The pharmacist provides comprehensive activities and performance to pediatric and adult patients, including counseling chronic disease medication such as diabetes, Asthma, and Epilepsy.The virtual pediatric counseling clinic must expand to cover more patients with considerable clinical and economic benefits, besides determining patient satisfaction with clinic services for improvement.The virtual pediatric medicine counseling clinic is crucial and highly recommended to be involved in patient care nationwide.

Table 2 : Demographic, social information.
International Journal of Pharmacology and Clinical Sciences, Vol 12, Issue 4, Oct-Dec, 2023