Drug-related problems and challenges encountered by pharmacists in nirmatrelvir/ritonavir counselling during the covid-19 pandemic: a multi-center study.

Pharmacists' counselling roles expanded significantly during the COVID-19 pandemic, yet drug-related problems (DRPs) and challenges during nirmatrelvir/ritonavir counselling remain underreported. The study aimed to characterise the DRPs and challenges encountered during nirmatrelvir/ritonavir counselling by pharmacists in the central region of Malaysia. A cross-sectional study was conducted in government hospitals and primary care clinics involving patients who received nirmatrelvir/ritonavir counselling from July to September 2022. The DRPs were adapted from a classification system for intermediate and long-term care settings. Descriptive analysis was conducted using SPSS version 20. The study included 3,626 patients, aged 18 to 99 years (54.56 ± 17.66). Overall, 2,371 (65.39%) patients had at least one DRP. A total of 3,687 DRPs were identified across 22 types, primarily for drug-drug interactions (n = 2,158, 58.53%), and adverse drug reactions (ADR) (n = 1,019, 27.64%). A total of 1,988 patients (54.83%) had at least one pre-existing drug interacting with nirmatrelvir/ritonavir. About 6.45% (n = 234) of patients discontinued nirmatrelvir/ritonavir, with 2.18% due to ADR. Overall, 2,775 challenges encountered during nirmatrelvir/ritonavir counselling were recorded, mainly involving communication medium barrier (n = 1,446, 52.11%) and inability to contact patients (n = 1,164, 41.95%). The study highlighted prevalent DRPs and challenges in nirmatrelvir/ritonavir counselling, emphasising personalised management and infrastructure improvements for optimal COVID-19 treatment.