Community chain pharmacists' perceptions of increased technicians' involvement in the immunization process

Vaccine administration by pharmacy technicians: Impact on vaccination volume, pharmacy workflow and job satisfaction

Background

Immunizing pharmacy technicians (IPTs) have become more prevalent in recent years, but their impact on community pharmacy practice has yet to be determined.

Objectives

Determine the impact of implementing IPTs on vaccination volume in a community pharmacy chain and assess pharmacy staff's perspectives on the clinical abilities of IPTs and their impact on pharmacy workflow and job satisfaction.

Methods

Retrospective data analysis comparing the number of vaccines administered in a supermarket pharmacy chain from September to March 2019-2020 and 2020-2021 in pharmacies with IPT(s) versus those without IPT(s). For the secondary objective, investigators developed and deployed two role-based mixed quantitative/qualitative surveys among pharmacy staff.

Results

Pharmacies with IPT(s) observed a greater mean increase in vaccination volume from 2019-2020 to 2020-2021 versus those without IPTs (+159.35 vs. +104.57, p = 0.011). Among IPT survey respondents, 50/75 (66.7%) felt more satisfied with their job after receiving immunization training. Among pharmacist respondents, 80/119 (67.3%) felt that IPTs positively impacted their job satisfaction and 61.7% felt that pharmacist clinical services were either somewhat positively affected, or positively affected.

Conclusion

Implementing IPTs can increase the volume of vaccines administered in a chain pharmacy and may positively affect job satisfaction and pharmacy workflow.

2022 national survey of immunizing community chain pharmacists: The case for codifying the PREP Act emergency authorities into practice

BACKGROUND

Pharmacy-based immunization services have expanded since the mid-1990s but still face multiple challenges. Amendments to the Public Readiness and Emergency Preparedness (PREP) Act broadened patient-care scope and the pool of eligible pharmacy personnel who could administer vaccinations. The expiration of these amendments in 2024 may threaten recent gains in vaccine and other health care access newly available through pharmacies.

OBJECTIVES

This study aimed to elicit community chain pharmacists' perspectives on immunization time demands, corporate guidance, data flow and information technology, workflow and workforce issues, and other newly provided services.

METHODS

A survey questionnaire was developed, pretested, and electronically administered in mid-2022 to a randomly sampled national database of pharmacists maintained by the American Pharmacists Association. Descriptive analyses of survey responses were performed and findings used to identify salient themes.

RESULTS

The survey collected 742 responses from a sample of 7845 community chain pharmacists (9.5% response rate). During the 2021-2022 influenza season, pharmacies administered on average 114 vaccinations daily (range 3-1000), mostly by appointment (51%). Pharmacists expressed somewhat greater preference for administering vaccinations (39%) than dispensing prescriptions (36%), and most (92%) considered it at least as important as other practice responsibilities. However, only 27% of pharmacists had adequate staff support and 67% spent more time addressing patients' vaccination confidence issues than before the pandemic. Most respondents (67%) had access to their patient's vaccination status, but only 51% said their company's computer system gave easy access. Only 49% considered corporate immunization feedback effective at enhancing their practice. Provision of nonvaccine services has expanded.

CONCLUSIONS

Frontline community chain pharmacists reportedly preferred administering vaccinations over dispensing prescriptions. The pandemic resulted in an increased responsibility among pharmacists as immunizers. Notwithstanding recent progress, pharmacists continue to face staffing, corporate guidance and feedback, information management, and other structural and process barriers to optimally provide comprehensive immunization services. Survey findings support making permanent and expanding the emergency authorities that pharmacists gained under the PREP Act.

Evaluating the Role of Pharmacy Technician-Administered Vaccines

Background: Before the COVID-19 pandemic, most states limited administration of vaccines to trained pharmacists and pharmacy interns. In October 2020 due to the public health emergency, the Federal Public Readiness and Emergency Preparedness Act (PREP Act) authorized qualified pharmacy technicians to administer vaccines nationally. Currently available research on the perception of pharmacy technician-administered vaccines is limited. Objectives: The primary objective was to evaluate the perceptions of licensed pharmacists and pharmacy technicians regarding pharmacy technician-administered vaccines. The secondary objective was to analyze correlations between demographic data and the perceptions of respondents. Methods: An anonymous, 24-question survey including 5-point Likert-scale and ranking type questions was distributed using Qualtrics® survey software to licensed pharmacists and pharmacy technicians in the state of Ohio. Results: Total of 52,240 pharmacists and pharmacy technicians were invited to participate in the survey, 26,226 viewed the e-mail and 2179 responses were collected, yielding a response rate of 8.3%. Results showed 65.9% (n = 365) of pharmacists and 76.2% (n = 675) of pharmacy technicians agreed that trained pharmacy technicians should be able to administer vaccines post-COVID-19 pandemic. Conclusion: Licensed pharmacists and pharmacy technicians in the state of Ohio support the continued administration of vaccines by trained pharmacy technicians fostering the need for legislative change.

Call to expand access to vaccines for children through pharmacist education, collaboration, and advocacy

Vaccines are a daycare and school requirement for children. The Public Readiness and Emergency Preparedness (PREP) Act 3rd amendment grants pharmacists and pharmacy interns the capability to vaccinate children at ages 3-18 years according to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices schedule of recommended vaccines. Before this, only some state boards of pharmacy allowed pharmacists to administer pediatric vaccines. Despite these opportunities, immunization training programs lack the comprehensive training of pediatric vaccines and administration for pharmacists and pharmacy interns without additional financial cost. All pharmacists should be adequately trained and pharmacies be reimbursed to provide vaccines to all ages of pediatric patients. Advocacy is necessary to ensure children have reliable, affordable, and convenient access to lifesaving vaccines today and after the PREP Act expires.

Pharmacist and Pharmacy Technician Attitudes and Experiences with Technician-Administered Immunizations

In response to the increased demand for healthcare services during the COVID-19 pandemic, the Public Readiness and Emergency Preparedness (PREP) Act amendments and guidance authorized pharmacy technicians, who are not otherwise authorized in their state, to administer the Advisory Committee on Immunization Practices (ACIP)-recommended immunizations and COVID-19 vaccines under pharmacist order. Subsequently, many pharmacies nationwide have expanded technician duties to include immunization administration. The primary objective of this study was to evaluate and compare the attitudes and experiences associated with technician-administered immunizations among community pharmacists and technicians. The cross-sectional study evaluated the primary endpoint through the completion of anonymous surveys containing peer-reviewed questionnaires. Pharmacy technicians and their supervising pharmacists were selected to complete the survey at a grocery chain’s pharmacies located in five states across the Northeast if they completed the immunization program and administered at least one immunization. Surveys were drafted using Microsoft Forms and results were analyzed using Microsoft Excel. Chi-squared tests were utilized for comparing categorical variables between groups. A total of 268 survey responses were obtained; 171 responses came from pharmacists and 97 responses came from immunization-certified technicians. Most pharmacists and pharmacy technicians responded that technicians could safely administer vaccines (87.1% and 96.9%, respectively) and competently process and bill vaccine services (90.6% and 99.0%, respectively). In addition, both participant populations responded that technician-administered vaccines improved the workflow of vaccine services (76.6% and 82.5%, respectively) without increasing the likelihood of vaccine errors (56.1% and 78.3%, respectively). When compared with technicians, fewer pharmacists were confident in a technician’s ability to competently prepare vaccines (63.7% vs. 91.8%; p < 0.001). A statistically significant association was observed between responses regarding an efficient process for immunizing patients and the likelihood of technician vaccination errors (χ2 = 14.36; p < 0.01). Pharmacists and pharmacy technicians responded that technicians competently administer immunizations and should participate in more patient-care duties. Multiple states are enacting legislation to include technician vaccine administration as a permanent component of their scope of practice.

Pharmacy technician-administered immunizations: A five-year review

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.