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Rahim MHA, Dom SHM, Hamzah MSR, Azman SH, Zaharuddin Z, Fahrni ML. Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 17:2285955. [PMID: 38205195 PMCID: PMC10775721 DOI: 10.1080/20523211.2023.2285955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake. Objective To evaluate the influence of pharmacist interventions on public vaccination rate. Methods SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed. Results Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)]. Conclusion While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.
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Affiliation(s)
- Mohamad Hafiz Abd Rahim
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Siti Hajar Mahamad Dom
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Mohd Shah Rezan Hamzah
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Siti Hawa Azman
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Zahirah Zaharuddin
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, Bandar Puncak Alam, Malaysia
- Center for Drug Policy and Health Economics Research (CDPHER), Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
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Jones G, Perry M, Bailey R, Arumugam S, Edwards A, Lench A, Cooper A, Akbari A, Collins B, Harris C, Richardson G, Barry M, Harris P, Fry R, Lyons RA, Cottrell S. Dimensions of equality in uptake of COVID-19 vaccination in Wales, UK: A multivariable linked data population analysis. Vaccine 2023; 41:7333-7341. [PMID: 37932133 DOI: 10.1016/j.vaccine.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
Vaccination has proven to be effective at preventing severe outcomes of COVID-19 infection, and uptake in the population has been high in Wales. However, there is a risk that high-level vaccination coverage statistics may mask hidden inequalities in under-served populations, many of whom may be at increased risk of severe outcomes of COVID-19 infection. The study population included 1,436,229 individuals aged 18 years and over, alive and residence in Wales as at 31st July 2022, and excluded immunosuppressed or care home residents. We compared people who had received one or more vaccinations to those with no vaccination using linked data from nine datasets within the Secure Anonymised Information Linkage (SAIL) databank. Multivariable analysis was undertaken to determine the impact of a range of sociodemographic characteristics on vaccination uptake, including ethnicity, country of birth, severe mental illness, homelessness and substance use. We found that overall uptake of first dose of COVID-19 vaccination was high in Wales (92.1 %), with the highest among those aged 80 years and over and females. Those aged under 40 years, household composition (aOR 0.38 95 %CI 0.35-0.41 for 10+ size household compared to two adult household) and being born outside the UK (aOR 0.44 95 %CI 0.43-0.46) had the strongest negative associations with vaccination uptake. This was followed by a history of substance misuse (aOR 0.45 95 %CI 0.44-0.46). Despite high-level population coverage in Wales, significant inequalities remain across several underserved groups. Factors associated with vaccination uptake should not be considered in isolation, to avoid drawing incorrect conclusions. Ensuring equitable access to vaccination is essential to protecting under-served groups from COVID-19 and further work needs to be done to address these gaps in coverage, with focus on tailored vaccination pathways and advocacy, using trusted partners and communities.
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Affiliation(s)
- Gethin Jones
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Malorie Perry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Sudha Arumugam
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Adrian Edwards
- Wales COVID-19 Evidence Centre, PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | - Alex Lench
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Brendan Collins
- Health and Social Services Group, Health Protection, Welsh Government, Cardiff, UK; Department of Public Health, Policy and Systems, University of Liverpool, UK.
| | - Caroline Harris
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Gill Richardson
- Policy, Research and International Development, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Mai Barry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Phillippa Harris
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University Swansea, SA2 8PP Wales, UK.
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
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