Impact of a multi-component immunization intervention on pneumococcal and herpes zoster vaccinations: A randomized controlled trial of community pharmacies in 2 states

Effectiveness of educational interventions for healthcare workers on vaccination dialogue with older adults: a systematic review

BACKGROUND

Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination.

METHODS

Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results.

RESULTS

In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings.

CONCLUSIONS

Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.

Mindfulness-Based Stress Reduction (MBSR) for Chronic Pain Management in the Community Pharmacy Setting: A Cross-Sectional Survey of the General Public's Knowledge and Perceptions

Patient access to mindfulness-based stress reduction (MBSR), a complementary and integrative health approach that is proven to reduce chronic pain, can be increased via community pharmacy-based implementation. However, the general public's awareness and preferences regarding MBSR as a treatment option for chronic pain, including provider roles (pharmacist vs. non-pharmacist), are unclear. Therefore, the purpose of this study was to assess the U.S. general public's knowledge, attitudes, barriers, and programmatic preferences regarding MBSR for chronic pain management, particularly in the community pharmacy setting. A cross-sectional, anonymous online survey was distributed to U.S. adults ≥18 years via the Amazon Mechanical Turk (MTurk) online survey platform. The survey instrument was informed by Anderson's framework for health service utilization. Measures were assessed using multiple-choice and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Primary outcome measures included: (1) knowledge and awareness of MBSR (12-items); (2) confidence in seeking out MBSR for pain (5-items); (3) barriers to receiving MBSR (11-items); (4) beliefs about MBSR in general (12-items); (5) beliefs about community pharmacy-delivered MBSR (15-items); and (6) preferences for MBSR classes/programs (6-items). Outcomes were analyzed using descriptive statistics, and influential factors associated with mean beliefs regarding community pharmacy-delivered MBSR for chronic pain management were assessed via multiple linear regression. Of the 302 survey respondents, the majority were white (79.1%) and female (50.7%), with a mean age of 44.65 years. Respondents' self-rated MBSR knowledge (mean [SD] scale score: 2.30 [0.68]) and confidence (2.65 [0.87]) were low, although perceived barriers to access were low overall (2.22 [0.53]). Beliefs regarding the use of MBSR for treatment of chronic pain were positive in general (3.67 [0.71]), but more negative regarding community pharmacy-delivered MBSR (2.38 [0.56]). Confidence in seeking out MBSR (β = 0.297, 95% CI = 0.219 to 0.375; p < 0.001) and current opioid use (β = 0.419, 95% CI = 0.147 to 0.690; p = 0.003) were positively associated with beliefs regarding pharmacy-delivered MBSR, while annual household income (β = -0.124, 95% CI = -0.244 to -0.004; p = 0.043) and level of bodily pain (β = -0.149, 95% CI = -0.291 to -0.008; p = 0.039) exerted statistically significant negative influences. Respondents preferred a hybrid MBSR class format including both online and in-person components (29.7%) as well as both group and individual session options (43.7%). In conclusion, further education is necessary to increase the public's perception of community pharmacies as a resource for complementary and integrative health.

Community pharmacists' participation in adult vaccination: A cross-sectional survey based on the theoretical domains framework

OBJECTIVES

This study aims to assess Qatar community pharmacists' practices in advocating and promoting adult vaccination and to characterize and quantify potential determinants of participation in adult vaccination as vaccine administrators, based on the theoretical domains framework (TDF).

METHODS

A cross-sectional survey of a randomly selected sample of community pharmacists in Qatar was conducted using a self-administered validated questionnaire. Items in the questionnaire on potential determinants of participation in adult vaccination were based on TDF. TDF items were subjected to principal components analysis.

RESULTS

In total, 271 respondents completed the questionnaire (67.7%). Most respondents (83.5%) did not have any previous training in vaccination administration and were not involved in any vaccine-related advocacy activities (78.9%). Principal components analysis of TDF items gave eight components: pharmacists' perceived knowledge and skills (median score of 22, interquartile range [IQR] 17-26, possible range: 7-35); perceived confidence (16; IQR 12-20, possible range: 5-25); perceived external support (9; IQR 7-11, possible range: 3-15); professional role identity (38; IQR 33-42, possible range: 11-55); emotions (10; IQR 9-12, possible range: 3-15); perceived consequences (22; IQR 18-24, possible range: 6-30); perceived usefulness (16; IQR 14-18, possible range: 4-20); and behaviour control (6; IQR 4-8, possible range: 2-10).

CONCLUSION

Pharmacists' perceived knowledge, skills, confidence and behavioural control are potentially important factors to address to facilitate participation in vaccination administration in Qatar. Along with providing vaccination training to community pharmacists, there is a need to change the current pharmacy practice structure to improve managerial and government support for and to equip pharmacies with resources for this role.

The role of pharmacy technicians in vaccination services: a scoping review

BACKGROUND

A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs.

PURPOSE

This research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date.

METHODS

In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer.

RESULTS

A total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction.

CONCLUSION

This review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.

The role of social determinants in timely herpes zoster vaccination among older American adults

CDC recommends that U.S. adults ≥50 years receive the herpes zoster (HZ) vaccine; but few are vaccinated at the recommended age. Little is known about how social determinants of health (SDH) influence timely vaccination. This retrospective observational study included U.S. adults aged ≥50 years who were vaccinated against HZ between 2014 and 2016 from IBM MarketScan commercial claims and Medicare supplemental databases. The cohort was classified into three groups based on age of vaccination: earlier (50-59 years), timely (60-64 years), and later (65+ years). Select SDH data from publicly-available sources were linked and included in multinomial logistic regression assessing the impact of SDH on timely vaccination. The final cohort comprised 549,544 individuals, 49.5% of whom were vaccinated at the age of 60-64. Odds of later HZ vaccination increased with higher poverty (OR: 1.035, 95% CI: 1.031-1.038), more democratic voters (OR: 1.011, 95% CI: 1.010-1.012), and lack of Internet access (OR: 1.028, 95% CI: 1.024-1.032), but decreased with higher health literacy (OR: 0.971, 95% CI: 0.970-0.973). Conversely, higher health literacy and lower poverty were associated with higher odds of earlier vaccination. Being male, not receiving a seasonal influenza vaccine, and higher healthcare utilization were associated with later vaccination. Individuals on an EPO/PPO vs. HMO plan, or who resided in regions other than the Northeast were more likely to receive the vaccine earlier. This study demonstrates the influence of SDH on time of HZ vaccination, but further research is needed to fully understand the impact of SDH on vaccination.

Enhancing pharmacy personnel immunization-related confidence, perceived barriers, and perceived influence: The We Immunize program

OBJECTIVES

Pharmacy personnel need practical strategies to incorporate nonseasonal vaccination services into pharmacy workflow. The objective of this study was to evaluate participants' confidence, perceived barriers and facilitators, and perceived influence on decision-making related to immunization services before and after the We Immunize program to assess program effectiveness.

DESIGN

Randomized controlled trial.

SETTING AND PARTICIPANTS

A total of 62 pharmacist-technician pairs from community pharmacies in Alabama and California participated in the randomized controlled trial. All participants were offered a 1-hour live immunization update. Intervention participants were also offered a 2-hour enhanced training at the beginning of the study period and tailored monthly feedback for 6 months.

OUTCOME MEASURES

A survey was administered at baseline and after the intervention. Likert-type scales were used to rank level of agreement and differences were analyzed using paired-sample t tests and 2-way mixed analysis of variance.

RESULTS

Sixty-seven participants completed both baseline and postintervention surveys (37 intervention; 30 control). Within the intervention group, participants' confidence in determining pneumococcal vaccine appropriateness (P = 0.027), confidence in pneumococcal vaccine-related patient interactions (P = 0.041), perceived external support (P = 0.016), and perceived influence on immunization services (P < 0.001) significantly improved. No change was observed within the control group. Compared to control participants, intervention participants showed a greater degree of change in perceived external support (P = 0.023) and influence on immunization services (P = 0.005) from baseline to post intervention. Neither confidence related to the herpes zoster vaccine nor marketing activities improved over the study period in either the intervention or control groups.

CONCLUSION

Immunization training, including educational interventions and tailored feedback, can be used to positively impact pharmacy personnel's confidence in providing pneumococcal vaccinations and perceptions related to environmental support and influence on immunization services. This, in turn, may increase immunization activities within community settings.

Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation

Background: Despite widely available nonseasonal immunization services in community pharmacies, actual pharmacist-administered vaccines are not yet optimal. A flexible choice multicomponent intervention, the “We Immunize” program, was implemented in Alabama and California community pharmacies, with the goal to enhance pneumococcal and zoster immunization delivery. Limited research has been done to qualitatively understand factors influencing immunization service expansion. Objective: Explore pharmacist perceptions of the We Immunize program in terms of its acceptability, impact, and real-world feasibility, and pharmacist-perceived facilitators and barriers influencing success in immunization delivery enhancement. Methods: This practice-focused qualitative research used semistructured telephone interviews with 14 pharmacists at the completion of the 6-month intervention. Results: Major program implementation facilitators were technician inclusion, workflow changes, training and feedback, goal setting, and enhanced personal selling and marketing activities. Multiple pharmacies increased the number of delivered pneumococcal and zoster immunizations, and increased revenue. Many pharmacists felt professional image, knowledge, skills, roles, and personal satisfaction were enhanced, as were technician knowledge, skills, and roles. Program flexibility, along with multiple perceived benefits, increases the potential for success. Conclusions: The We Immunize program appears to have been viewed positively by participating pharmacists and was seen as having a beneficial impact on immunization delivery in the community pharmacies in which it was implemented.