The role of pharmacists in the delivery of influenza vaccinations

Pharmacists' Role in Global TB Elimination: Practices, Pitfalls, and Potential

Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists' role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination.

Influenza vaccine coverage and factors associated with non-vaccination among caregiving and care-receiving adults in the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake.

OBJECTIVES

We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years.

METHODS

We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015-2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients.

RESULTS

Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white.

DISCUSSION

Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs.

CONCLUSION

The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

BACKGROUND

Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.

METHODS

We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.

FINDINGS

Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.

INTERPRETATION

Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.

Clinical and economic implications of increasing access to herpes zoster vaccination rate in community pharmacies

BACKGROUND

A community pharmacist plays an important role in providing vaccination to the general public in the United States. No economic models have been used to assess the impact of these services on public health and economic benefits.

OBJECTIVE

This study aimed to estimate the clinical and economic implications of community pharmacy-based herpes zoster (HZ) vaccination services with a hypothetical scenario of nonpharmacy-based vaccination in the State of Utah.

METHODS

A hybrid model of decision tree and Markov models was used to estimate lifetime cost and health outcomes. This open-cohort model was populated based on Utah population statistics and included a population of 50 years and older who were eligible for HZ vaccination between the years 2010 and 2020. Data were derived from the U.S. Bureau of Labor Statistics, the Utah Immunization Coverage Report, the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, the CDC National Health Interview Survey, and existing literature. The analysis was performed from a societal perspective. A lifetime time horizon was used. The primary outcomes were the number of vaccination cases increased and the number of shingles and postherpetic neuralgia (PHN) cases averted. Total costs and quality-adjusted life-years (QALYs) were also estimated.

RESULTS

Based on a cohort of 853,550 people eligible for HZ vaccination in Utah, an additional 11,576 individuals were vaccinated in the community pharmacy-based scenario compared with the nonpharmacy-based vaccination, resulting in 706 averted cases of shingles and 143 averted cases of PHN. Community pharmacy-based HZ vaccination was less costly (-$131,894) and gained more QALYs (52.2) compared with the nonpharmacy-based vaccination. A series of sensitivity analyses showed that the findings were robust.

CONCLUSIONS

Community pharmacy-based HZ vaccination was less costly and gained more QALYs and was associated with improved other clinical outcomes in the State of Utah. This study might be used as a model for future evaluations of other community pharmacy-based vaccination programs in the United States.

Need a flu jab? Let's try pharmacy: patient characteristics and experiences with pharmacy immunisation services

OBJECTIVES

New Zealand pharmacists have been providing immunisation services since 2011. Literature from other developed countries reports the positive experience of people with community pharmacy immunisation services resulting in expansion of the scope of pharmacy practice. However, there is a dearth of such data in a New Zealand context. Therefore, we aimed to understand patients' experiences with pharmacy immunisation services in New Zealand.

METHODS

A self-administered questionnaire developed after considering the aims and objectives of the study, and previously published literature was delivered to 14 pharmacies covering a range of socio-economic areas across New Zealand. The survey assessed patients' experiences in a community pharmacy setting and measured their satisfaction using a 5-point Likert scale.

KEY FINDINGS

Out of the 364 survey participants, 60.7% were female, 76.9% were of European ethnicity and 43.4% belonged to the age group of 45-64 years. Convenience (65.4%) and accessibility (44.8%) were cited as the most common reasons for choosing a community pharmacy to receive vaccinations. Over 90% of the respondents reported that they were satisfied with the pharmacy immunisation services, were vaccinated professionally, would choose a community pharmacy again next time for vaccination and would like to see pharmacists administering other vaccines.

CONCLUSIONS

The pharmacy immunisation services were highly valued by patients because of the associated convenience and professionalism demonstrated by the pharmacists. A possible expansion of pharmacist-administered vaccination services to a wider range of vaccines will not only improve access to immunisation but will also potentially escalate immunisation rates.

Development and Assessment of Innovative High-Fidelity Simulation Vaccination Course Integrating Emergency Cases for Pharmacy Undergraduates-A Randomized Controlled Study

Recently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. In order to adapt the pharmacy curriculum for clinical practice, an innovative, vaccination training course using a high-fidelity simulator (HFS) was developed, implementing clinical scenarios to manage adverse events. In a randomized controlled trial using a pre and post design with pharmacy undergraduates, the intervention group interacted with an HFS, while the control group was trained with low-fidelity injection pads. Before and after the respective training, each participant went through an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire and knowledge quiz. Both training methods showed a significant increase in skills, but there was also a significant greater increase in the intervention group when compared to the control group, particularly with respect to the vaccination process. Furthermore, every individual in the intervention group improved from the pre- to post-training OSCEs. Therefore, HFS has been proven to be an appropriate tool to train pharmacy students for the purposes of vaccine administration and to prepare for future challenges. Particularly, recognizing and managing adverse reactions can be addressed in a very effective way.

Characteristics of U.S. older adult medicare beneficiaries receiving the influenza vaccination at retail pharmacies

Background

Pharmacy-provided influenza vaccination services have become more prevalent among the older adult population. However, little is known about the characteristics of older adults associated with receiving the influenza vaccination at retail pharmacies and how these associated characteristics have changed.

Objective

To examine characteristics of older adults associated with use of retail pharmacy-provided influenza vaccination services and how the characteristics changed between 2009 and 2015.

Methods

The study used a retrospective, cross-sectional design with data from the 2009 and 2015 Medicare Current Beneficiary Survey. Older adults aged 65 and older who completed a community questionnaire and received the influenza vaccination during the previous winter were identified. Andersen's Behavioral Model of Health Services Use was the conceptual framework for inclusion of the population characteristics. A multivariable log-binomial regression was performed to estimate the association between the population characteristics and use of pharmacy-provided vaccination service, and the relative change in associations between 2009 and 2015. Survey weights were applied in all analyses.

Results

The results showed older adults who were non-Hispanic black (compared to non-Hispanic white), who did not have secondary private insurance (compared to those who had), who did not have physician office visit (compared to those who had) and who lived in non-metro area (compared to those who lived in metro area) had become more likely to use pharmacy-provided influenza vaccination services in 2015 than in 2009.

Conclusions

Pharmacy-provided influenza vaccination services appear to reduce access barriers for racially and socioeconomically disadvantaged older adults. Findings could help inform not only the retail pharmacies that provide vaccination services to better outreach to potential target populations but also policy makers about the disadvantaged populations that would benefit from the vaccination services provided by retail pharmacies.

Addressing Women’s Needs with Human Immunodeficiency Virus (HIV) and Enhancing the Visibility of Pharmacists in the Public Health Arena

Human Immunodeficiency Virus (HIV) continues to have a staggering effect on women’s lives in the United States (U.S.). Women Living With HIV (WLWH) face many challenges, such as mental health disorders, compared to their male counterparts. These diagnoses make women more disproportionally affected, and meaningful healthcare interventions must address these conditions. This review has three foci: WLWH in the U.S., their access to care and staying in care once antiretroviral treatment has been initiated, coping with mental health, and the role of the U.S. pharmacists in access to the treatment. Pharmacists are the most easily accessible healthcare profession in the U.S. For example, 93% of American customers live within 5 miles of a community pharmacy. Pharmacists are the last healthcare provider with whom the patient interacts before a medication is dispensed; thus, they are in an ideal position to intervene. Engaging pharmacists to provide care for patients with chronic disease states such as HIV has resulted in positive outcomes. Although there are global and U.S. studies that emphasize the role of pharmacists in directing care for persons living with HIV, there is a lack of studies conducted about the role of pharmacists in managing mental health. Future research must address WLWH and mental health conditions to develop targeted interventions from an interdisciplinary team perspective.

Evaluation of Patient Experiences Regarding Pharmacist-Administrated Vaccination and Attitude towards Future Additional Pharmacy Services in Poland

In order to increase the number of vaccinations performed during the COVID-19 pandemic in Poland, a significant change was introduced in the legislation allowing for the vaccination to also be performed in pharmacies. A cross-sectional survey was conducted among those who chose a pharmacy as a vaccination point during the pandemic COVID-19. The aim of the study was to determine the overall level of patient satisfaction with pharmacist-administered vaccination in pharmacies and to examine patient opinions regarding the further expansion of pharmacy services. A patient survey was conducted immediately after vaccination in the period from January to March 2022. A total of 398 questionnaires were completed. The respondents reported high satisfaction with pharmacist-administered vaccinations (94.5%). In addition, the majority of consumers felt safe during the vaccination procedure (98.5%), and 88.4% declared they would come for other vaccinations at the pharmacy. The two main reasons for choosing this vaccination place were easy access regarding location (94.2%) and proposed vaccination hours (95.2%). The participants reported high levels of satisfaction concerning the pre-vaccination interview (91.2%), information level before immunization (91.5%), injection technique (96.7%), adjusting the premises to the service (95%) and general care in pharmacy after with vaccination (87.7%). The majority of respondents supported the future expansion of pharmacist-administered services, although the support rate ranged from 52% to 83% depending on the type of service offered. The majority of patients supported the continuation of ongoing prescriptions, blood pressure and blood glucose measurement services by pharmacists. Our findings indicate that the involvement of pharmacies in vaccination programs and other public health services met high levels of patient acceptance.

The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis

Background

The underutilization of immunization services remains a big public health concern. Pharmacists can address this concern by playing an active role in immunization administration.

Objective

We performed a systematic review and meta-analysis to assess the impact of pharmacist-involved interventions on immunization rates and other outcomes indirectly related to vaccine uptake.

Methods

A systematic literature search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception to February 2022 to identify randomized controlled trials (RCTs) and observational studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Meta-analyses were performed using a random-effects model.

Results

A total of 14 RCTs and 79 observational studies were included. Several types of immunizations were provided, including influenza, pneumococcal, herpes zoster, Tdap, and others in a variety of settings (community pharmacy, hospital, clinic, others). Pooled analyses from RCTs indicated that a pharmacist as immunizer (risk ratio 1.14 [95% CI 1.12–1.15]), advocator (1.31 [1.17–1.48]), or both (1.14 [1.12–1.15]) significantly increased immunization rates compared with usual care or non–pharmacist-involved interventions. The quality of evidence was assessed as moderate or low for those meta-analyses. Evidence from observational studies was consistent with the results found in the analysis of the RCTs.

Conclusion

Pharmacist involvement as immunizer, advocator, or both roles has favorable effects on immunization uptake, especially with influenza vaccines in the United States and some high-income countries. As the practice of pharmacists in immunization has been expanded globally, further research on investigating the impact of pharmacist involvement in immunization in other countries, especially developing ones, is warranted.

Community pharmacists workforce readiness to deliver vaccination services: A cross-sectional study from Jordan

This study assesses Jordanian community pharmacists’ readiness and willingness to deliver vaccination services in their practice sites. Between February and April 2021, a self‐administered online questionnaire was distributed via social media, WhatsApp messages, and personal communication. The questionnaire targeted practicing community pharmacies. Descriptive and inferential data analysis was carried out. A total of 403 community pharmacists participated in the study. Almost 146 (36%) community pharmacists reported vaccinating patients in their practice sites. However, readiness assessment revealed that only 54 (13.4%) pharmacists received the required training and qualifications. Moreover, 33 (8.2%) study participants worked in adequately equipped and designed community pharmacies. Overall, surveyed participants held positive attitudes toward their involvement in vaccination services: 260 (64.5%) pharmacists were willing to vaccinate patients, and 227 (65.0%) out of unready, unqualified, participants were willing to get needed training and qualifications. According to study participants, regulatory and professional bodies (Ministry of Health, Jordan Pharmacists Association) are influential in supporting pharmacist‐vaccinators. Among the investigated factors, organizational structure and employment status were significantly associated with pharmacists’ readiness to deliver vaccination. This study revealed that further work is needed to increase pharmacists’ and pharmacies’ readiness to deliver vaccination services and that regulators should follow a more active approach in highlighting the importance of training and the impact of training in patients’ safety and satisfaction.

Pharmacists as immunizers in Lebanon: a national survey of community pharmacists' willingness and readiness to administer adult immunization

BACKGROUND

Since the focus of healthcare has shifted toward prevention, pharmacists were highly encouraged to expand their practice to include immunization services. Our study aimed to assess the knowledge, attitudes and beliefs of community-based Lebanese pharmacists, in addition to their willingness to expand their practice scope to include vaccine administration.

METHODS

A cross-sectional study was conducted during the phase preceding the arrival of the COVID-19 vaccine in Lebanon between 1 and 31st December 2020. Using a stratified random sampling method, data were collected from Lebanese community pharmacists (CPs) through an online survey that included information on socio-demographic characteristics, clinical experience, willingness to administer vaccines, knowledge about vaccination, attitudes towards immunization, reasons supporting utilizing pharmacists as immunizers and the requested elements to incorporate immunization in pharmacists' practice scope. Multivariable analyses were performed to identify the factors associated with knowledge.

RESULTS

A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed CPs are willing to administer vaccines. The majority of them (89.8%) had an overall good level. Out of all, 92.7% showed a positive overall attitude score toward immunization, 95.4% agreed that community pharmacists can play an important role in advertising and promoting vaccination. The main needed elements for implementing immunization services in pharmacies listed by participants were: support of health authorities (99.3%), statutory allowance (82.8%), patient demand (95.4%), pharmacist's interest (96.1%) and continuous education and training workshops on immunization. Older CPs (50 years and above) [aOR = 0.703, CI 95% (0.598-0.812)] and those working in Bekaa and North have lower knowledge score than their counterparts. High educational level [aOR = 1.891, CI 95% (1.598-2.019)], previous experience in immunization [aOR = 3.123, CI 95% (2.652-4.161)] and working in urban areas [aOR = 3.640, CI 95% (2.544-4.717)] were positively associated with a good knowledge level.

CONCLUSION

Most of Lebanese community pharmacists are willing to offer immunizations. The expansion of the pharmacists practice scope to include provision of immunizations required a national plan that encompasses strengthening knowledge, training, certification for eligibility to administer vaccines, enhancing pharmacovigilance and statutory reform.

National and State-Specific Estimates of Settings of Receiving Human Papillomavirus Vaccination Among Adolescents in the United States

PURPOSE

Human papillomavirus (HPV) vaccination in the United States has been recommended for girls since 2006 and for boys since 2011. However, settings of receiving HPV vaccination have not been assessed. The purpose of this study is to assess settings of receiving HPV vaccination among adolescents in order to understand what strategies are needed to improve vaccination uptake.

METHODS

Data from the 2018 National Immunization Survey-Teen (NIS-Teen) were analyzed to assess place of HPV vaccination overall, and by gender, quarter, and other selected variables among adolescents in the United States. The 2016-2018 NIS-Teen data were combined to assess state-specific place of HPV vaccination.

RESULTS

Among vaccinated adolescents aged 13-17 years, a doctor's office was the most common place where HPV vaccination was received (79.2%), followed by clinics, health centers, or other medical facilities (13.5%), health department (4.1%), hospital or emergency room (2.3%), schools (.5%), and pharmacies or stores (.4%). Overall, 99.1% of adolescents aged 13-17 years received HPV vaccination at medical settings and only .9% at nonmedical settings. Reported vaccination in nonmedical settings by state ranged from less than .1% in Delaware, Florida, and New Hampshire to 4.1% in North Dakota, with a median of 1.0%.

CONCLUSIONS

Doctor's offices were the most common medical setting for adolescents to receive HPV vaccination. Less than 1% of adolescents received vaccination at nonmedical settings. Continuing work with medical and nonmedical settings to identify and implement appropriate strategies are needed to improve HPV vaccination coverage among adolescents.

Immunization training for pharmacy students: a student-centered evaluation

Background:

Persistent and emerging public health challenges mean Pharmacy students require training in immunization services. Curtin University, Australia, integrated blended-delivery immunization training into the final-year Bachelor of Pharmacy (Hons) and graduate-entry Master of Pharmacy curricula in 2019 and 2020, utilizing materials licenced from the Pharmaceutical Society of Australia.

Objective:

This study evaluated changes in students’ attitude, confidence, self-perceived knowledge and self-perceived skills pre- and post-training delivered in 2020.

Methods:

Pre- and post-training questionnaires featured 42 opinion statements grouped under headings ‘Attitudes’, ‘Confidence’, ‘Self-Perceived Knowledge’ and ‘Self-Perceived Skills’, and answered using five-point Likert scales (1 = strongly disagree to 5 = strongly agree). Completed pre- and post-training questionnaires were matched using respondent-generated codes. Data were subjected to descriptive and multivariate regression analysis to test pre-post changes and associations and changes in mean scores.

Results:

128 (95.5%) and 132 (98.5%) students completed the pre- and post-training questionnaires, respectively. Immunization training resulted in significant (p<0.05) improvement in students’ mean Confidence score (3.33 vs 3.96), Self-Perceived Knowledge score (3.08 vs 4.47) and Self-Perceived Skills score (2.81 vs 4.55). Improvement in students’ mean Attitude score was also statistically significant (4.45 vs 4.61), yet more positively skewed pre-training. No significant pre-post differences were found between the Bachelor and Master students. Post-training, all respondents agreed that the training program increased their attitude, confidence, perceived knowledge and perceived skills, rating the training experience as either Excellent (91.6%) or Good (8.4%).

Conclusions:

Immunization training integrated into final-year BPharm (Hons) and MPharm curricula improved Attitudes, Confidence, Self-Perceived Knowledge and Self-Perceived Skills, all key to further role development in public health. This method is recommended to other Pharmacy schools to determine the impact and acceptability of immunization training programs amongst students.

Public awareness, attitudes, beliefs, and behaviors regarding the role of pharmacists as immunizers

Vaccine coverage is below desired levels in Canada, despite National Advisory Committee on Immunization recommendations. One solution to improve coverage is to offer vaccines in pharmacies. We explore the awareness, attitudes, beliefs, and behaviors of the general public in four communities in Nova Scotia (NS) and New Brunswick (NB) about the changing role of pharmacists as immunizers. Adult members of the public were invited to complete an online survey through advertisements in print and online, and through e-mail lists at local universities. Immunization status among participants (n = 985) varied across vaccines with slightly more than one-half of the participants (51.8%) reporting receipt of a seasonal influenza vaccine last year, 38.0% reporting receipt of the meningococcal C or ACWY vaccine, and 77.7% reporting receipt of the pertussis vaccine. Despite variable self-reported receipt of vaccines, the pervasive belief that participants were not at risk of getting vaccine-preventable diseases, and a lack of awareness about which vaccines are recommended for adults, participants in this study held vaccine-positive beliefs. Participants, especially those who had previously been vaccinated in a pharmacy (39.0%), were supportive of the inclusion of pharmacists as immunizers although nearly one-half of the participants would feel more comfortable getting vaccinated by a pharmacist if another practitioner recommended it to them. While cost threatens to be a barrier to pharmacists as immunizers, this study suggests that they are well-positioned to improve vaccine coverage and to communicate recommendations and other vaccine-related information to the public.

The impact of the COVID-19 pandemic on addressing common barriers to pharmacy-based point-of-care testing

Introduction: Pharmacy-based point-of-care testing has long had the potential to improve patient access to timely care, but adoption has been slowed by financial and regulatory barriers. The COVID-19 pandemic reduced or temporarily eliminated many of the barriers to pharmacy-based testing. This review examines how the changes brought on by may impact pharmacy-based testing after the pandemic.Areas covered: This review searched peer-reviewed, lay, and regulatory literature to explore the implementation of pharmacy-based COVID-19 testing. This includes a review of regulatory and financial changes that removed barriers to testing. Additionally, it reviews the literature related to the growth of pharmacy-based testing.Expert opinion: It is clear that the COVID-19 pandemic created an awareness and opportunity for pharmacy-based point-of-care testing. The changes made in response to the pandemic have the potential to increase the role of pharmacy-based testing, but additional regulatory changes and wider pharmacy adoption are still needed to maximize the value of such services.

Trends in place of early-season influenza vaccination among adults, 2014-15 through 2018-19 influenza seasons-The importance of medical and nonmedical settings for vaccination

BACKGROUND

Annual vaccination is the most effective strategy for preventing influenza. We assessed trends and demographic and access-to-care characteristics associated with place of vaccination in recent years.

METHODS

Data from the 2014-2018 National Internet Flu Survey were analyzed to assess trends in place of early-season influenza vaccination during the 2014-15 through 2018-19 seasons. Multivariable logistic regression was conducted to identify factors independently associated with vaccination settings in the 2018-19 season.

RESULTS

Among vaccinated adults, the proportion vaccinated in medical (range: 49%-53%) versus nonmedical settings (range: 47%-51%) during the 2014-15 through 2018-19 seasons were similar. Among adults aged ≥18 years vaccinated early in the 2018-19 influenza season, a doctor's office was the most common place (34.4%), followed by pharmacies or stores (32.3%), and workplaces (15.0%). Characteristics significantly associated with an increased likelihood of receipt of vaccination in nonmedical settings among adults included household income ≥$50,000, having no doctor visits since July 1, 2018, or having a doctor visit but not receiving an influenza vaccination recommendation from the medical professional.

CONCLUSIONS

Place of early-season influenza vaccination among adults who reported receiving influenza vaccination was stable over 5 recent seasons. Both medical and nonmedical settings were important places for influenza vaccination. Increasing access to vaccination services in medical and nonmedical settings should be considered as an important strategy for improving vaccination coverage.

Who receives influenza vaccinations at the Pharmacy? An analysis of the Texas Behavioral Risk Factor Surveillance System

INTRODUCTION

Vaccination helps to prevent influenza infection and reduce associated costs but the influenza vaccination rate in Texas for adults between the ages of 18 to 64 years old is the lowest in the US. Pharmacies and alternative locations have been shown to help increase vaccination rates but many adults still go unvaccinated.

OBJECTIVE

This research aims to determine the factors associated with obtaining influenza vaccination at the pharmacy compared to non-pharmacy locations in Texas.

METHOD

This study used pooled Texas Behavior Risk Factor Surveillance System datasets (2014 to 2018) for this assessment. The main outcome variable was categorized into pharmacy and non-pharmacy vaccination locations and analyzed using a logistic regression analysis. Further statistical analysis was done using a multinomial logistic regression after re-categorizing the outcome variable into pharmacy, doctor office, and other locations.

RESULT

Blacks were 63% (AOR 0.37, C.I. 0.26, 0.50) and Hispanics were 38% (AOR 0.62, C.I. 0.48, 0.80) less likely to receive influenza vaccinations at the pharmacy respectively when compared to Whites. Furthermore, those who did not live in a Metropolitan Statistical Area (MSA) were 33% (AOR 0.67, C.I 0.53, 0.84) less likely to receive influenza vaccinations at the pharmacy compared to those who lived in an MSA. While there was no observed difference in the likelihood of receiving influenza vaccination, the unemployed population were 40% (AOR 1.40, C.I 1.15, 1.71) more likely to be vaccinated in the pharmacy compared to the employed population.

CONCLUSION

There is potential for increased utilization of pharmacies as a source of influenza vaccination in Texas. Racial differences exist both for receiving influenza vaccinations and being vaccinated in the pharmacy. Influenza vaccination advocacy and education efforts may be necessary to improve pharmacy-based vaccination in Texas, especially for minorities and rural-dwelling Texans.

The Knowledge and Perceptions of Florida Pharmacists in Administering Inactivated Influenza Vaccines to Pregnant Women

BACKGROUND

Influenza vaccine rates in pregnant women remain suboptimal despite the recommendations from healthcare organizations. Though pharmacists can provide immunization services as a result of the standing order, few studies have examined the role of the pharmacist in providing immunization to pregnant women or explored their perspective on their role in providing influenza vaccines among pregnant women.

PURPOSE

This study explored the perceptions and knowledge of Florida pharmacists in administering inactivated influenza vaccines (IIV) to pregnant women.

METHODS

Semi-structured in-depth interviews guided by the theory of planned behavior were conducted with 18 licensed Florida pharmacists, including clinical and retail pharmacists. A thematic analysis was conducted.

RESULTS

The majority of pharmacists (94%) were knowledgeable about the IIV in pregnant women. Participants expressed mixed attitudes, identified barriers and facilitators, and subjective norms influencing vaccine administration in pregnant women. Participants expressed the importance of trust and how that influenced vaccine uptake. Participants also expressed their position not to only provide immunization services but also to counsel and educate patients.

CONCLUSION

There is a need to strengthen immunization services, provided by pharmacists to more individuals, including high-risk groups such as pregnant women.

Pharmacy, workplace or primary care? Where Australian adults get their influenza vaccines

OBJECTIVE

To estimate the proportion of influenza vaccines administered in non-medical settings in Australia in 2019 and identify factors associated with vaccination site.

METHODS

We surveyed 1,444 Australian adults online in October 2019. To identify factors associated with vaccination site, we used Pearson's chi-square test. We used thematic analysis to describe responses to the question, 'Please explain why you chose to get vaccinated there'.

RESULTS

Most participants (73%) received the influenza vaccine in a medical setting, while 13% received it at a pharmacy and 14% at their workplace. Being vaccinated in pharmacy was associated with being under 65 years of age (p<0.01), marital status (p=0.01), and not having a high-risk comorbidity (p<0.01). Workplace vaccination was associated with being under 65 (p<0.01), household income (p<0.01), not having a regular general physician/practice (p=0.01), having private insurance (p<0.01), and not having a high-risk comorbidity (p<0.01). There was no association between site of vaccination and first-time vaccination (p=0.71, p=0.22).

CONCLUSIONS

Despite new policies allowing pharmacists to administer influenza vaccines, most Australian adults are still vaccinated in medical settings. Pharmacy and workplace vaccination settings were more common among younger adults without high-risk comorbidities. Implications for public health: Workplaces, pharmacies and other non-medical settings may provide an opportunity to increase influenza vaccination among healthy, working-age adults who might otherwise forego annual vaccination. Pharmacies may also provide a convenient location for the rollout of the COVID-19 vaccine, particularly in medically underserved areas.

Exploring beliefs about pneumococcal vaccination in a predominantly older African American population: the Pharmacists' Pneumonia Prevention Program (PPPP)

Objectives: To assess the association of the Pharmacists' Pneumonia Prevention Program (PPPP) with changes in beliefs related to pneumonia vaccination (PV) in a predominately older African American population.Methods: PPPP was an educational intervention delivered using a senior center model of care consisting of a formal pharmacist presentation, live skit, small group action planning, and optional PV. A 15-item instrument assessed participants' beliefs at baseline, post-test, and three months across four domains: pharmacists and pharmacies, vaccination, pneumococcal disease, and physicians. Friedman tests and pairwise Wilcoxon signed rank tests were used to determine the statistical significance of the mean change in belief responses across timepoints.Results: 190 older adults participated; the sample was majority female (76.3%) and African American (80.5%), and had a mean age of 74.3 years. Statistically significant improvements in beliefs at post-test were observed in the following domains: pharmacists and pharmacies, vaccination, and the pneumococcal disease; however, some of these gains were incompletely sustained at three months.Conclusion: PPPP positively impacted beliefs post-program regarding the pneumococcal disease, pharmacists and pharmacies, and vaccination; however, sustained efforts may be needed to reinforce these gains.Policy implications: Support for pharmacist educational services in senior centers should be considered.

An Assessment of Pharmacy School Curricula in Florida and Inactivated Influenza Vaccine (IIV) Administration to Pregnant Women

Background: There is a high risk for morbidity and mortality in pregnant women associated with influenza virus illness. Vaccine uptake rates in pregnant women remain lower than the targeted Healthy People 2020 goals despite recommendations from the Centers for Disease Control (CDC). Few studies have examined the role of the pharmacist in providing immunization services to pregnant women, fewer still have directly examined the PharmD curricula and the perspectives of pharmacy students on how they perceive their role in providing influenza inactivated vaccine (IIV) to pregnant women. Objective: This study examined the PharmD curricula instruction with regard to immunizing pregnant women and how pharmacy students perceive it. Methods: Semi-structured, in-depth, in-person qualitative interviews were conducted with the six Academic Deans of the accredited schools of pharmacy in Florida, and three focus group sessions were held with third- and fourth-year pharmacy students (n = 18) in Florida. A thematic analysis was conducted. Results: Most academic deans reported providing instruction on immunization in schools with respect to vaccine administration in pregnant women and called for a need for all schools to make it compulsory to include pregnant-women-specific content. Pharmacy students reported a gap in knowledge of content related to administering the IIV in pregnant women, but feel that when presented with the opportunity, they will be willing to provide IIV to pregnant women. Conclusions: Pharmacists are in a good position to play a role in increasing IIV rates among pregnant women. Implications for practice include the need for incorporation of pregnancy-specific content to immunization curricula.

Clinical Preventive Services and Self-Management Practices Among Adult Cancer Survivors in the United States Over Time

The objective of this research was to determine if the engagement/participation in health promotion activities of cancer survivors in the United States (US) changed between 2006 and 2015. We pooled two independent cross-sectional data of cancer survivors using Medical Expenditure Panel Surveys from 2006 (N = 791; weighted N = 9,532,674) and 2015 (N = 1067; weighted N = 15,744,959). Health promoting activities consisted of past year influenza immunization, routine physical examination, and dental visit. Self-care included maintaining normal weight, not smoking, and engagement in recommended vigorous physical activity. We conducted unadjusted and adjusted logistic regression analyses to examine the change in engagement in health promoting activities over time. We found rates of annual influenza immunization (66.8% vs 70.3%), dental visit (71.8% vs 70.3%), and normal weight (33.9% vs 33.5%) did not change from 2006 to 2015. The percent with physical examination (90.8% vs 93.8%; P = .03) and non-smokers increased (87.9% vs 91.2; P = .04). Between 2006 and 2015, despite guidelines and recommendations for personalized cancer survivorship health plans, health promoting activities among cancer survivors did not change significantly.

Pharmacists' Perspectives on Providing the Influenza Vaccine in Community Pharmacies: A Qualitative Study

Purpose

The objective of this study was to explore community pharmacists’ views on providing influenza vaccine administration services in community pharmacies in Jordan.

Methods

The current study is a cross-sectional exploratory study conducted using semi-structured telephone interviews. The semi-structured interview schedule was developed by the researchers and comprised open-ended questions aligned with the study objectives. The telephone interviews were recorded and fully transcribed, and the transcripts were quantitatively coded following a generic qualitative approach.

Results

A total of 19 pharmacists took part in this study. Eight participants (42.1%) reported that they had administered the influenza vaccine during their practice. The three overarching themes which described the participating pharmacists’ views towards providing influenza vaccine administration services in community pharmacies were benefits, enablers, and barriers. The reported benefits included enhanced therapeutic relationships with patients and increased patient accessibility to vaccines. The majority of the participants indicated that they would be more willing to provide influenza vaccine administration if they received the support they needed from the Jordan Pharmacists Association, third-party insurance companies, and drug stores. Further, from the participants’ perspectives, the main barriers to this change in practice were physicians, regulations, and lack of sufficient training.

Conclusion

Overall, the participating pharmacists had positive attitudes towards administering the influenza vaccine in community pharmacies. The participants highlighted the need for support from regulatory bodies and stakeholders to change the current scope of practice in Jordan. Moreover, the study highlighted the need to incorporate vaccine administration in the curricula used to train new pharmacy graduates.

Flu Vaccinations in Pharmacies-A Review of Pharmacists Fighting Pandemics and Infectious Diseases

The phenomenon of population ageing observed over recent years involves growing healthcare needs and the limited staffing and financing of healthcare systems, and as such demands some functional changes in the healthcare model in many countries. This situation is particularly significant in the face of a pandemic, e.g., flu, and currently COVID-19.As well as social education, preventive vaccinations are the most effective method of fighting the infectious diseases posing a special threat to seniors. Despite this, the vaccination coverage level in most European countries is relatively low. This is largely due to patients having limited access to vaccinations. In some countries, implementing vaccinations in pharmacies and by authorized pharmacists has significantly improved vaccination coverage rates and herd immunity, while lowering the cost of treating infections and the resulting complications, as well as minimizing the phenomenon of inappropriate antibiotic therapies. This article presents the role of pharmacists in the prevention of infectious diseases, pointing out the measurable effects of engaging pharmacists in conducting preventive vaccinations, as well as analyzing the models of implementing and conducting vaccinations in pharmacies in selected countries, and depicting recommendations regarding vaccinations developed by international organizations. The presented data is used to suggest requirements for the implementation of preventive vaccinations in community pharmacies.

Community pharmacist-administered seasonal influenza vaccination: a national customer survey

BACKGROUND

In Switzerland, the influenza vaccination is recommended for high-risk groups and people who have contact with high-risk groups. Since 2015, Swiss pharmacists are allowed to vaccinate healthy adults after acquiring a certificate of competence for vaccination and blood sampling techniques. We aimed to assess customers of the seasonal influenza vaccination in pharmacies in regard to their satisfaction, motivation, and reasons.

METHODS

Swiss pharmacies collected survey data during a period of 12 weeks from mid-October 2019 to mid-January 2020. Each participating pharmacy was sent 20 questionnaires to be handed out to vaccinated customers. The questionnaire was available in German and French and subdivided into four sections: demographic information, satisfaction, reasons for getting the vaccination, and reasons for choosing a pharmacy as a place of vaccination. We tested for statistical differences in answer tendencies across strata on questionnaire language, age groups, and levels of education.

RESULTS

Of the 1600 surveys sent, 80 pharmacies sent back 656 completed questionnaires (return rate, 41%). Main age bracket was 65-74 years (26.2%), followed by 55-64 years (24.7%), with an equal distribution of reported sex (female, 49.5%). Of the respondents, 99% would have recommended the service and 88.5% felt very comfortable being vaccinated by a pharmacist. Satisfaction included injection technique, used facilities, preparatory discussions, and pricing of the service. Easy scheduling was a main motivation for choosing a pharmacy as the vaccination provider. We identified minor differences in answer tendencies across questionnaire language and age groups, but not across levels of education.

CONCLUSION

Customer satisfaction with community pharmacist-administered seasonal influenza vaccinations is high in Switzerland.

Does policy change to allow pharmacist provision of influenza vaccination increase population uptake? A systematic review

Objective The aims of this study were to estimate the effect of pharmacists' vaccinating for influenza on overall vaccination rates and to assess whether any effect differs for at-risk subgroups compared with the general population. Methods A systematic review was undertaken, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched during July 2019 and included Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and the Cochrane Library. Results The largest difference reported in overall population vaccination rates associated with pharmacists undertaking influenza vaccinations was an increase of 10%; the smallest showed no discernible effect. The effect was graduated: pharmacists with the most autonomy demonstrated the largest rate increases. There was evidence of substitution by pharmacists, but the effect size was small. Conclusions The effect of allowing pharmacists to administer influenza vaccinations appears positive, but small. Given that pharmacists are likely to provide vaccinations at a lower cost than doctors, there may be cost-savings to the health system and consumers. Future research may include evaluating pharmacist-provided vaccinations compared with (or in combination with) other strategies, such as advertising, to increase access and uptake across the range of providers, as well as ongoing research to address vaccine hesitancy. What is known about the topic? In Australia, and many other countries, community pharmacies provide an alternative and accessible option for influenza vaccination; however the effect on overall vaccination rates remains unclear. What does this paper add? This systematic review of the international literature suggests that pharmacist-provided vaccinations increase uptake; substitution of doctors by pharmacists may result in cost savings. What are the implications for practitioners? The findings of this study are important for health policy makers and health workforce researchers aiming to maximise population vaccination rates and workforce efficiency. In the absence of available Australian data, data from the international experience of legislating pharmacists to vaccinate against influenza are summarised and critiqued. Results can be used when determining the best health workforce and policy mix with regard to the vaccination workforce.

Community Pharmacists: On the frontline of health service against COVID-19 in LMICs

The COVID-19 outbreak is a global public health crisis which has affected healthcare practice across professions. In the context of this pandemic, there is a need to highlight the roles and responsibilities of pharmacists. Community pharmacists are the most accessible healthcare professionals to the general public and have a lot to offer amid the COVID-19 response. This have led to significant changes in the health systems of many countries. This article seeks to highlight additional roles and activities relating to the public health response that can be undertaken by community pharmacists that could help to reduce pressure on general practice and other areas of the health service.

California Pharmacists' and Pharmacy Technicians' Opinions on Administration of Immunizations in Community Pharmacies by Pharmacy Technicians

Pharmacy technicians are prohibited from administering immunizations in California. This study sought to determine the opinions of California pharmacists and pharmacy technicians on the administration of immunizations in community pharmacies by pharmacy technicians. Both pharmacists and pharmacy technicians supported the authorization of pharmacy technicians to administer immunizations. Both believed that pharmacy technicians' assistance in administering immunizations would be beneficial.

A systematic review of the role of pharmacists in vaccination services in low-and middle-income countries

BACKGROUND

Pharmacists' role in vaccination has expanded in some countries with pharmacists having greater authority to perform various immunization activities, from vaccine storage, vaccine adverse event reporting, vaccination education and advocacy, to vaccine administration. However, pharmacists' present involvement in vaccination services is poorly understood across low- and middle-income countries (LMICs).

OBJECTIVE

To identify and synthesize evidence on pharmacists' roles in offering vaccination services in LMICs.

METHODS

We searched three databases (PubMed, Embase, Scopus) and the gray literature to identify articles which described pharmacist involvement in vaccination services in LMICs. We abstracted data on reported roles of pharmacists in vaccination, as well as relevant country, vaccines, and populations served.

RESULTS

From the initial 612 records we identified, twenty-five (n = 25) studies representing 25 LMICs met our inclusion criteria. The most commonly reported role of pharmacists in vaccination across identified LMICs was vaccine advocacy and education (n = 15 countries). Pharmacist administered vaccination and storage of vaccines at pharmacies was reported in 8 countries. An additional 6 countries reported allowing vaccination at community pharmacies by other healthcare professionals. Immunization related training for pharmacists was reported or required in 8 countries. Fewer studies reported that pharmacists have access to patient immunization records in their respective LMICs (n = 6 countries) or had reported pharmacist involvement in vaccine adverse event reporting (n = 4 countries).

CONCLUSIONS

Pharmacists have the potential to play an important role in increasing access to vaccines and improving coverage, yet evidence of their role in vaccinations remains limited across LMICs. Greater documentation of pharmacists' involvement in vaccination services in LMICs is needed to demonstrate the value of successful integration of pharmacists in immunization programs.

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.

Pharmacist role in vaccination: Evidence and challenges

Vaccines prevent an estimated 2.5 million deaths worldwide each year and are amongst the most cost-effective preventive measures against infectious diseases. Despite the effectiveness and availability of vaccines in many parts of the world, vaccination rates and service uptake remains suboptimal among both healthcare providers and the public. Pharmacists as established advocates, educators as well as qualified providers of vaccinations have a significant role to play in promoting and supporting the uptake of vaccination. Challenges and barriers to pharmacist vaccination are multifactorial, which needs effective strategies to address. Overcoming these barriers will increase the role of pharmacists as vaccinators that ultimately increases public access to vaccination and accurate and reliable information about vaccines.

The essential role of pharmacists facilitating vaccination in older adults: the case of Herpes Zoster

Older adults share a disproportionately high burden of vaccine-preventable diseases. Despite recommendations from national and international health organizations, vaccination rates among older patients remain suboptimal, suggesting poor access and barriers to vaccination. Pharmacists are uniquely positioned to assist patients in overcoming many of these barriers. In this commentary, we describe some of the common barriers to vaccination that older adults encounter and the role pharmacists have in overcoming these barriers, in the US and abroad. We provide a case study of pharmacists' impact in supporting herpes zoster vaccination. We also identify areas of opportunities to promote further pharmacist involvement in vaccination efforts.

Towards a Greater Professional Standing: Evolution of Pharmacy Practice and Education, 1920-2020

The history of community pharmacy in America since the 1920s is one of slow progress towards greater professional standing through changes in pharmacy education and practice. The history of American community pharmacy in the modern era can be divided into four periods: 1920-1949 (Soda Fountain Era), 1950-1979 (Lick, Stick, Pour and More Era), 1980-2009 (Pharmaceutical Care Era), and 2010-present (Post-Pharmaceutical Care Era). As traditional compounding has waned, leaders within community pharmacy have sought to shift focus from product to patient. Increasing degree requirements and postgraduate training have enhanced pharmacists' ability to provide patient care services not directly associated with medication dispensing. However, the realities of practice have often fallen short of ideal visions of patient-focused community pharmacy practice. Positive trends in the recognition of the impact of community pharmacists on healthcare value and the need for more optimal medication management suggest that opportunities for community pharmacists to provide patient care may expand through the 21st century.

Managing Medical Emergencies in Hungarian Pharmacies

To amass a body of knowledge for managing emergency situations in pharmacies, we surveyed the occurrence and nature of medical problems in Hungarian pharmacies. The occurrence of real or suspected emergencies in pharmacies was markedly different and varied from 1–52 per year, with five cases per year on average. The most frequent problems were bleeding (69%) and dizziness (55%), but other more serious problems (allergic reaction (32%), collapse (23%), and chest pain (25%)) also occurred. Sometimes more than one symptom was reported by a patient. People appear to consider pharmacies to be an appropriate site for receiving first aid for minor ailments, including common medical problems (e.g., fever (12%)). Unfortunately, the range of interventions was very limited because of local legal regulations and the lack of appropriate guidelines for emergencies in pharmacies. The most frequent interventions were wound treatment, control of bleeding (78%), alleviation of anxiety (68%), and providing patients with a glass of water (55%). Very often, more than one intervention was reported for the same case. Whereas 76.3% of pharmacists provided interventions only for adults, 21% of pharmacists provided interventions for all types of patients (adults, co-workers in pharmacies, and children). Pharmacists appeared to be reluctant to treat children, owing to the special issues related to pediatrics. This poor range of intervention should encourage responsible officials to develop guidelines for pharmacists to ensure pharmacists’ familiarity with the appropriate interventions in emergency situations. Such knowledge could also provide a good basis for preparing pharmacists to perform vaccinations in the future. The pharmacists had a positive attitude toward providing first aid, and 88% of respondents requested more postgraduate education on medical first aid issues.

A Review of the Pharmacist as Vaccinator

Objective:

The aim of this study is to review literature about how the pharmacist’s role as vaccination providers has been financially and clinically measured.

Methods:

A broad literature search was conducted up to May 2016 to identify economic or clinical data on pharmacy vaccinations. MEDLINE® and PUBMED databases were searched for publications useful or potentially useful for this review. The NIH and CDC websites were also searched for relevant materials. Search terms included vaccination, pharmacist, economic, pharmacoeconomics, cost, benefits cost-effectiveness, physicians, immunizations, vaccinations, pharmacy vaccines, cost, physician vaccines, financial, benefit, ambulatory pharmacist vaccination, clinical pharmacist, economics, pharmacist vaccine impact.

Results:

The search yielded a total of 68 articles of which 12 met the criteria to be included in this review. After examining articles for relevance to pharmacy vaccinations, two tables were created to highlight the clinical and economic advantages of the pharmacist as a vaccinator.

Conclusion:

Pharmacists who administer vaccines are an underutilized provider. This literature review reveals a pattern among studies measuring the pharmacist’s impact on vaccination rates, patient preferences, and cost savings. Pharmacists have a history of demonstrated dependability, accuracy, and cost effectiveness. State laws, collaborative agreements, and health plans have continued to prevent patients from using the pharmacy to receive the CDC recommended vaccines. These barriers ultimately delay the Healthy People 2020 goals.

Pharmacist-prescribed hormonal contraception: A review of the current landscape

OBJECTIVE

The objective of this article is to review the current supply-side, demand-side, and regulatory landscape of pharmacist-prescribed hormonal contraception (HC) in the United States.

SUMMARY

Pharmacists appear to be supportive of pharmacist-prescribed HC. However, support does not necessarily indicate likelihood to implement the practice, even when reimbursement mechanisms exist. The likelihood of implementation can be increased with education and training of HC prescribing. Previous investigations suggest that women broadly support accessing contraception within a pharmacy. Expanded access, where available, can improve rates of use and adherence. Women at higher risk for unintended pregnancy, such as younger women and women without health insurance, are likely to use the pharmacy to procure HC. Despite a willingness to pay for HC consultations with pharmacists, costs can remain a significant barrier for many women.

CONCLUSIONS

Expanding access to HC through pharmacist-prescriptive authority could help curb the rates of unintended pregnancy in the United States. Pharmacists are well positioned for such a role; however, significant barriers for pharmacists and patients remain. Examination of current implementation methods will assist policy makers in overcoming these barriers.

Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study

Background

Pregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore.

Methods

Between September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants’ influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake.

Results

Response rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3–12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92–12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54–4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43–3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30–2.01).

Conclusions

Influenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7172-8) contains supplementary material, which is available to authorized users.

Community pharmacists at the heart of public health: A longitudinal evaluation of the community pharmacy influenza vaccination service

BACKGROUND

Influenza ("flu") is a contagious viral infection causing approximately 600 deaths/year in the United Kingdom. Annual vaccination is the most effective prevention strategy with a target of 75% uptake in 'at-risk' patient groups. Before 2012, immunisation was conducted in General Practice (GP), but uptake was below target. NHS Wales therefore introduced a programme allowing community pharmacists to administer the vaccine to certain patient groups^. OBJECTIVES: This study aimed to evaluate the community pharmacy (CP) flu Vaccination Programme in Wales.

METHODS

A longitudinal study was undertaken by secondary data analysis on data related to all NHS funded flu vaccinations administered in CP between 2012 and 2018 (n = 103941). Data were analysed using IBM SPSS® and Excel®. Pearson's correlation and independent sample t-test were conducted to compare the number of vaccines administered in CP vs overall numbers and those under 65 years and in the 'at risk' category in CP and GP respectively. Ethical approval was not required.

RESULTS

In total, pharmacists administered 103941 vaccinations. Vaccination numbers increased each season from 1568 in 2012/13 to 36238 in 2017/18. The main risk group was those aged 65 and over (59.9% of vaccinations). The proportion of those vaccinated who were aged <65 years and in an 'at risk' category was significantly higher in CP than GP (p < 0.01). There was a shift in balance between vaccinations administered by GPs and CPs in which CPs increased their share of all vaccinations in the flu programme from 0.3% in 2012-13 to 5.7% in 2017-18. A strong positive correlation was observed between increasing CP vaccinations and total vaccination numbers (R = 0.9316, p < 0.01).

CONCLUSIONS

Community pharmacists are providing increasing numbers of flu vaccinations in Wales, benefitting patients in all at-risk groups and reinforcing the valuable role of pharmacists at the heart of their communities, in terms of public choice and accessibility.

Cost-utility analysis of offering a novel remunerated community pharmacist consultation service on influenza vaccination for seniors in Ontario, Canada

BACKGROUND

Despite the availability of free and accessible influenza vaccine to all Ontarians, uptake has remained suboptimal. Although reasons to not receive the vaccine vary widely, health care provider recommendations remain the most effective strategy to positively influence vaccination decisions.

OBJECTIVES

This study aimed to predict the relative quality of life, costs, and cost-effectiveness of introducing a remunerated community pharmacist consultation service on influenza vaccination for Ontarians aged ≥ 65 years.

METHODS

A cost-utility analysis was performed from a third-party public payer perspective over 1 year. The delivery of consultation services by community pharmacists on influenza vaccination, billable at CAD $15 was compared with current standard practices (absence of remunerated consultations). Model inputs were derived primarily from existing literature. The impact of parameter uncertainties was assessed through deterministic and probabilistic sensitivity analyses.

RESULTS

The provision of influenza vaccine consultation services was predicted to prevent 2407 cases of mild influenza and 3 influenza-related deaths at an additional cost of CAD $2.03 per person over current practices. The incremental costs per quality-adjusted life-year (QALY) gained for the enhanced care strategy compared with standard care was CAD $2087. The interpretation of the base-case result was found to be robust across all sensitivity analyses. The projected additional costs of implementing pharmacist consultations in Ontario was estimated at CAD $1.15 million per year, and the anticipated benefits included a gain of 507 QALY per year.

CONCLUSION

Pharmacist-delivered consultation services on influenza vaccination are cost-effective and lead to improved clinical outcomes for Ontario seniors. Introduction of such services offers a promising strategy to address challenges related to poor vaccine uptake in this group.

Seasonal influenza vaccination policies in the Eastern Mediterranean Region: Current status and the way forward

BACKGROUND

The World Health Organization recommends annual influenza vaccination, especially in high-risk groups. Little is known about the adoption and implementation of influenza vaccination policies in the Eastern Mediterranean Region.

METHODS

A survey was distributed to country representatives at the ministries of health of the 22 countries of the Region between December 2016 and February 2017 to capture data on influenza immunization policies, recommendations, and practices in place.

RESULTS

Of the 20 countries that responded to the survey, 14 reported having influenza immunization policies during the 2015/2016 influenza season. All countries with an influenza immunization policy recommended vaccination for people with chronic medical conditions, healthcare workers and pilgrims. Two of the 20 countries did not target pregnant women. Eight countries used the northern hemisphere formulation, one used the southern hemisphere formulation and nine used both. Vaccination coverage was not monitored by all countries and for all target groups. Where reported, coverage of a number of target groups (healthcare workers, children) was generally low. Data on the burden of influenza and vaccine protection are scarce in the Region.

CONCLUSIONS

Despite widespread policy recommendations on influenza vaccination, attaining high coverage rates remains a challenge in the Eastern Mediterranean Region. Tackling disparities in influenza vaccine accessibility and strengthening surveillance systems may increase influenza vaccine introduction and use.

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

BACKGROUND

The purpose of this study was to assess the impact of the We Immunize Program on structures, processes, and outcomes of pneumococcal and herpes zoster pharmacy-based immunization services.

METHODS

Pharmacy-technician pairs from 62 Alabama and California community pharmacies participated in a 6-month randomized controlled trial (intervention = 30/control = 32). All received immunization update training; intervention participants also received practical strategies training and monthly telephonic expert feedback. Completion of immunization service structure and process activities were analyzed using Fisher's Exact and one-way Mann-Whitney U tests. The primary outcome, change in number of pneumococcal, herpes zoster, and total vaccine doses administered, was assessed using one-way Wilcoxon signed rank and Mann-Whitney U tests. Associations between program and vaccine doses across time were explored using generalized estimating equations (GEE).

RESULTS

Intervention pharmacies completed more structure (median 12.00 versus 9.00, p = 0.200) and process activities (median 8.00 versus 7.00, p = 0.048) compared to control. Statistically significant increases in the median number of pneumococcal vaccine doses (7.50-12.00 doses, p = 0.007), and total vaccine doses (12.50-28.00 doses, p = 0.014) were seen from baseline to post-intervention within the intervention group. However, these changes were not statistically significant when compared to the control group (pneumococcal p = 0.136, total p = 0.202). Changes in median herpes zoster vaccine doses did not reach significance among intervention (8.50-9.00, p = 0.307) or control (9.00-13.00, p = 0.127) pharmacies.

CONCLUSIONS

Practical strategies training combined with tailored expert feedback enhanced existing pneumococcal immunization services in community pharmacies.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02615470.

Pharmacists' immunization experiences, beliefs, and attitudes in New Brunswick, Canada

Background:

The expansion of pharmacist scope of practice to include provision of immunizations has occurred or is being considered in various countries. There are limited data evaluating the experiences of Canadian pharmacists in their role as immunizers.

Objective:

To describe the experiences of pharmacists in the Canadian province of New Brunswick as immunizers, including vaccines administered and perceived barriers and facilitators to providing immunizations.

Methods:

An anonymous, self-administered, web-based questionnaire was offered via email by the New Brunswick Pharmacists’ Association to all its members. The survey tool was adapted, with permission, from a tool previously used by the American Pharmacists Association and validated using content validity and test-retest reproducibility. Pharmacist reported immunization activities and perceived facilitators and barriers to providing immunization services were assessed.

Results:

Responses from 168 (response rate of 26%) were evaluable. Approximately 90% of respondents worked in community practice full time, 65% were female and 44% were practicing for 20 or more years. Greater than 75% reported administering: hepatitis A and B, influenza, and zoster vaccines. The majority of respondents felt fully accepted (agreed or strongly agreed) as immunization providers by patients, local physicians, and the provincial health department (97%, 70%, and 78%, respectively). Most commonly reported barriers were: lack of a universally funded influenza immunization program, insufficient staffing and space, and concerns around reimbursement for services.

Conclusions:

Pharmacists in New Brunswick, Canada are actively participating in the provision of a variety of immunizations and felt fully supported by patients and other healthcare providers. Barriers identified may provide insight to other jurisdictions considering expanding the role of pharmacists as immunizers.

Reasons for use and non-use of the pertussis vaccine during pregnancy: an interview study

INTRODUCTION In New Zealand, pertussis vaccination is recommended and government-funded during every pregnancy to protect the infant after birth. However, uptake is low and needs to be increased. AIM To investigate enablers and barriers for uptake of the pertussis vaccination by pregnant women in New Zealand, and explore the acceptability of provision in pharmacies. METHODS Women with infants were recruited in selected pharmacies and interviewed using abrief structured interview. Transcripts were analysed using a framework approach. RESULTS Thirty-seven women aged 18-43 years provided data for analysis. Seventeen women reported receiving a pertussis vaccination during their pregnancy. Information from health professionals appeared important to encourage vaccination, but other sources of information (eg antenatal groups and media) were also cited. Non-vaccination arose from being unaware of the need for pertussis vaccination during pregnancy, concerns about safety, and misinformation. Participants supported pertussis vaccination in pharmacies to help access or increase the opportunity for health professionals to inform women. DISCUSSION The information received by participants affected their uptake of the pertussis vaccine during pregnancy. Education of the public and health professionals about the pertussis vaccine during pregnancy is necessary.