U.S. clinicians' and pharmacists' reported barriers to implementation of the Standards for Adult Immunization Practice

Role of new vaccinators/pharmacists in life-course vaccination

BACKGROUND

Vaccines against diseases such as herpes zoster, pneumococcus and influenza are broadly recommended for older adults, but uptake is frequently low.

VACCINATION BOTTLENECK

Part of the reason may be that access to adult vaccination can be problematic, particularly for minorities and other under-served populations. Potential barriers include complex procedures, limited resources in healthcare systems and lack of structured infrastructure.

STRESS-TESTING EXPENDED VACCINATION

The Covid-19 pandemic necessitated rapid expansion of the infrastructure to deliver adult vaccination, and triggered the use of facilities including pharmacies, schools, faith-based organizations, community organizations, shops and hair salons, drive-through centres and mobile vaccination units.

IMPROVED ADULT VACCINATION SYSTEM

Although many such initiatives were temporary, they demonstrated the principle of effective expansion of adult vaccination and education to a range of new providers and settings. Of these, pharmacist involvement in immunization in particular has consistently been shown to be associated with increased immunization rates.

INTEGRATION OF NEW VACCINATORS

This review discusses results from attempts to expand and simplify the adult vaccination process, potentially allowing vaccination to be initiated by the recipient and completed in a single visit. These studies suggest that expanding adult vaccination access to new providers and/or new settings will require development of an integrated plan for preventive healthcare, covering areas such as setting target coverage rates, financial support, and development of immunization information systems accessible to all vaccination providers to maintain accurate immunization records and support interventions such as reminders.

SARS-CoV-2 Vaccination Coverage in Italian Children with Celiac Disease

Background: Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods: We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0-19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients' eligibility for vaccination at different times. Results: Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions: Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.

Focused Preceptor Feedback Assessing Student Pharmacists' Ability to Administer Pediatric Immunizations

OBJECTIVE

To evaluate experiential pharmacy preceptor perceptions of student pharmacists' ability to administer pediatric immunizations.

METHODS

Semi-structured, qualitative key informant interviews using the Outcomes Evaluation Framework were conducted with 10 pharmacist preceptors in outpatient community pharmacies where pediatric immunizations were provided. Interviews were audio-recorded, transcribed, and deidentified prior to analysis by the research team. Qualitative analysis and thematic coding procedures were used to identify relevant themes.

RESULTS

Saturation was met after 10 pharmacists participated. All stated that it was beneficial for student pharmacists to administer pediatric vaccines if trained in proper technique. Participants acknowledged that the training students currently receive in immunization administration within the PharmD curriculum is valuable but did identify general confidence and child-comforting techniques during and after vaccination as areas of improvement for students. Just-in-time training, preceptor coaching, and hands-on practice outside of the didactic curriculum were utilized to help build confidence. Barriers to the implementation or expansion of pediatric immunization delivered by students in community pharmacies were identified as competing priorities, time, and reimbursement.

CONCLUSION

Student pharmacists can be helpful in easing the challenges of incorporating pediatric immunization services into the community pharmacy setting. Results demonstrate that the integration of student pharmacists into these services is beneficial. Pediatric immunizations are still relatively new to many pharmacists and specific training for pediatric immunization administration may not be integrated into all Doctor of Pharmacy curricula but the experiential education of pediatric immunization training can be beneficial to help prepare student pharmacists for hands-on practice.

Exploring the implementation of national health and social care standards in Ireland: A qualitative descriptive study

BACKGROUND

National health and social care standards are complex, quality improvement interventions. Standards typically describe a process and/or outcome of safe, quality, person-centred care according to best evidence. Currently, there are 11 national standards that apply to diverse services in Ireland including residential centres, acute hospitals and rehabilitation and community inpatient healthcare services. A better understanding of contextual factors influencing implementation will inform decision-making when selecting implementation strategies to enhance the implementation of standards.

AIM

To explore experiences of implementing national health and social care standards and secondly, to identify enablers and barriers to implementation with stakeholders from across multiple levels of the health system.

DESIGN

A qualitative descriptive study.

METHODS

We conducted six focus groups and eight individual interviews from October to November 2021 with stakeholders at system level (n = 14), organizational level (n = 14) and individual level (n = 10). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis.

RESULTS

Six themes were generated; (1) Top-down, bottom-up, a team approach: everybody together, we are all involved, we are all responsible, (2) Support tools: accessible tools and bite-size material pertaining to standards will support us to implement standards, (3) Empower with knowledge: increase awareness and understanding of standards, make them relatable in practice so we can make sense of them, (4) A system-wide malaise: we do not have the bandwidth to implement standards, (5) Follow the leader: we need a lead person at every level to inspire implementation, (6) A bi-directional influence: we know inspections drive quality improvements but we still feel trepidation around inspection outcomes.

CONCLUSION

Key enablers identified related to teamwork, support tools, leadership and inspections. Key barriers related to workforce issues, a lack of awareness of standards and fear of inspection outcomes. Our findings can be incorporated into strategies to support implementation of standards, ultimately for the benefit of service-users.

IMPLICATIONS FOR PRACTICE

The enablers and barriers described in this study reflect the importance of organizational factors in the implementation of standards. Interdisciplinary teams can infer from these findings, which enablers and barriers apply to their own context. These findings can inform decision-making when selecting strategies that can be effective in supporting the implementation of standards.

REPORTING METHOD

We have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Willingness of Canadian community pharmacists to adopt a proactive life-course approach to vaccination services

BACKGROUND

Most Canadian jurisdictions authorize pharmacists to administer vaccines, with differences in vaccine and patient age eligibility. Vaccination rates could be further optimized if pharmacists took a more proactive role in life-course vaccine screening and administration. Health professional vaccine fatigue following the COVID-19 pandemic may negatively impact service delivery.

OBJECTIVES

To assess vaccine fatigue among Canadian pharmacists, understand their willingness to provide proactive life-course vaccination services and identify associated vaccine practice facilitators.

METHODS

One-on-one interviews were conducted with pharmacists recruited through a national community pharmacist Facebook group. Purposive sampling was used to select a diverse sample considering gender, province, and years of practice. Online interviews were conducted using a semi-structured guide with questions about vaccination experiences, perceptions of assuming a more proactive vaccinator role for adults and children, and current level of fatigue related to offering vaccination services. Interviews were audio-recorded, transcribed, and coded independently by 2 researchers; content analysis was used to identify themes.

RESULTS

In spring 2023, interviews were conducted with 24 pharmacists from 5 Canadian provinces. Participants were receptive to a more proactive vaccinator role, feeling that vaccine fatigue had lessened, but strongly advocated for system and practice modifications to facilitate successful implementation. They emphasized the need for patient vaccination history access, the ability to administer all publicly funded vaccines, and fair compensation. Participants requested the development of electronic tools that connected to pharmacy systems that helped them navigate complex vaccine guidelines and clinical decision making, and the required documentation/billing. They also spoke of logistical concerns related to the incorporation of vaccination into their workflow and adequate staffing. Most participants were willing to vaccinate younger children if legislated age limits were lowered, provided they were trained and compensated appropriately.

CONCLUSION

Pharmacists are interested in furthering their vaccination services offerings, including proactive screening and vaccination of young children.

Factors Related to, and Effective Interventions for, Vaccination Uptake Among Older Adults in Two Asia-Pacific Countries: A Rapid Review

This rapid review aims to present a comprehensive overview of barriers, facilitators, and effective interventions that promote vaccination uptake by older adults in the Asia-Pacific region. Rapid review methodology was applied, using two databases (PubMed, Embase). Articles were included if studies were conducted in Australia, Singapore, Indonesia, and the Philippines; included human population ≥50 years of age, and was published from 2016 to August 2022. Related articles were not found from Indonesia and Philippines. A total of 23 articles met the inclusion criteria, with 19 reporting on barriers and facilitators, whereas, four articles reported effective interventions to promote vaccination uptake. Among the 19 studies that identified barriers and facilitators to vaccination uptake, the more common factors were social influences (n = 8/19), perceived benefits of vaccine (n = 7/19), and perceived vaccine safety (n = 6/19). Interventions that focused on supporting clinicians were found to be effective in leading them to recommend vaccinations among older adults, such as creating awareness on the low baseline vaccination rates among older adults, provision of structured health assessment, and nurse reminders. More studies are needed to ascertain the barriers and facilitators to uptake, as well as to identify effective interventions influencing vaccine uptake among older adults in the Asia-Pacific region.

Pharmacists' Perceptions of Mental Well-Being and Immunization Safety During COVID-19

Purpose: To assess pharmacists' mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists' beliefs about the pandemic's impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists' concerns and well-being.

Exploring the future adult vaccine landscape-crowded schedules and new dynamics

Amidst the backdrop of the COVID-19 pandemic, vaccine innovation has garnered significant attention, but this field was already on the cusp of a groundbreaking renaissance. Propelling these advancements are scientific and technological breakthroughs, alongside a growing understanding of the societal and economic boons vaccines offer, particularly for non-pediatric populations like adults and the immunocompromised. In a departure from previous decades where vaccine launches could be seamlessly integrated into existing processes, we anticipate potentially than 100 novel, risk-adjusted product launches over the next 10 years in the adult vaccine market, primarily addressing new indications. However, this segment is infamous for its challenges: low uptake, funding shortfalls, and operational hurdles linked to delivery and administration. To unlock the societal benefits of this burgeoning expansion, we need to adopt a fresh perspective to steer through the dynamics sparked by the rapid growth of the global adult vaccine market. This article aims to provide that fresh perspective, offering a detailed analysis of the anticipated number of adult vaccine approvals by category and exploring how our understanding of barriers to adult vaccine uptake might evolve. We incorporated pertinent insights from external stakeholder interviews, spotlighting shifting preferences, perceptions, priorities, and decision-making criteria. Consequently, this article aspires to serve as a pivotal starting point for industry participants, equipping them with the knowledge to skillfully navigate the anticipated surge in both volume and complexity.

Integrated Immunization Information System in Indonesia: Prototype Design Using Quantitative and Qualitative Data

BACKGROUND

As the volume of immunization records increases, problems with fragmented records arise, especially since the majority of records in developing countries, including Indonesia, remain paper based. Implementing an immunization information system (IIS) offers a solution to this problem.

OBJECTIVE

In this study, we designed an integrated IIS prototype in Indonesia using the design science research (DSR) methodology.

METHODS

The stages of the DSR methodology followed in this study included identifying problems and motivating and defining objectives for a solution, design and development, demonstration, evaluation, communication, and drawing conclusions and suggestions. Specifically, this study began with problem formulation and a literature review. We then applied quantitative (questionnaire with 305 members of the public) and qualitative (interviews with 15 health workers including nurses, midwives, and doctors) data collection approaches.

RESULTS

The resulting high-fidelity prototype follows the 8 golden rules. There are 2 IIS designs, one for the public as immunization recipients and another for health workers. The functionalities include immunization history, schedule, recommendations, verification, certificates, reminders and recalls, coverage, monitoring, news, and reports of adverse events. Evaluation of the prototype was carried out through interviews and a questionnaire designed according to the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). The SUS value was 72.5 or "Good (Acceptable)," while the system usefulness, information quality, interface quality, and overall value on the PSSUQ were 2.65, 2.94, 2.48, and 2.71, respectively, which indicate it has an effective design.

CONCLUSIONS

This provides a guide for health facilities, health regulators, and health application developers on how to implement an integrated IIS in Indonesia.

Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary

BACKGROUND

Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation.

METHODS

Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers.

RESULTS

4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%).

CONCLUSIONS

The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.

Understanding Over-immunization in North Dakota's Adult Population

CONTEXT

Over-immunization, or administration of excess doses of vaccine, is an understudied topic in immunization. Adult over-immunization is particularly understudied, so building a basic understanding of the sources and scope of over-immunization is necessary to direct action.

OBJECTIVE

The aim of this evaluation was to quantify the extent of over-immunization in North Dakota's adult population from 2016 to 2021.

DESIGN

Records for all pneumococcal, zoster, and influenza vaccines administered to adults in North Dakota were extracted from the North Dakota Immunization Information System (NDIIS) from January 1, 2016, through December 31, 2021. The NDIIS is a state-wide immunization registry that captures all childhood and most adult immunizations.

SETTING

North Dakota.

PARTICIPANTS

North Dakotan adults 19 years or older.

MAIN OUTCOME MEASURE

The number and percentage of adults identified as over-immunized as well as the number and percentage of doses identified as an extra dose.

RESULTS

Frequency of over-immunization was less than 3% for all vaccines over the 6-year period assessed. Pharmacies and private practices were the most common sources of over-immunization of adults.

CONCLUSIONS

These data show that over-immunization is still an issue in North Dakota, although the percentage of the adult population impacted is low. Reducing over-immunization is worth pursuing but should be balanced with the importance of improving low immunization coverage rates in the state. Improving utilization of the NDIIS by adult providers can help prevent over-immunization and under-immunization alike.

Challenges of vaccination information system implementation: A systematic literature review

Globally, healthcare services have begun to show interest in switching from paper-based to electronic-based vaccination records through Vaccination Information Systems (VIS). VIS have been implemented in various countries, but the study on the challenges of implementing VIS in these countries is still limited. The challenges of implementing VIS need to be understood to become a subject of discussion and anticipation by other countries that are just starting to implement VIS. We analyzed 32 selected publications from 634 initially retrieved. Fourteen challenges were successfully identified when implementing VIS, including interoperability, data quality, security and privacy, standardization, usability, internet connectivity, infrastructure, workflow, funding, government regulations, awareness, skeptical response, computer literacy, and staff-related challenges. The challenges of interoperability and data quality were found to be the most widely discussed by previous studies. In addition to identifying the challenges, this study includes a series of solutions that can be applied to overcome each challenge.

Perceived Role, Identity and Experiences of Pharmacists and the Potential Impact on COVID-19 Vaccine Uptake per Louisiana Region: A Prospective Cohort Study

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.

Student pharmacists delivering academic detailing on adult pneumococcal vaccination to community pharmacists

BACKGROUND

Academic detailing is an educational outreach approach to disseminate evidence-based information to health care professionals and improve clinical decision making. Pharmacists and physicians are recognized as the most qualified individuals to perform academic detailing; however, trained student pharmacists may also serve as suitable academic detailers.

OBJECTIVES

To describe our academic detailing intervention that used trained student pharmacists to disseminate an updated pneumococcal vaccination clinical pathway (i.e., decision-support tool) and education to community pharmacists in Rhode Island and Massachusetts.

METHODS

We updated an academic detailing initiative that included a pneumococcal vaccination clinical pathway and education for community pharmacists in 2021. Two University of Rhode Island (URI) College of Pharmacy pharmacist faculty members trained 6 student pharmacists to perform academic detailing. Student pharmacists visited URI-affiliated community pharmacies throughout Rhode Island and Massachusetts. After each session, each participant received a 6-question anonymous paper survey to assess the effectiveness of the updated pathway and academic detailing session. The survey used a 5-point Likert-type scale. We assessed the percentage agreement with each question.

RESULTS

Academic detailing was delivered to 76 community pharmacists from May to August 2021. Most respondents agreed (89.2%, 58/65) that their knowledge of which patient populations met eligibility for the pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine improved. Respondents were confident they could apply the knowledge gained (93.8%, 61/65) and intended to apply the pathway (93.8%, 61/65) to clinical practice. Most respondents expected vaccination practices to change because of the academic detailing and education materials received (83.6%, 51/61). Almost all respondents (95.4%, 62/65) found the educational materials easy to understand.

CONCLUSION

Trained student pharmacists can deliver academic detailing regarding adult pneumococcal vaccination to community pharmacists. Enlisting the help of student pharmacists may be a sustainable approach to academic detailing and provides students with valuable opportunities to practice delivering educational outreach to community pharmacists.

Challenges and opportunities to provide immunization services: Analysis of data from a cross-sectional study on a sample of pharmacists in a developing country

Background and Aims

Vaccine-preventable illnesses continue to be a global health concern as immunization coverage remains below its targets. National plans emphasize on the essential role of multidisciplinary efforts and approaches to vaccination programs. Pharmacists are globally getting involved in immunization services as important members of the healthcare team. This study aimed to determine barriers, and assess challenges and possible opportunities to provide immunization in the Lebanese pharmacy practice.

Methods

This was a cross-sectional study that included pharmacists from all over Lebanon, as part of a national research to assess the role of pharmacists as immunizers. All registered pharmacists in Lebanon practicing in community, hospital, or other clinical settings were considered eligible for participation. A web-based self-administered validated questionnaire, which is initially developed by the American Pharmacists Association, was adapted with permission.

Results

A total of 315 pharmacists responded to the survey. Only 23.1% declared completing an immunization training program. Over half of pharmacists (58.4%) administer vaccines to patients. A significant association between lack of support from physicians to pharmacists (adjusted odds ratio [ORa] = 2.099, 95% confidence interval [CI] = 1.290-3.414, p = 0.003) and vaccine administration was found, while cost associated with professional development and additional training (ORa = 0.533, 95% CI = 0.287-0.989, p = 0.046) was inversely associated to it. Logistic, financial, and legislative requirements as essential necessities were determined to successfully expand pharmacist-led immunization services.

Conclusions

The major barriers and challenges to vaccine administration by pharmacists comprised a lack of physicians' support and expenses associated with professional development and additional training. Pharmacists administer more vaccination despite lack of support from physicians; whereas they administer less vaccination due to cost associated with professional development and further training. The scope of pharmacy practice in Lebanon is not well recognized by other healthcare providers and stakeholders to include immunization services.

Missed Pneumococcal Vaccination Opportunities in Adults With Invasive Pneumococcal Disease in a Community Health System

Background

Adult vaccination programs are suboptimal.

Methods

Pneumococcal vaccination history, and healthcare contact were assessed in patients with invasive pneumococcal disease.

Results

Of the 229 cases, 14% were vaccinated. Observed mortality was 20.1%.

Conclusions

Numerous missed vaccination opportunities were identified.

How colleges intervene to increase student body vaccination coverage

OBJECTIVE

The interventions colleges use to help students be compliant with vaccinations is unknown. This study describes colleges' use of practices consistent with Centers for Disease Control and Prevention (CDC) recommendations to encourage student body vaccination.

PARTICIPANTS

Participants were a convenience sample of 136 student health center (SHC) administrators from colleges across the U.S.

METHODS

An online survey assessed SHCs' use of various practices, policies and services to improve student body vaccination coverage.

RESULTS

There was wide variability in use of evidence-based interventions overall and with respect to specific vaccinations. While most SHCs (92.7%) coordinated vaccination outreach events on campus, only half (50%) accessed an immunization registry to verify vaccination histories. While 88.6% requested student vaccination histories for MMR, only 39.7% requested it for human papillomavirus (HPV).

CONCLUSIONS

The discrepancies in SHC implementation of interventions to increase coverage of the recommended vaccinations for students suggest that helping colleges expand their capacity to intervene may decrease coverage rate disparities.

Health Care Professionals' Herpes Zoster Awareness and Vaccine Recommendations for Patients with COPD

Objectives

The objective of this study was to assess health care professionals' (HCPs) knowledge of an increased herpes zoster (HZ) risk and burden for patients with chronic obstructive pulmonary disease (COPD), HCPs' familiarity with the Advisory Committee on Immunization Practices' (ACIP) HZ vaccine recommendations, and the HCPs' current adult vaccine practices. Another objective was to evaluate the impact of a short educational video on knowledge and future vaccine intent.

Participants and Methods

An online survey of family physicians (FPs), pulmonologists, nurse practitioners (NPs), and physician assistants (PAs) querying demographics, awareness of ACIP HZ vaccine recommendations, and HZ burdens and risks in patients with COPD and their current recommendations for HZ, influenza, and pneumococcal vaccines was conducted. For those not strongly recommending HZ vaccines concordant with ACIP recommendations, a 5-minute educational video was presented, and post video questions assessed future intended HZ vaccine recommendations.

Results

Among 1020 HCP responders, awareness and ACIP concordant HZ vaccine recommendations ranged from 59.0% to 95.2% across HCPs. Lowest recommendation rates were consistently reported by pulmonologists for the 2-dose HZ vaccine beginning at age 50; for the 2-dose vaccine use in those with prior 1-dose HZ vaccinations, and for those with prior HZ. Among all HCPs, HZ vaccine recommendations were lower than for pneumococcal and influenza vaccines. After viewing the educational video, reported vaccine recommendation intent increased significantly in all groups of HCPs, as did awareness of increased HZ risk among patients with COPD.

Conclusions

Significant educational opportunities exist for HCPs related to HZ and its vaccine prevention among patients with COPD which may be responsive to brief, targeted interventions.

Vaccine perceptions in a free urban clinic for underserved, uninsured adults

BACKGROUND

Adult vaccine rates remain low despite public health efforts. Despite the likelihood that underserved patients face more barriers to vaccination, little is known on the perceptions underserved patients have about vaccines as a whole. Additional information could guide health care providers in efforts to improve adult vaccination rates in the medically underserved population.

OBJECTIVES

The primary objective of this survey was to assess perceived susceptibility to and severity of vaccine-preventable disease (VPD) and perceived safety and effectiveness of vaccines in a medically underserved population.

METHODS

This cross-sectional, descriptive study evaluated vaccine perceptions using a self-administered paper survey in a free clinic providing care to uninsured, low-income adults. All patients with scheduled appointments in the clinic were eligible to participate. Two Likert-type items were used to define responses regarding trust and beliefs. Level of trust was defined as "Not at all" (1), "A little" (2), "Not sure" (3), "Some" (4), and "A lot" (5). Responses to vaccine belief items were defined as "Strongly disagree" (1), "Disagree" (2), "Neither agree nor disagree" (3), "Agree" (4), and "Strongly agree" (5). Statistical analyses were descriptive in nature.

RESULTS

Final analysis included 131 surveys. Health care providers were the most common patient-reported vaccine information source (73.3%) and the most trusted (median: 5). Despite clear agreement among respondents that vaccines are safe (median: 3.94) and effective (median: 4) in adults, with similar results regarding children, the results regarding personal risk from VPDs were less definitive (median: 3).

CONCLUSION

Overall, survey responses in this uninsured, low-income population indicate that vaccines are perceived as safe and effective, but there is less consensus regarding the individual risk patients face from VPD. Focusing patient education on individual risk as much as overall vaccine safety and efficacy may help improve low adult vaccination rates in the medically underserved.

The impact of community pharmacy utilization of immunization information systems on vaccination rates: Results of a clustered randomized controlled trial

BACKGROUND

Adult immunization rates in the United States remain low. More convenient access to immunization information systems (IIS) may improve vaccination rates.

OBJECTIVE

The objective of this multilevel, clustered, randomized controlled study was to measure the impact of providing pharmacists with software and training to query IIS for patient vaccine history/recommendations on adult influenza, pneumococcal, herpes zoster, and Td/Tdap vaccination rates.

METHODS

California Rite Aid pharmacy districts were randomized into intervention/control groups using stratified randomization based on baseline influenza vaccination rates. Store demographic characteristics were collected at baseline (January 1-December 31, 2018). During follow-up (April 1, 2019-March 31, 2020), intervention group stores received access to ImmsLink, software that allows health care providers to review immunization records from IIS and identify a patient's recommended vaccinations. The difference-in-difference between intervention and control groups compared the changes in vaccination rates from baseline to follow-up by calculating adjusted ratios of risk ratios (RRRs). Analysis was performed at the store level.

RESULTS

Thirty-six districts comprising 501 Rite Aid stores (intervention: n = 244 stores; control: n = 257) were included. We found no significant differences in vaccination rates between groups: influenza, 19-64 years (adjusted RRR 0.99 [95% CI 0.83-1.17]); influenza, ≥65 years (1.02 [0.86-1.22]); herpes zoster (1.07 [0.90-1.28]); pneumococcal (0.95, 0.80-1.14); and Td/Tdap (0.88, 0.73-1.05). Reasons that recommended vaccines were not given in the intervention group included patient being deferred to future visit, patient declining, patient having already received the vaccination, patient declining because of cost, or vaccine being unavailable. Overall, pharmacist engagement with ImmsLink was low.

CONCLUSION

Providing pharmacists with software and training to query IIS did not improve vaccination rates compared with control pharmacies in this study. Factors such as an inconvenient interface or inadequate training or motivation may have caused low engagement with the software and should be considered in future interventions.

Exploring determinants of community pharmacist-led influenza vaccination in a Middle Eastern country: a national web-based cross-sectional study

BACKGROUND

Utilizing community pharmacists (CPs) as immunizers has being adopted in various countries as approach to boost influenza vaccination coverage. Our study aims to explore the Lebanese CPs' willingness to administer influenza vaccine, and to identify factors associated with this willingness.

METHODS

This is a web-based, cross-sectional study, conducted over 2 months, from the 1st of November to the end of December 2020. Self-reported data were collected electronically from Lebanese CPs through an anonymous, questionnaire using google form. The collected data were analyzed using the statistical software SPSS (Statistical Package for Social Sciences). Bivariate and multivariable analyses were performed to examine factors associated with the willingness of CPs to administer influenza vaccine.

RESULTS

A total of 412 CPs participated in this survey of which 76.9% are willing to administer influenza vaccines. More than 90% of them had a good overall knowledge score and 88.8% of CPs showed a positive overall attitude score, particularly towards involvement of CPs in influenza vaccine provision. Their willingness to administer vaccine was positively associated with the younger age (aOR = 3.12 with 95% CI (1.597-4.040)), higher education level (aOR = 2.02 with 95% CI (1.093-3.741)), previous experience in immunization (aOR = 2.72 with 95% CI (1.320-5.627)) and urbanicity of pharmacy (aOR = 1.542 with 95% CI (1.219-4.627)). Extensive working hours (aOR = 2.34 with 95% CI (1.131-4.845)), working in pharmacies that are operating round-the-clock, showing positive attitude towards immunization (aOR = 3.01 with 95% CI (1.872-6.422)) and towards provision of influenza vaccines (aOR = 13.72 with 95% CI (13.721-38.507)) were also positively associated to this willingness. Conversely, patient privacy (aOR = 0.55 with 95% CI (0.079-0.983)), time and cost for professional development (aOR = 0.55 with 95% CI (0.172-0.918)), limited patient's trust (aOR = 0.39 with 95% CI (0.203-0.784)), financial remuneration (aOR = 0.18 with 95% CI (0.088-0.377)), and requirement of formal certification in vaccine administration (aOR = 0.07 with 95% CI (0.020-0.279)) were negatively associated to this willingness.

CONCLUSION

Addressing the unearthed concerns related to utilizing CPs as influenza immunizers through a concerted effort is a key to success in any future implementation of vaccination services in pharmacies.

Accuracy of Self-Reported Vaccination Status in a Cohort of Patients with Inflammatory Bowel Disease

BACKGROUND AND AIMS

Prevention of vaccine-preventable diseases is important in the care of patients with inflammatory bowel disease (IBD). Thus, accurate immunization histories are critical. Many providers rely on patient self-report when assessing immunization status. The primary aim of our study was to determine the accuracy of self-reported influenza vaccination status in a cohort of patients with IBD.

METHODS

We conducted a prospective study of patients with IBD who answered a vaccination status questionnaire and compared their responses to the Wisconsin Immunization Registry, a state-wide electronic immunization information system. The primary outcome was the sensitivity and specificity of self-reported influenza vaccination status. A secondary outcome evaluated the sensitivity and specificity of pneumococcal vaccination status.

RESULTS

A total of 200 patients with IBD were included in the study. Documented immunization rates were 74.5% for influenza vaccinations and 79.9% for pneumococcal vaccinations. Influenza vaccination self-report had a sensitivity of 98.7%, a specificity of 90.2%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 95.8%. In comparison, the sensitivity for pneumococcal vaccination was 83.5% with a specificity of 86.2%, PPV of 96.4%, and NPV of 54.3%.

CONCLUSIONS

Self-reported influenza immunization status is sensitive and specific in patients with IBD. Accuracy for pneumococcal vaccination is slightly lower, but responses were notable for a high PPV. Self-report is an effective way to determine influenza immunization status and provides useful information for receipt of pneumococcal vaccine in patients with IBD.

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

BACKGROUND

Over the past 2 decades, pharmacists have positioned immunization services as an important aspect of their expanding role in patient care.

OBJECTIVES

To examine how community chain pharmacists view time spent on immunization, available in-store resources and barriers, and pharmacy technician involvement in the context of their views about the achievement of key National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice in their workplace.

METHODS

A representative, nationwide survey was administered electronically to chain community pharmacists over a 4-week period. Community pharmacists offering year-round immunization in retail chain, supermarket, and mass-merchant settings, randomly sampled from a database maintained by the American Pharmacists Association. We examined several sets of interrelated relationships regarding pharmacists' perceived achievement of 3 key NVAC standards (assessment, recommendation and administration), time spent on the overall immunization process, the effectiveness of available in-store resources, immunization impediments, and the endorsement of increased technician involvement in community pharmacy-based immunization service (PBIS) delivery.

RESULTS

A sample of 590 survey responses was obtained from 9717 e-mails delivered, with 489 deemed eligible (5% response rate). Sizeable numbers of pharmacists acknowledged that several activities integral to achieving optimal immunization levels were not being addressed. Although pharmacists accepted that appropriately trained pharmacy technicians should be able to ask (77%) and assess (66%) patients, only 24% agreed that technicians should be able to administer vaccine doses. Pharmacists satisfied with in-store immunization resources and technicians' involvement were more likely to report achieving the 3 key NVAC standards. Paradoxically, how pharmacists viewed their immunization time expenditures was unrelated to whether they agreed that pharmacy technicians should have an expanded role in asking, assessing, or administering vaccines to their patients.

CONCLUSION

Overall, community pharmacies would likely better meet national immunization goals by achieving all 3 key NVAC standards and incorporating expanded roles for appropriately trained and supervised technicians in PBIS.

Pneumococcal vaccination coverage among adults aged 19 to 64 years with immuno-compromising conditions, cerebrospinal fluid (CSF) leaks, or cochlear implants in the US

Background: Adults with immuno-compromising conditions, CSF leaks, or cochlear implants are at increased risk for pneumococcal disease (high-risk patients), yet pneumococcal vaccination rates in the US for this group are low.Methods: A retrospective cohort analysis was conducted from 2010 to 2018 using the Truven Health MarketScan database to estimate pneumococcal vaccination coverage among adults aged 19 to 64 years newly diagnosed with high-risk conditions, and to assess factors associated with receiving the recommended pneumococcal vaccines.Results: The study sample included 2,497,799 adults aged 19 to 64 years old with newly diagnosed high-risk conditions. Most of the study cohort had seven or more annual physician office (52%) and pharmacy (56%) visits. The proportion of high-risk adults who received at least one pneumococcal vaccination increased from 5.4% after 1 year of follow-up to 14.2% after 6 years of follow-up. Compared to those who received no pneumococcal vaccination, high-risk adults who received any pneumococcal vaccination were more likely to be older, female, enrolled in an HMO, had more healthcare encounters, and were treated by a primary care provider.Conclusion: Despite numerous healthcare encounters annually, very few high-risk adults received pneumococcal vaccines, highlighting the need for implementing targeted interventions to increase vaccine uptake in this vulnerable population.

Improving Pneumococcal Vaccination Rates among Rural Older Adults through Academic Detailing: Medicine, Nursing and Pharmacy Partnership

Academic detailing is an educational approach involving provision of evidence-based information by healthcare providers for healthcare providers with the goal of improving clinical decision-making. An interprofessional academic detailing initiative was developed to encourage rural providers to utilize guidelines when deciding which patients to vaccinate against pneumonia. This study utilized a quasi-experimental, single-group, pre-post observational design with physicians, nurses, and staff at two rural medical clinics. The 12-month academic detailing intervention included a needs assessment, workflow assessment of practice-based health information technology, vaccination training for providers and staff, and creation of exam-room posters encouraging patients to discuss vaccination with their provider. Six visits were made to deliver education, discuss needs, select priorities, and develop action plans from recommendations. Data were collected from each site for three years prior to the intervention year and for one year following the intervention. The annual rate of patients vaccinated increased during the five-year study. The cumulative proportion of the sample population that received vaccination also increased over time. Interprofessional academic detailing was well received and increased pneumococcal vaccination rates among rural-dwelling older adults. Given the alarming disparities in health outcomes for rural patients, educational outreach is needed to improve healthcare access and outcomes.

The Role of Intern Pharmacists in Implementing Innovative and Sustainable Practices to Enhance Rates of Non-influenza Immunizations

Background Intern pharmacists are likely an underutilized resource for addressing immunization barriers and improving immunization rates. Studies have addressed methods that pharmacists use to improve immunization rates, but few have focused on the role of intern pharmacists, with particular emphasis on non-influenza immunizations. Methods An online survey was distributed through email listservs associated with California pharmacy schools and organizations. Data collected included title (“pharmacist” or “intern pharmacist”), practice setting, perceptions of the intern pharmacists’ role in improving immunization rates (strongly agree to strongly disagree using a 5-point Likert scale), and opinions regarding potential implementations. Immunization barriers were assessed using a 9-point scale, from least to most feasible to be addressed. Statistical comparisons between intern pharmacist and pharmacist responses were made using chi-square or Fisher’s exact tests. Results A total of 133 respondents completed the survey. The immunization barrier most likely to be successfully overcome by intern pharmacists was lack of patient awareness. There was strong support in favor of intern pharmacists having greater involvement in programs that increase patient non-influenza immunization rates. The two most feasible implementations by intern pharmacists were determined to be intern-led college/university campus clinics providing free non-influenza immunizations and educational booths/outreaches that raise awareness about immunizations. Conclusion Identification of immunization barriers capable of being addressed by intern pharmacists and effective intern pharmacist-led initiatives may contribute to enhanced immunization outcomes. Future steps include the implementation of intern pharmacist-led activities and further evaluation of whether these intern pharmacist-specific initiatives contribute to increasing non-influenza immunizations.

Pharmacists' views and desires regarding pharmacist administration of vaccines in New Zealand

OBJECTIVES

To explore pharmacists' views and experiences of pharmacist-administered vaccinations, motivators and barriers to pharmacists administering vaccinations and their preferences for expansions to such services.

METHODS

All practising pharmacist members (n = 3400) of the Pharmaceutical Society of New Zealand were invited to participate in an online survey in 2017.

KEY FINDINGS

A total of 468 pharmacists completed the survey (14%). Most (86%) strongly agreed/agreed that pharmacists should provide vaccinations, primarily citing patient benefit, for example, convenience, potential for increased vaccination uptake, easing general practice burden and better utilisation of the pharmacist. Half had completed vaccinator training, mainly for professional satisfaction, to help public or community health and/or to provide a new service for their community. Trained pharmacists had administered influenza (95%), pertussis (47%), zoster (45%) and/or meningococcal vaccines (13%), with patient cost limiting some vaccination uptake. Cost or workplace constraints were leading reasons for the 17% not planning to undertake vaccinator training. Key barriers for pharmacy owners not offering vaccinations were set-up or other costs, insufficient funding (62%) or staffing/time concerns (27%). Some trained vaccinators (39%) wanted the recipient age lowered below 13 years, and 44% wanted intern pharmacists to be able to administer vaccinations.

CONCLUSION

This study found strong support for this service, including benefits for patients, and for customer relationships. Identified barriers including service setup and patient costs could be reduced by expanding the categories (e.g. pharmacy students and technicians) of staff able to vaccinate and having more government funded vaccines available through pharmacies, therefore, improving access for patients.

Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE

BACKGROUND

Project VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow.

OBJECTIVE

The objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members' perceptions of work system factors that influenced the implementation of key intervention features.

METHODS

Pharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems.

RESULTS

A total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage.

CONCLUSIONS

Several key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy-based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.

Vaccinations and Chronic Diseases: Knowledge, Attitudes, and Self-Reported Adherence among Patients in Italy

The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), those with diabetes, those who had received information by Internet, physicians, and friends/relatives, and those who needed more information were more likely to know that the influenza vaccine is recommended for patients with chronic diseases. More than half (58.2%) and 8.9% self-reported to have received at least one recommended vaccination and more than one, respectively. Patients who believed that vaccine-preventable diseases (VPDs) were dangerous for them, those who had received information by physicians, and those who needed information were more likely to have received at least one recommended vaccination. This behavior was less likely in married patients, those who were worried about the side effects of the vaccines, and those who suffered from renal failure. The results highlight the need to implement effective vaccination programs in order to decrease the complication of VPDs in at-risk population.

Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers

The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.

Identifying vaccination rates of adult patients in ambulatory care clinics

BACKGROUND

While pharmacists have provided vaccinations to patients in the community pharmacy setting, pharmacist involvement within the medical office setting is not well documented in the literature. The American Society of Health-System Pharmacists reports that ambulatory care pharmacists are screening for and administering vaccinations at a declining rate, despite standards of practice. Vaccination rates for adults 19-64 years of age remain low, based on Healthy People 2020 goals, putting them at risk for vaccine-preventable diseases.

OBJECTIVES

The aim of the study was to assess vaccination rates of ambulatory care pharmacy clinic patients aged 19-64 years and to compare the rates between three clinics and to Healthy People 2020 goals.

METHODS

This was a baseline retrospective analysis of vaccination rates for patients aged 19-64 years who attended at least one pharmacy clinic visit at one of the three medical office practices. Age, sex, medical conditions, cigarette or alcohol use, immunosuppressive medications, and vaccines recommended and received were recorded. Vaccination status was assessed according to the Advisory Committee for Immunization Practices recommendations. Data were collected from January 2016 to March 2017. The percentage of eligible patients who received each vaccine was determined overall and for each clinic.

RESULTS

There were 240 patients who met the inclusion criteria, with a mean age of 52.8 years. The percentage of patients with vaccination documented in the medical record was 25% for pneumococcal conjugate, 35.7% for pneumococcal polysaccharide, 26.9% for zoster vaccine live, 6.4% for hepatitis B, and 50.6% for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Vaccination rates for pneumococcal conjugate, pneumococcal polysaccharide, and zoster vaccine live were below established Healthy People 2020 goals.

CONCLUSION

Vaccination rates remain low in adults 19-64 years of age. Ambulatory care pharmacists should consider assessing vaccination status during clinic visits as a component of comprehensive vaccination programs.

Increasing adult immunization rates in a rural state through targeted pharmacist education

BACKGROUND

Most immunization rates fall below the Healthy People 2020 goals for adults. Pharmacists have the potential to have a positive effect on immunization rates through vaccine administration.

OBJECTIVE

The purpose of this study was to assess if an educational program developed for pharmacists could increase pharmacist-delivered statewide immunization rates.

PRACTICE DESCRIPTION

This study was conducted in the state of North Dakota. North Dakota law allows authorized pharmacists to provide any immunization to individuals aged 11 years or older.

PRACTICE INNOVATION

In collaboration with the state health department, a needs assessment of North Dakota pharmacists was conducted to determine what resources and education could increase the delivery of immunizations within the pharmacy. The results were used to develop focused continuing pharmacy education material, create an online toolkit, and provide immunization administration certification.

EVALUATION

The number and proportion of pharmacist-delivered immunizations and overall adult immunizations rates were compared pre- and postintervention. The North Dakota Immunization Information System was used for data comparison. In addition, the number of pharmacists registered to provide immunizations with the State Board of Pharmacy was tabulated.

RESULTS

The number of pharmacist-provided immunizations increased by more than 3900 doses. In addition, the percentage of adult immunizations provided by pharmacists and overall adult immunization rates increased throughout the state. After adjusting for seasonality, there was an increase in the number of pharmacist-delivered pneumococcal polysaccharide vaccine immunizations (P < 0.001). The number of pharmacists registered to provide immunizations increased throughout the study period by 39%.

CONCLUSION

This study suggests that focused education and resources delivered to pharmacists can increase pharmacy-based immunization rates and adult immunization rates overall. Improving adult immunization rates through greater pharmacist engagement may help to decrease overall infectious disease threats.

Healthcare Workers' Knowledge, Attitudes, and Practices about Vaccinations: A Cross-Sectional Study in Italy

The cross-sectional study assessed the knowledge, attitudes, and practices regarding the recommended vaccinations and factors affecting such outcomes among a sample of healthcare workers (HCWs) in public hospitals in Italy. Only 14.1% knew all the recommended vaccinations for HCWs. Physicians and those who had received information about vaccinations from scientific journals, educational activities, or professional associations were more likely to have this knowledge, while those aged 36–45 were more likely to have less knowledge than those in the age group below 36 years. Only 57.3% agreed that the information received about vaccinations was reliable. Respondents who had children, who worked in pediatric/neonatal wards, who were more knowledgeable, or who did not need further information about vaccinations considered the available information to be reliable. Only 17.7% of respondents always recommended vaccinations to their patients. This behavior was more likely to occur in physicians, in HCWs, in pediatric/neonatal wards, in those who considered the information received about vaccinations reliable, and in those who considered themselves to be at high risk of transmitting an infectious disease to their patients. Health promotion programs and efforts are needed to improve the level of knowledge about vaccinations and immunization coverage among HCWs.

Investigating knowledge, attitudes, and practices regarding vaccinations of community pharmacists in Italy

The purposes of this cross-sectional study were to determine the level of knowledge, attitudes, and behaviors related to vaccinations among community pharmacists in Italy and to understand the characteristics associated with the different outcomes of interest. The data were collected between September 2018 and April 2019 using semi-structured telephone interviews among a nationally representative sample of community pharmacists. Out of 550 pharmacists who were contacted, a total of 389 responded yielding a response rate of 70.7%. Only 23.9% indicated correctly all ten mandatory vaccinations for newborn. Participants with a lower number of years since degree, employee compared to owners, those who often/always collected information about public’s immunization, and who have received information from educational activities were more likely to know all ten mandatory vaccinations for newborn. Almost all (91.7%) believed that they could play a prominent role in the educational interventions on vaccinations and 75.3% that they should be more engaged in these interventions. Only 23.7% had recommended HPV vaccine to 11–12 years-old adolescents. Pharmacists who have obtained information from educational activities, who knew all ten mandatory vaccinations for newborn, and who believed that they should be more engaged in vaccination interventions were more likely to recommend the vaccine. The HPV vaccine was less likely recommended by those who have obtained information from scientific journals, mass-media and internet, and educational activities compared to those who have not received any information, who worked a higher number of hours per week, who often/always collected data on immunization, and employee pharmacists compared to owners. The findings may be useful to design interventions that can overcome the knowledge gaps of community pharmacists and to improve vaccine recommendations.

Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort

INTRODUCTION

This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations.

METHODS

This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives.

RESULTS

Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings.

CONCLUSIONS

A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.

Vaccination of Adults in General Medical Practice

In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.

Addressing common barriers in adult immunizations: a review of interventions

Introduction: Low levels of adult vaccination have been documented in the United States and globally. Research has been conducted to identify reasons for low immunization rates; however, the most useful studies are those that implemented interventions for identified barriers to evaluate their impact on rates of immunization. Identifying successful interventions provides immunization providers with evidence-based methods that can be utilized to increase the uptake of recommended vaccines.Areas covered: This review focuses on known barriers to adult immunizations and the interventions available in the literature to overcome these barriers. It outlines interventions that may increase vaccine uptake in the adult population through addressing barriers related to lack of vaccine knowledge, cost, access, provider and practice-based challenges, and racial and ethnic disparities.Expert opinion: Improving adult immunization rates is critical to protecting a population against vaccine-preventable diseases. Those interventions that appeared to increase immunization rates in the adult population included education and reminders about vaccination using text and telephone calls, low-cost or subsidized vaccines, easy access to immunization services, and understanding the cultural and social needs of different racial and ethnic populations. It is likely that an evidence-based multimodal approach using different categories of interventions is necessary to significantly improve adult immunization rates.

Assessment of the factors influencing primary care physicians' approach to vaccination of adult risk groups in Istanbul, Turkey

Background

We aimed to assess the factors influencing primary care physicians’ (PCPs) approach to adult vaccination in specific risk groups and evaluate the compliance to adult immunization guidelines.

Methods

This cross-sectional study performed between January 2016 and April 2016 in İstanbul, Turkey. A questionnaire designed to obtain physicians’ demographical data, experience, immunization status, and attitude on prescribing or recommending vaccines for adults in the risk group. Healthy individuals older than 65 and patients suffer from chronic diseases or had splenectomy before are considered as a risk group. The questionnaire was sent via email to a randomly selected group of 1,500 PCPs. The data of 221 physicians who responded emails were recorded for statistical analysis.

Results

Of the 221 participants (123 women, 98 men), the majority were aged 31–40 years. Their vaccination rates were 74.2% for hepatitis B, 54.3% for seasonal influenza, and 47.1% for tetanus. Among participants, the highest recommendation and prescription rate of adult vaccines was recorded in PCPs aged 31–40 years. In addition, PCPs with <10 years occupational experience were found to prescribe adult vaccines more frequently than PCPs with longer occupational experience.

Conclusions

Primary care physicians with lower age and relatively less experience are more intent to prescribe adult vaccines to patients that are in risk groups. This result may be due to increased awareness of adult immunization among PCPs who had more recent medical training. However, many other factors could have caused this difference, including physicians’ approach to primary medical care.

Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion

As the global population ages, there is concern about the effect of an increased proportion of older individuals on the economic sustainability of healthcare systems and the social effects of an older society. Health authorities and advocacy groups in countries at the forefront of this trend are now developing strategies to ameliorate the social and financial effects of an ageing population. There is broad agreement that for both society and for the individuals, it is important to ensure that increasing lifespans are matched with increased "healthspans" - the number of years spent in good health. There is also growing consensus that vaccination is one of the tools that can play an important role in improving adult health - though currently vaccination coverage is often poor. This review focuses on two issues that consistently appear to be associated with under-vaccination: the low awareness of risk (and potential consequences) for vaccine-preventable diseases and a poor understanding of the value of improved vaccination coverage for adults. We suggest that understanding of vaccination as a health-promoting activity, rather than a medical intervention designed to prevent the spread of a specific pathogen - is a crucial step to improve vaccination uptake among adults (see Supplementary video abstract ). Key messages As populations age globally, we are seeing an increasing burden of vaccine-preventable disease in adults. Adult vaccination against some common diseases has been shown to dramatically improve health and quality of life for older people. Despite the attested benefits, vaccination coverage is almost always poor in adults, even in countries where access is free at point of care. In this article, we discuss what appears to a neglected issue in adult vaccination, that of personal autonomy. We argue that adult vaccination will only be successful if it respects individual autonomy and that this requires treating the choice to vaccinate as a public health issue akin to smoking cessation, exercise and healthy diet.

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.