Pharmacist role in vaccination: Evidence and challenges

Promotion and COVID-19 lockdown increase uptake of funded maternal pertussis vaccination in pharmacy: A mixed methods study

Pertussis vaccination is recommended during pregnancy to protect the baby. Pertussis vaccination was initially free to pregnant people through general practice and hospitals in New Zealand, but uptake was suboptimal. In one district funding of maternal pertussis vaccination was widened to community pharmacies in 2016. Eighteen months later promotion to pharmacies, midwives and pregnant people took place. In 2020 and 2021, COVID-19 lockdowns occurred.

AIM

To explore the effects of promotion and COVID-19 lockdowns on uptake of funded maternal pertussis vaccination in pharmacy, and awareness, use and opinions of promotional elements.

METHODS

Five years of pharmacy claims data were analysed and 12 pharmacists, 18 people eligible/recently eligible for maternal pertussis vaccination and 11 midwives were interviewed.

RESULTS

Provision of maternal pertussis vaccination increased during and after promotion. Qualitative data showed that pharmacists valued phone calls with information about maternal pertussis vaccination and recommendations for increasing uptake. Prompted by these calls, some pharmacists contacted midwives to inform them of funded maternal pertussis vaccination in the pharmacy (which midwives appreciated) and recommended pertussis vaccination to pregnant clients. Pharmacy staff reportedly were motivated to recommend this vaccination by being informed about it and having posters displayed in the pharmacy. Pregnant people valued healthcare professionals' conversations about maternal pertussis vaccination, but appeared to be uninfluenced by posters and promotional social media posts about this vaccination. During COVID-19, maternal pertussis uptake in pharmacies increased 31% March to May 2020 (before and during the first COVID-19 lockdown) versus the same time the previous year, then declined.

CONCLUSION

Promotion appeared to have a sustained effect on uptake of maternal pertussis vaccination in pharmacies. Pregnant people were most influenced by discussions with healthcare professionals. Pharmacists and pharmacy staff increased proactivity with maternal vaccinations after promotion to them. Promotion may need to be repeated over time.

Public Knowledge and Beliefs Regarding Pharmacy-Based Immunization in Poland-A Nationwide Cross-Sectional Study, 2024

Pharmacy vaccinations are a key public health intervention. This study aimed to assess society's knowledge about pharmacy vaccinations in Poland. A cross-sectional study was conducted from 10 to 13 May 2024 among 1126 adults; the survey questionnaire contained 13 closed questions. Men (OR: 1.32; [1.02-1.70]; p < 0.05), and people aged 50-64 (OR: 1.55; [1.05-2.28]; p < 0.05), people with higher education (OR:1.74; [1.35-2.26]; p < 0.001), and people declaring trust in the pharmacist's competencies (OR:3.95; [3.03-5.15]; p < 0.001) more often declared knowledge of vaccinations in pharmacies. Support for these services was declared by men (OR:1.74; [1.28-2.36]; p < 0.001) and people with higher education (OR:1.39; [1.02-1.89]; p < 0.05) and participants declaring trust in the pharmacist's competences (OR:20.30; [14.65-28.11]; p < 0.001). Trust in pharmacists was important. People declaring trust in pharmacists were much more willing to get vaccinated against influenza (40.2%) and zoster (38.0%) at a pharmacy and declared that they would vaccinate their children against HPV at a pharmacy (38.8%) compared to people who did not trust the competences of pharmacists (p < 0.001). There was a significant difference in the case of influenza. People who trusted pharmacists were five times more likely to declare their willingness to get vaccinated against influenza (p < 0.001).

Public health audit of vaccine cold chain management in general practice and community pharmacy in Western Australia

OBJECTIVE

To support immunisation providers through a cold chain management audit.

METHODS

An electronic audit survey using the National Vaccine Storage Guidelines as a gold standard was developed for general practice (GP) and community pharmacy. It included automated feedback, with individualised support from a clinical nurse specialist as required. Responses were analysed to determine the proportion of providers meeting criteria in four categories: procedures, refrigerators and equipment, temperature monitoring and emergency storage.

RESULTS

Of 818 providers invited, 420 GPs (89.6%) and 276 pharmacies (82%) responded. Over 70% met all procedural and emergency storage criteria. Although most providers (98.1% GPs, 97.0% pharmacies) used a data logger, the proportion measuring at 5-minute intervals, reviewing data logger printouts weekly and manually recording minimum and maximum temperatures was lower. In total, 58% of providers required follow-up by the clinical nurse specialist, most regarding the need for equipment.

CONCLUSION

An electronic audit enabled public health to engage with a large number of immunisation providers. Most reported high compliance with the national guidelines although opportunities for education were identified and actioned.

IMPLICATIONS FOR PUBLIC HEALTH

Electronic solutions can support public health units to engage with providers to ensure vaccines remain effective and wastage is limited.

Effectiveness of patient reminders on influenza vaccination coverage among adults with chronic conditions: A feasibility study in Australian general practices

BACKGROUND

Influenza vaccination is recommended for Australians 18+ years old with medical risk factors, but coverage is suboptimal. We aimed to examine whether automatic, opportunistic patient reminders (SMS and/or printed) before appointments with a general practitioner increased influenza vaccination uptake.

METHODS

This clustered non-randomised feasibility study in Australian general practice included patients aged 18-64 years with at least one medical risk factor attending participating practices between May and September 2021. Software installed at intervention practices identified unvaccinated eligible patients when they booked an appointment, sent vaccination reminders (SMS on booking and 1 h before appointments), and printed automatic reminders on arrival. Control practices provided usual care. Clustered analyses adjusted for sociodemographic differences among practices were performed using logistic regression.

RESULTS

A total of 12,786 at-risk adults attended 16 intervention practices (received reminders = 4066; 'internal control' receiving usual care = 8720), and 5082 individuals attended eight control practices. Baseline influenza vaccination uptake (2020) was similar in intervention and control practices (∼34%). After the intervention, uptake was similar in all groups (control practices = 29.3%; internal control = 30.0%; intervention = 31.6% (p-value = 0.203). However, SMS 1 h before appointments increased vaccination coverage (39.3%, adjusted OR = 1.65; 95%CI 1.20;2.27; number necessary to treat = 13), especially when combined with other reminder forms. That effect was more evident among adults with chronic respiratory, rheumatologic, or inflammatory bowel disease.

CONCLUSION

These findings indicate that automated SMS reminders delivered at proximate times to appointments are a low-cost strategy to increase influenza vaccination among adults at higher risk of severe disease attending Australian general practices.

Assessment of community pharmacists' knowledge, attitudes and their willingness to provide vaccination services in Saudi Arabia

BACKGROUND

Community pharmacists play an important role in increasing vaccination rates especially in countries where they offer vaccination services and administration. However, little is known about community pharmacist's willingness to provide vaccination services in Saudi Arabia. The objective of this study was to assess knowledge, attitudes, willingness and beliefs of community pharmacists in Saudi Arabia towards providing vaccines at pharmacies.

METHODS

A cross-sectional, online questionnaire-based study using convenience sampling (Snowball technique) was used to obtain responses from community pharmacists across Saudi Arabia. The survey collected information on participants' demographics, knowledge about vaccine, attitude towards vaccine and their attitude to be immunization providers. Bivariate analysis and multiple linear regression models were employed to assess the relationships between demographic variables and outcomes.

RESULTS

The study sample consisted of 384 community pharmacists. More than half of participants had poor knowledge about vaccines (54%). Only 8.4% of participants had good knowledge about vaccines. The results indicated that community pharmacists in the study sample have positive attitude toward vaccines and are willing to provide vaccination services. There was a significant relationship between knowledge about vaccine and attitude toward vaccines. Pharmacists with poor knowledge about vaccines had negative attitude toward vaccines as compared to those with high knowledge (β = -1.743; P-value = 0.024). Additionally, there was a significant relationship between knowledge about vaccine and attitude to be immunization providers. Pharmacists with poor knowledge about vaccines had negative attitude to be immunization providers as compared to those with high knowledge (β = -2.631; P-value = 0.002). Furthermore, a significant number of the community pharmacists reported facing critical barriers to provide vaccines including legal liability, lack of personal resources and lack of appropriate training.

CONCLUSION

Comprehensive training and certification programs for pharmacists are crucial to improve their competencies in handling and administering vaccines to increase the rate of vaccinations in Saudi Arabia.

Knowledge and perceptions of French community pharmacists and pharmacy students about the papillomavirus vaccine

INTRODUCTION

In a French context of low vaccination coverage for human papillomavirus (HPV) disease, we conducted a study on pharmacy students and community pharmacists to assess their self-reported knowledge about HPV infection and vaccination and their perceptions of vaccination.

MATERIAL AND METHODS

A prospective volunteered-based study was conducted in the French Franche-Comté region based on a questionnaire targeting pharmacy students (from the 2nd to 6th years) and community pharmacists.

RESULTS

All in all, 220 students and 55 pharmacists completed a questionnaire. Fewer than a third knew which HPV genotypes are considered to be high-risk (p-value = 0.11) and were aware of the diversified nature of HPV-induced cancers (p-value = 0.02). Their overall level of general knowledge about vaccination was estimated to be good by 62% of students and 85% of pharmacists (p-value = 10-3). More than 75% of students and pharmacists considered that HPV vaccination has a positive benefit-risk balance (p-value = 0.44) but that its low coverage is due to non-confirmed adverse events that were suggested in the past (p-value = 0.60). Pharmacists had a better perception of the safety of HPV vaccination (84% versus 64%, p-value = 6·10-3). More than 50% of students and pharmacists agreed with mandatory HPV vaccination for girls and boys (11-14 years).

CONCLUSION

This study allowed us to assess the knowledge of students and community pharmacists and their more or less favorable perceptions of HPV vaccination. It helped us to suggest their needs in terms of practical training. Future changes should include pharmacists in the implementation of public health policies and to improve vaccination coverage.

Council of Europe Resolution on the Implementation of Pharmaceutical Care-A Step Forward in Enhancing the Appropriate Use of Medicines and Patient-Centred Care

Pharmaceutical care was proposed to address morbidity and mortality associated with medicine-related problems. It utilises the pharmacist's expertise in medicines, their relationship with the patient and cooperation with other healthcare professionals to optimise the use of medicines. The European Directorate for the Quality of Medicines & HealthCare (EDQM), part of the Council of Europe, found significant variation in the acceptance of pharmaceutical care and in the implementation of pharmaceutical care in Europe. A multidisciplinary group was established to draft a statement of principles and recommendations concerning pharmaceutical care. Through face-to-face meetings, circulation of draft texts and informal consultation with stakeholders, the group produced a resolution. On 11 March 2020, the resolution was adopted by the Committee of Ministers of the Council of Europe. It explains pharmaceutical care and illustrates pharmacists' contribution to medicine optimisation in different care settings. Pharmaceutical care's value to health services and its place in health policy were emphasised by addressing the risks and harms from suboptimal use of medicines. Pharmaceutical care can improve medicine use, promote rational use of healthcare resources and reduce inequalities in healthcare by realigning the roles and responsibilities of pharmacists and healthcare professionals. EDQM will promote and advocate for the implementation of pharmaceutical care by enacting practice Resolution CM/Res(2020)3.

Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece

We aimed to document vaccination coverage for five vaccines, predictors of each vaccine's uptake and attitudes regarding adult vaccination. Adults visiting four pharmacies were randomly invited to participate during summer 2022. Among 395 participants (mean age 51.2 years, range 19-96), vaccination rates were 78.1% for influenza and 25.8% for herpes zoster (≥60 years old), 64.3% for pneumococcal disease (≥65 years old), 33.1% for tetanus, while 11.4% had received two and 74.8% ≥3 COVID-19 vaccine doses. Half of participants (50.1%) voiced some degree of hesitancy, and 1.3% were refusers. The strongest predictor of each vaccine's uptake was doctor's recommendation (OR range 11.33-37.66, p < 0.001) and pharmacist's recommendation (4.01-19.52, p < 0.05), except for the COVID-19 vaccine, where the Attitude Towards Adult VACcination (ATAVAC) value of adult vaccination subscale's score was the only predictor (OR: 5.75, p < 0.001). Regarding insufficient coverage, thematic content analysis revealed seven main themes. Insufficient knowledge, the absence of health professionals' recommendation, perception of low susceptibility to disease, negligence and dispute of vaccine effectiveness were universal themes, whereas safety concerns and distrust in authorities were reported solely for COVID-19 vaccination. Designing public interventions aiming to increase trust in adult vaccination is essential in the aftermath of the COVID-19 pandemic. Health professionals' role in recommending strongly adult vaccination is crucial.

Vaccine knowledge, attitudes, and recommendation practices among health care providers in New York State

Community-wide vaccine uptake remains sub-optimal. Healthcare provider (HCP) vaccine recommendations influence patient vaccination; however, provider vaccine recommendation behavior is highly influenced by one's own vaccine attitudes and/or knowledge. We aim to describe vaccine knowledge, attitudes, and recommendation practices (KAP) among New York State HCPs. A survey to assess HCP KAP was developed and electronically distributed to NYS members of national medical organizations via their local chapter administrators. Descriptive statistical methods were used to define provider KAP. A total of 864 surveys were included, 500 (60%) and 336 (40%) primary and specialty care providers, respectively. Eighty-one percent (402/499) of primary care providers (PCPs) report encountering vaccine hesitant patients daily or weekly. Of the 500 PCPs who responded, only 204 (41%) stated strong agreement with confidence in their communications with vaccine hesitant patients. HCPs who correctly answered all four knowledge questions were more likely to self-report routine recommendations of standard vaccines to all patients when compared to those who correctly answered fewer questions (489/588 (83%) vs 135/241 (56%), p < .05). HCPs were more likely to routinely recommend standard vaccines to all patients if they also report initiating vaccine discussion (476/485 (98%) vs 148/344 (43%), p < .05) and reviewing and recommending vaccinations at each encounter (315/320 (98%) vs 308/508 (61%), p < .05). Vaccine hesitancy exists across healthcare specialties and provider roles. Focused interventions should include reaching all HCPs to promote vaccinations for disease prevention, tailoring messages to reduce HCP vaccine misperceptions, and increasing awareness of evidence-based office strategies known to facilitate immunizations.

Impact of a pharmaceutical intervention on influenza vaccination in patients receiving treatment with biological medicines

OBJECTIVE

The aims of this study were twofold - to determine the impact of a health education intervention led by a hospital pharmacy department on influenza vaccination take-up in patients diagnosed with immune-mediated diseases. Patients were receiving treatment with biological medicines. Secondly, to compare those rates with the vaccination percentages of another hospital pharmacy with similar characteristics in which no educational intervention was conducted.

METHODS

This was a retrospective cohort study of adult patients with immune-mediated diseases receiving treatment with biological medicines. The medicines were dispensed by the hospital pharmacy departments of two hospitals between 1 January 2019 and 31 December 2020. In Cohort A (intervention group), a health education strategy was implemented with regards to influenza vaccination. Cohort B acted as a control group. The influenza vaccination rates obtained in both cohorts during 2019 and 2020 were compared.

RESULT

A total of 355 patients took part in the study - 148 (41.7%) in Cohort A and 207 (58.3%) in Cohort B. The hospital pharmacy department in Cohort A implemented a health education strategy after which the vaccination percentage during the 2020 campaign increased by 38 patients (45.7%), compared with a 10 patient (5.8%) increase in Cohort B (p<0.001).

CONCLUSIONS

The health intervention by the pharmacy department had a positive impact. This included an opportunity to improve vaccination take-up and is a strategy to consider when implementing a vaccination programme. Health education is a fundamental objective of healthcare. In our case it led to an increase in vaccination and had a positive impact on public health. It also provides opportunities for pharmacists to work in a multidisciplinary way with other healthcare professionals.

Knowledge and attitudes of community pharmacists on vaccination, barriers and willingness to implement community pharmacy-based vaccination services in Ethiopia

This study aimed to evaluate the knowledge and attitudes of community pharmacists (CPs) on vaccination and assess the barriers and willingness to implement community pharmacy-based vaccination services (CPBVS) in Ethiopia. An online cross-sectional study was conducted on 423 CPs in Ethiopia, and questionnaires were distributed to CPs through the Ethiopian Pharmaceutical Association telegram group and e-mail invitations. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 27. Most CPs (92%) had good knowledge of vaccination, and 43.5% strongly agreed that the population's immunization rates would rise if CPs were authorized to provide vaccinations. The overall mean attitude score (±SD) toward vaccination was 35.95 (±4.11) out of a total score of 45, with 187 (44.2%) scoring below the mean. The most common barriers were lack of authorization (94.1%), costs and time associated with professional development and training (71.4%), time requirements for professional development (70%), and insufficient staff or resources for implementation (70%). Two hundred thirty CPs (54.4%) expressed a willingness to implement CPBVS. Educational qualifications were significantly associated with knowledge of CPs regarding vaccination. Those with inadequate knowledge had about 2.5 times (AOR = 2.51, 95% CI: 1.19, 5.31, p = .016) a poorer attitude toward vaccination services compared with those with adequate knowledge. Those study participants who had a good attitude toward vaccination services were nearly seven (AOR = 6.80, 95% CI: 4.36-10.59, p = .0001) times more willing to provide CPBVS when compared with their counterparts. Implementing CPBVS in Ethiopia requires overcoming barriers and providing professional development opportunities.

Norwegian Community Pharmacists' Experiences with COVID-19 Vaccination-A Qualitative Interview Study

BACKGROUND

Immunising the population became important during the COVID-19 pandemic. Community pharmacies in Norway collaborated with municipalities to offer a vaccination services to increase the vaccination rate. Only some pharmacies were allowed to offer this service in the pandemic's early phase. This study learns about pharmacists' experiences during this first period of COVID-19 vaccination services in community pharmacies, which is relevant for informing policy and organisational decision makers about the feasibility and acceptability of pharmacy vaccination.

METHODS

Individual interviews were conducted with 13 pharmacists in community pharmacies offering a COVID-19 vaccination service. Informants were recruited from the eleven pharmacies that first offered COVID-19 vaccinations. The key themes in the interview were COVID-19 vaccination, what the pharmacists think about the vaccination service, and how it is performed. The data were analysed using systematic text condensation.

RESULTS

Three main themes and eight subthemes were identified. The main themes were creative solutions, organising and making resources available, and professionally satisfying and an important mission. The interviewed pharmacists experienced the COVID-19 vaccination service as hectic but something important that they would prioritise. They experienced their efforts to be substantial in the pandemic's early phase.

CONCLUSIONS

Pharmacists in community pharmacies were a resource for increasing the vaccination rate during the COVID-19 pandemic. The pharmacies' easy accessibility and the pharmacists' ability to adjust their daily workflow for a new service should be considered when an expanded healthcare service is needed.

A systematic review and pooled prevalence of burnout in pharmacists

BACKGROUND

Burnout is an occupational phenomenon caused by ineffectively managed work-related stress. Burnout is common among healthcare professionals and has the capacity to compromise patient care, but is not well characterised in pharmacists.

AIM

This systematic review aimed to establish the prevalence of burnout among pharmacists, and its associated risk factors.

METHOD

A systematic search of Embase, PubMed, CINAHL and PsychInfo was carried out. Studies were included using the following eligibility criteria; original research investigating burnout prevalence in pharmacists in patient-facing roles in any jurisdiction, using any validated burnout measurement instrument. No language or date barriers were set. Data were extracted by the first author and accuracy checked by co-authors. A pooled prevalence was estimated, and narrative synthesis provided.

RESULTS

Burnout prevalence data were extracted from 19 articles involving 11,306 pharmacist participants across eight countries. More than half (51%) of pharmacists were experiencing burnout. Associated risk factors included longer working hours, less professional experience, high patient and prescription volumes, excessive workload and poor work/life balance. The COVID-19 pandemic has negatively impacted pharmacist burnout and resilience. Involvement in education and training and access to burnout management resources were associated with lower rates of burnout, but burnout intervention effectiveness is unknown.

CONCLUSION

Burnout remains high among pharmacists and may negatively affect the quality of patient care. There is significant heterogeneity pertaining to the definition and assessment of burnout and there remains a need to identify and evaluate effective individual and organisational burnout interventions.

Exploring the impact of the New York State repeal of nonmedical vaccination exemptions on student enrollment, absenteeism, and school workload: Perspectives from a survey of school administrators

In June 2019, New York State (NYS) adopted Senate Bill 2994A eliminating nonmedical vaccine exemptions from school entry laws. Since student noncompliance with the law required school exclusion, we sought to evaluate the law's effects on student enrollment and absenteeism, and school workloads related to its implementation. In November 2019, we sent an electronic survey to NYS (excluding New York City) schools. Due to the COVID-19 pandemic, outreach was curtailed in March 2020 with 525 (14%) of 3,759 eligible schools responding. To account for non-response, results were analyzed using inverse probability weighting. After weighting, 39% (95% CI: 34%, 44%) of schools reported enrollment changes and 31% (95% CI: 26%, 36%) of schools reported absenteeism related to the law. In addition, 95% (95% CI: 93%, 98%) of schools reported holding meetings and/or preparing correspondence about the law, spending a mean of 14 (95% CI: 11, 18) hours on these communication efforts. Schools in the highest pre-mandate nonmedical exemption tertile (vs. lowest) were more likely to report enrollment and absenteeism changes, and higher workloads. While our results should be interpreted with caution, changes in student enrollment, absenteeism, and school workloads may represent important considerations for policymakers planning similar legislation.

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.

Preparedness for a pandemic: Independent community pharmacists' experiences delivering COVID-19 vaccines

OBJECTIVE

To identify the experiences and preparedness for independent community pharmacies to deliver COVID-19 vaccines.

DESIGN

A mixed-methods study collected quantitative and qualitative data.

SETTING AND PARTICIPANTS

Every independent community pharmacy providing COVID-19 vaccines in North Dakota.

OUTCOME MEASURES

During state-required site visits, quantitative data determined by a Centers for Disease Control and Prevention (CDC)-developed reviewer guide were collected on each pharmacy's preparedness on vaccine provision and quality assurance to provide COVID-19 vaccines. Qualitative data to describe the lived experiences of pharmacists were collected through site visit documentation and semistructured interviews with participating pharmacists.

RESULTS

Fifty-two pharmacies received site visits. All visited pharmacies met full compliance with CDC's reviewer guide for billing and documentation of vaccine, vaccine procedures, recipient communication, and handling of ancillary supplies. Pharmacies varied in their compliance of vaccine storage and handling requirements. Forty-three interviews yielded 4 main themes about pharmacies' role in vaccination during the pandemic: (1) professional role, (2) accessibility, (3) patient relations, and (4) community role.

CONCLUSION

Site visits demonstrated that independent community pharmacies were prepared to provide COVID-19 vaccines in response to public need, despite varying degrees of experience with and provision of routine immunizations. Interviews revealed that pharmacists recognized their important contribution to COVID-19 vaccine provision efforts.

A typology of vaccine hesitancies: Results from a study of community pharmacists administering COVID-19 vaccinations during the pandemic

Pharmacists were integral to the vaccine administration process during the first two years of the COVID-19 pandemic. As such, they encountered a variety of different forms of vaccine resistance. This qualitative study explored 33 community pharmacists (from varying geographical and practice types) responses to vaccine resistance and tactics utilized to support vaccination amongst diverse community members. A typology of 8 different variants of vaccine hesitancy emerged, each with its own root cause and potential opportunities for intervention. Pharmacists in this study described techniques to support adherence to public health guidance based on their assessment of root causes for resistance demonstrated by patients. Importantly, all pharmacists in this study described feelings of anger towards truly anti-vax patients and unwillingness to actually engage or even try to address this group in their practice.

Country score tool to assess readiness and guide evidence generation of immunization programs in aging adults in Europe

Objectives

Delaying of policies for immunization of aging adults, low vaccine uptake, and the lack of supportive evidence at the national level could diminish the value in health and economics of such programs. This study aims to develop a "country score tool" to assess readiness and to facilitate evidence generation for aging adult immunization programs in Europe, and examine the comprehensiveness, relevance, acceptability, and feasibility of the tool.

Methods

The tool was developed in two phases. First, a modified Delphi process was used to construct the tool. The process included a literature review, stakeholder consultations, and a three-round Delphi study. The Delphi panel included researchers, supra-national and national decision-makers of immunization programs recruited from five countries, using snowball sampling method. The consensus was predefined at the agreement rate of 70%. Pilot testing of the tool was conducted in the Netherlands, Germany, Serbia, and Hungary involving researchers in the field of health technology assessment. After assessing the countries' readiness, researchers evaluated four features, namely comprehensiveness, relevance, acceptability, and feasibility of the tool via an online survey that included 5-scale Likert questions. The percentages of affirmative answers including "agree" and "totally agree" choices were presented.

Results

The review identified 16 tools and frameworks that formed the first version of our tool with 14 items. Eight experts were involved in the Delphi panel. Through three Delphi rounds, four items were added, one was dropped, and all others were amended. The consensus was achieved on the tool with 17 items divided into decision-making and implementation parts. Each item has a guiding question, corresponding to explanations and rationales to inform assessment with readiness scores. Eight researchers completed the pilot testing. The tool was rated as comprehensive (75%), relevant (100%), acceptable (75%), and feasible (88%) by participants.

Conclusion

Through a thorough and transparent process, a country score tool was developed helping to identify strengths, weaknesses, and evidential requirements for decision-making and implementation of immunization programs of aging adults. The tool is relevant for different European contexts and shows good comprehensiveness, acceptability, and feasibility.

Talking about the Vaccine after the Pandemic: A Cross-Sectional Study among Youth in Turkey and Ethical Issues

Examining the factors that affect the vaccination rate among young people in an ethical frame can support vaccination promotion. Therefore, this study will elaborate, through an ethical lens, on young people's hesitation about and decisions regarding getting vaccinated. The cross-sectional study was conducted with 2428 people aged 15-30 in Turkey in June 2022. The questionnaire included the following subtitles: psycho-social situation, health services and health policies, COVID-19 vaccine, and predictions about life and health after the pandemic. The average age was 22.9 years. In the study sample, 80% were vaccinated, while 20% were not. Vaccinated participants acted more cautiously to protect their health. Receiving accurate and sufficient information on proposed vaccines affects vaccination status. The primary reason for getting vaccinated was "to protect their health, families, and relatives", and the primary reason for not getting vaccinated was "not trusting the vaccine content or the country where the vaccine was produced". Specifically, those vaccinated felt more relaxed physically, psychologically, and socially. In addition, the expectations for the future of those vaccinated were significantly higher. Accurate and adequate information is essential for reducing vaccine hesitancy. In addition, promoting prosocial behaviors in young people and highlighting related values will support vaccination.

The Development, Implementation, and Evaluation of a Pharmacist-Managed Therapeutic Drug Monitoring (TDM) Service for Vancomycin-A Pilot Study

BACKGROUND

In recent years, pharmacists in Australia have been able to expand their scope to include the provision of a range of services. Although evidence has demonstrated the benefits of pharmacist-managed TDM services, recent studies have shown that these services are not prominent within Australia and that the current TDM workflow may not be optimal.

METHODS

An interventional pilot study was conducted of a pharmacist-managed TDM program for vancomycin at a tertiary hospital in Australia.

RESULTS

In total, 15 pharmacists participated in the program. They performed 50.5% of the medication-related pathology over the intervention period. Pharmacist involvement in the TDM process was more likely to lead to appropriate TDM sample collection (OR 87.1; 95% CI = 11.5, 661.1) and to an appropriate dose adjustment (OR 19.1; 95% CI = 1.7, 213.5). Pharmacists demonstrated increased confidence after the education and credentialling package was provided.

CONCLUSIONS

This study demonstrated that a credentialling package for pharmacists can improve knowledge, skills, and confidence around the provision of pharmacist-managed TDM services for vancomycin. This may lead to the evolution of different roles and workflows enabling pharmacists to contribute more efficiently to improving medication safety and use.

Associations between pharmacy choice and influenza vaccination: Mail order vs community pharmacy users

BACKGROUND: Despite the effectiveness of vaccines, US adult vaccination rates remain low. This is especially true for the influenza vaccine, which is recommended annually and widely available. The accessibility of community pharmacies as convenient places to receive influenza vaccines has been shown to increase uptake. However, use of mail order pharmacies may reduce in-person pharmacist encounters and reduce the likelihood that users receive annual influenza vaccines. OBJECTIVE: To determine the association between the type of pharmacy a patient uses and their likelihood of receiving an influenza vaccine. METHODS: This cross-sectional cohort study used the 2018 Medical Expenditure Panel Survey to observe noninstitutionalized US adult pharmacy users. Pharmacy type was dichotomized into community use only vs any mail order pharmacy use. Multivariable weighted logistic regression was used to identify associations between the type of pharmacy used and influenza vaccination, adjusting for sociodemographic, health status, and health care access and utilization confounders. All analyses were stratified by age (< 65 and ≥ 65 years). RESULTS: The aged younger than 65 years and aged 65 years and older samples had 8,074 and 4,037 respondents who represented 95,930,349 and 40,163,276 weighted observations, respectively. Compared with community pharmacy users, mail order users were more likely to be aged 65 and older, be White, have high income, and have a usual source of care (P < 0.0001). Adjusted odds ratios (AORs) for influenza vaccination were significantly lower among community pharmacy users than mail order users among individuals aged younger than 65 years (AOR=0.71; 95% CI = 0.580.87) but was not significant among those aged 65 years and older (AOR = 0.87; 95% CI = 0.69-1.09). CONCLUSIONS: Community pharmacy users aged younger than 65 years are less likely to receive the influenza vaccine than their mail order pharmacy user counterparts. These counterintuitive results could be caused by residual confounding due to differences in factors that influence pharmacy use type and vaccination likelihood. Further exploration is needed to account for differences between these populations that independently drive vaccination choice. DISCLOSURES: Dr Burbage was a fellow in the Real World Evidence, Population Health and Quality Research Postdoctoral Fellowship Program in collaboration with University of North Carolina Eshelman School of Pharmacy and Pharmacy Quality Alliance, and supported by Janssen Scientific Affairs at the time of this study. She is now employed by Janssen Scientific Affairs. Dr Parikh is an employee of Pharmacy Quality Alliance. Dr Campbell was employed by Pharmacy Quality Alliance at the time of the study. He is now employed by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Ramachandran has received an unrelated research contract with Pharmacy Quality Alliance. Dr Gatwood has received vaccine-related research grants from Merck & Co. and GlaxoSmithKline unrelated to this project and consulting fees for a vaccine-related expert panel with Merck & Co. unrelated to this manuscript and is an advisory board member with Janssen Scientific Affairs. Dr. Urick was employed by the UNC Eshelman School of Pharmacy at the time of this writing and is currently employed by Prime Therapeutics. He has received community pharmacy-related consulting fees from Cardinal Health and Pharmacy Quality Solutions unrelated to this work. Dr Ozawa has a research grant from Merck & Co. unrelated to this project. This project did not receive funding from any agency in the public, commercial, or not-for-profit sectors.

Patient satisfaction with pharmacist-administered COVID-19 vaccines in Poland: a survey study in the vaccination centres context

Background

Since 2021, pharmacists in Poland have been authorised to administer vaccinations against COVID-19, which is of particular significance in the efforts towards preventing the spread of the pandemic. The primary objective of this study was to evaluate the patients’ satisfaction with delivering vaccinations through national vaccination centres.

Methods

This study was conducted in 2021. The research tool was an anonymous questionnaire distributed to patients after vaccination. The questionnaire was developed specifically for the purpose of the study. Ultimately, 628 patients participated in this study.

Results

Nearly 97% of the respondents agreed that the administration of vaccinations by pharmacists had been convenient, and pharmacists possessed the relevant skills to provide this service. Almost 90% of the respondents expressed their readiness to be vaccinated by pharmacists again. Nearly all the respondents indicated that pharmacists should also provide other vaccinations.

Conclusions

Patients in Poland have a positive attitude toward vaccinations administered by pharmacists in national vaccination centres.

Role of community pharmacy professionals in child health service provision in Ethiopia: a cross-sectional survey in six cities of Amhara regional state

BACKGROUND

Community pharmacy professionals have great potential to deliver various public health services aimed at improving service access, particularly in countries with a shortage of health professionals. However, little is known about their involvement in child health service provision in Ethiopia.

OBJECTIVE

The purpose of this study was to evaluate the level of involvement of community pharmacy professionals in child health service provision within Ethiopia.

METHODS

A multi-center cross-sectional survey was conducted among 238 community pharmacy professionals from March to July 2020 in Amhara regional state of Ethiopia. Independent samples t-test and one way Analysis of Variance (ANOVA) was used to test the mean difference.

RESULTS

Most community pharmacy professionals were 'involved' in providing child health services related to 'advice about vitamins/supplements' (46.6%), 'advice about infant milk/formulas' (47.1%) and 'responding to minor symptoms' (50.8%) for children. The survey revealed that, community pharmacy professionals were less frequently involved in providing childhood 'vaccination' services. Further, level of involvement of community pharmacy professionals differed according to participants' licensure level, setting type, responsibility in the facility and previous training experience in child health services.

CONCLUSION

Community pharmacy professionals have been delivering various levels of child health services, demonstrating ability and capacity in improving access to child health services in Ethiopia. However, there is a need for training and government support to optimize pharmacist engagement and contribution to service delivery.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

The 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.

The tension between national consistency and jurisdictional professional expansion: The case of pharmacist-administered vaccinations

Background

The COVID-19 pandemic has highlighted the importance of coordinating policies on vaccinations at the national level. In Australia, the regulation and management of pharmacist-administered vaccination programs are the responsibility of each of the eight jurisdictions (six states and two territories), and have been developed independently of each other, leading to substantial variation. Consequently, there are variations regarding which vaccines pharmacists can administer, the minimum age, and whether these vaccines are publicly funded.

Objective(s)

To identify opportunities for a nationally consistent approach to pharmacist-administered vaccinations in Australia.

Methods

This policy analysis used the Multiple Streams Framework to identify barriers and enablers within the three “streams” of problem, policy, and politics, and how they affected the development of a national approach. Data were drawn from semi-structured interviews with 13 key policy actors and documents (pre-budget submissions and parliamentary inquiry reports). Themes were generated around actor interests, current and proposed pharmacist vaccination programs, and policymaking processes.

Results

From the pharmacy sector, there was little clarity around the need for a nationally consistent approach. This issue was linked to their ultimate goal of expanding pharmacist vaccination programs; it was seen as a means for states/territories with smaller programs to ‘catch up’ to other jurisdictions. There was also no unified policy approach from this sector; additionally, decision-makers within jurisdictional health departments faced different service delivery models, policy priorities, agendas, and policy actor relationships. Lastly, there was no federal body that had the capacity to coordinate a national approach. Possible enablers include refining the problem definition and re-framing it to a patient-centric model.

Conclusions

Coordination of vaccination policies is an ongoing policy issue with implications for pharmacist vaccination programs and other health policy areas in which a national approach is being considered. This analysis provides insight into how this may be developed in the future.

Influenza Vaccine Utilization: A Comparison between Urban and Rural Counties in Florida

(1) Background: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend that every person aged six months and over receive the influenza vaccine every year. Previous studies indicate that rural-area residents have less access to preventative health care services. This study aims to examine the variation in influenza vaccine use among rural and urban counties in Florida. (2) Methods: The study studied 24,116 participants from the Behavioral Risk Factor Surveillance System database. The study included only patients who live in Florida. We performed logistic regression analysis using survey procedures available in SAS®. Our regression model assessed the association between receiving the influenza vaccine and county status, age, income level, education level, and health coverage. We used ArcGIS software to create prevalence and vaccination maps. (3) Results: Of the total number of the study participants, 45.31% were residents of rural counties, and 54.69% were residents of urban counties. The logistic regression model showed no significant association between residing in rural counties and not receiving influenza vaccine in the past year (−0.05560, p-value = 0.0549). However, we found significant associations between not receiving influenza vaccine and age, high education level, and not having health care coverage (−0.0412, p-value < 0.0001; −0.04462, p-value = 0.0139; and 0.4956, p-value < 0.0001, respectively). (4)Conclusions: Our study did not find an association between influenza vaccine use among rural and urban residence. Increasing age, higher education, and having health care insurance had positive associations with influenza vaccine use.

The Lean Six Sigma Define, Measure, Analyze, Implement, Control (LSS DMAIC) Framework: An Innovative Strategy for Quality Improvement of Pharmacist Vaccine Recommendations in Community Pharmacy

Community pharmacies represent a highly accessible and convenient setting for vaccination. However, setting-specific barriers exist which contribute to suboptimal vaccination rates, particularly for pneumococcal vaccinations. One proven quality improvement framework growing in use within healthcare settings is Lean Six Sigma (LSS). This paper describes the application of the LSS framework in select locations of a national pharmacy chain. The implementation of a training program for improved recommendation techniques to promote higher rates of pneumococcal vaccinations in high-risk adult populations is also addressed. A mixed-methods approach including pre/post quasi-experimental design and in-depth key informant interviews was used.

Community pharmacists' willingness and barriers to provide vaccination during COVID-19 pandemic in Jordan

Providing vaccination in community pharmacies could increase the vaccination coverage rate as well as help reducing the workload of the healthcare system. The current study was conducted to evaluate community pharmacists' willingness and barriers to provide vaccination in community pharmacy setting. A validated questionnaire which included eight items to evaluate willingness and eleven items to evaluate the barriers to provide vaccines was distributed online. Binary logistic regression was conducted to explore the factors that are significantly associated with willingness and barriers to provide the vaccine. Among the 201 participating pharmacists, 174 (86.6%) had a high willingness level. Lack of authorization (91.6%), lack of collaboration with other healthcare professionals (85.6%), and lack of space for storage (74.1%) were the most recognized barriers to vaccinate. Pharmacists with BSc degree demonstrated less willingness (OR = 0.18 (0.07-0.46), and increased barriers (OR = 4.86 (1.56-15.17) to provide the vaccine when compared with Pharm D and postgraduate pharmacists P < .01. Factors including male gender (OR: 6.10), working in chain pharmacy (OR: 8.98) and rural areas (OR: 4.31), moderate income (OR: 19.34) and less years of experience (OR:0.85) were significantly associated with increased barriers to provide the vaccine (P < .05). Despite the high willingness of the community pharmacists to vaccinate, several barriers were present. Enhancing pharmacists' authorization and collaboration with other healthcare professionals and providing space for storage along with providing training courses and workshops should be considered to enhance pharmacist's engagement in vaccination service.

Examining community pharmacists' intention to provide pharmacist-driven vaccination services: A structural equation modelling

BACKGROUND

The evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists' intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.

OBJECTIVE

Considering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the "Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)" by using the theory of planned behavior (TPB).

METHODS

Based on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.

RESULTS

In the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.

CONCLUSION

Results of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.

Community pharmacist engagement in HIV and HCV prevention: Current practices and potential for service uptake

Background

Objective

Methods

Results

Conclusions

•

Pharmacists are largely willing to help people who need HIV/HCV prevention services.

•

Perception of HIV/HCV prevention fit with pharmacist professional identity varies.

•

Cognitive HIV/HCV prevention services are preferred over hands-on clinical services.

•

Pharmacists often engage in gatekeeping to limit sales of non-prescription syringes.

•

Willingness to sell syringes potentially hinges on minimal contact with requestors.

A Behavioral analysis of nurses' and pharmacists' role in addressing vaccine hesitancy: scoping review

The purpose of this review was to identify, characterize, and map the existing knowledge on a) nurses' and pharmacists' perceived barriers and enablers to addressing vaccine hesitancy among patients; and b) strategies or interventions for nurses and pharmacists to address vaccine hesitancy in their practice. Our comprehensive search strategy targeted peer-reviewed and grey literature. Two independent reviewers screened papers and extracted data. We coded narrative descriptions of barriers and enablers and interventions using the Behavior Change Wheel. Sixty-six records were included in our review. Reported barriers (n = 9) and facilitators (n = 6) were identified in the capability, opportunity and motivation components. The majority of the reported interventions were categorized as education (n = 47) and training (n = 26). This current scoping review offers a detailed behavioral analysis of known barriers and enablers for nurses and pharmacists to address vaccine hesitancy and interventions mapped onto these behavioral determinants.

Multidisciplinary Effort and Integrative Preparedness: A Lesson for the Foreseen Multivariate COVID-19 Pandemic Flare-Up

It has been a year and a half since the world suffered the horrific COVID-19 pandemic which has still continued becoming a prominent headache for the whole world. Recently, we are facing the second and third wave of multivariate outbreaks with great intensity of transmission which renders huge disaster. Presently, new strains of the virus are emerging that are predicted to be resistant for the current vaccines and other management approaches. It needs collaborative and coordinated role at professional, facility, regional, and global levels to ameliorate the pandemic by monitoring the existing and emerging variants. This review addressed the multidisciplinary roles in patient screening and detection, emergency management, moderate and critical care, vaccination, complication prevention, comorbidity management, psychological therapy, and digital health care. The inevitable roles of academicians, researchers, private health sectors, policy makers, regulatory bodies, and partners are also discussed.

Using an online nominal group technique to determine key implementation factors for COVID-19 vaccination programmes in community pharmacies

Background One vital strategy to fight the COVID-19 pandemic is the rapid roll-out of vaccination programmes. In a number of countries pharmacists are joining the vaccination programme workforce, including plans to involve community pharmacies. Objectives (1) to determine key implementation factors for rapid roll-out of COVID-19 vaccination programmes in European community pharmacies and (2) to trial an online nominal group technique to generate ideas and reach consensus on the first aim. Setting In February 2021, during a workshop at the 12th Working Conference of the Pharmaceutical Care Network Europe. Method An online nominal group technique workshop over 10 hours was conducted. Identified implementation factors were mapped to the Framework for the Implementation of Services in Pharmacy and assessed in terms of importance and changeability. Main outcome measure Consensus of key implementation factors. Results In total, 85 implementation factors were identified. The top 3 factors were the same for both criteria: “(Regular) Staff training on correct vaccination procedure/to perform hands-on injection technique”; “Training in basic life support/first aid (Cardiopulmonary resuscitation)”, and; “Definition of process, roles and responsibilities in the team”. Conclusion An online nominal group technique enabled international collaboration to gather diverse perspectives on the implementation of COVID-19 vaccination programmes in a time and cost-efficient manner. “Staff training on correct vaccination procedure”, “training in basic life support” and “definition of process, roles and responsibilities in the team” were deemed the most important and changeable implementation factors. Online nominal group technique may be a suitable method for other implementation problems.

Immunisation provider experiences with an automated short message service-based active surveillance system for monitoring adverse events following immunisation: A qualitative descriptive study

Objective

Currently, active surveillance systems to monitor adverse events following immunisation are limited to hospitals, and medical and immunisation clinics. Globally, community pharmacies represent a significant destination for immunisation services. However, until recently, pharmacies lacked active surveillance systems. We therefore wished to explore pharmacists’ experiences with SmartVax: an active surveillance system that has recently been integrated for use in Australian community pharmacies. Specifically, we wished to explore pharmacists’ perceived (1) benefits of using SmartVax, (2) areas for improvement in the system, and (3) issues with future/ongoing access to the system.

Methods

The present study forms the qualitative arm of a convergent mixed-methods pilot study. In the present study, we performed semi-structured interviews with pharmacist immunisers after a 21- to 22-week trial period with SmartVax. Thematic analysis of interview transcripts was performed independently by two researchers in QSR NVivo 12, using the framework method.

Results

Fifteen participants completed the semi-structured interviews. A broad range of perceived benefits were cited by participants, including the usability of SmartVax, the ease of patient follow-up facilitated by the system, and enhancement to the patient–pharmacist relationship. Participants voiced a desire for the system to have more granularity and a faster response time in the report generated for pharmacies. When asked about issues with future/ongoing access to SmartVax, cost concerns of the system were the prevailing theme.

Conclusions

The present study suggests that, among pharmacist immuniser end-users of SmartVax, the system is perceived to be easy-to-use, facilitates patient follow-up, and enhances the patient–pharmacist relationship.

Self-reported vs RUCA rural-urban classification among North Carolina pharmacists

Background:

The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.

Objective:

The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.

Methods:

This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.

Results:

Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications – 94 (56.6%) of the 166 participants who reported working in “rural” areas were considered “urban” according to RUCA.

Conclusions:

A significant discordance between pharmacists’ self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as “rural” as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.

A comprehensive review on global contributions and recognition of pharmacy professionals amidst COVID-19 pandemic: moving from present to future

BACKGROUND

COVID-19, a respiratory tract infection caused by SARS-CoV-2, is a burning question worldwide as it gives rise to a pandemic situation. No specific medications are still recommended for COVID-19; however, healthcare support is crucial for ameliorating the disease condition. Pharmacists are the frontline fighters who are responsible for providing healthcare support to the COVID-19 infected patients around the world. This review endeavored to briefly rationalize the contributions of several pharmacy professionals in diverse fields along with their collaborative efforts and dedication regarding their limitations during the COVID-19 situation and view the prospects of pharmaceutical care services in the post-pandemic period.

MAIN BODY OF THE ABSTRACT

Online databases were utilized to search for scholarly articles and organizational websites, to sum up the information about the contemporary and expanded role of pharmacists. Key articles were retrieved from Google Scholar, PubMed, and Science Direct databases using terms: "COVID-19," "novel coronavirus," "community," "industrial," "hospital," "clinical," "recognition," "obstacles," "collaboration," "SARS-CoV-2," "healthcare," and "outbreak" in combination with "pharmacist." The articles were included from the inception of the pandemic to January 25, 2021. The current review found pharmacist's global contributions and involvements with other professionals to provide healthcare services amidst COVID-19. This included testing of suspects, providing medical information, psycho-social support, debunking myths, mitigating drug shortage events, telemedicine, e-prescription, infection control, and controlling the drug supply chain. In many countries, pharmacists' activities were much appreciated but in some countries, they were not properly acknowledged for their contributions amidst COVID-19 outbreak. They played additional roles such as participating in the antimicrobial stewardship team, improving value-added services, conducting clinical data analysis to suppress the outspread of the SARS-CoV-2.

SHORT CONCLUSION

During the COVID-19 pandemic while the whole world is fighting against an invisible virus, the pharmacists are the earnest hero to serve their responsibilities along with additional activities. They need to be prepared and collaborate with other healthcare professionals further to meet the challenges of post-pandemic circumstances.

Active vaccine safety surveillance of seasonal influenza vaccination via a scalable, integrated system in Western Australian pharmacies: a prospective cohort study

OBJECTIVES

We integrated an established participant-centred active vaccine safety surveillance system with a cloud-based pharmacy immunisation-recording program in order to measure adverse events following immunisation (AEFI) reported via the new surveillance system in pharmacies, compared with AEFI reported via an existing surveillance system in non-pharmacy sites (general practice and other clinics).

DESIGN

A prospective cohort study.

PARTICIPANTS AND SETTING

Individuals >10 years receiving influenza immunisations from 22 pharmacies and 90 non-pharmacy (general practice and other clinic) sites between March and October 2020 in Western Australia. Active vaccine safety surveillance was conducted using short message service and smartphone technology, via an opt-out system.

OUTCOME MEASURES

Multivariable logistic regression was used to assess the primary outcome: differences in proportions of AEFI between participants immunised in pharmacies compared with non-pharmacy sites, adjusting for confounders of age, sex and influenza vaccine brand. A subgroup analysis of participants over 65 years was also performed.

RESULTS

Of 101 440 participants (6992 from pharmacies; 94 448 from non-pharmacy sites), 77 498 (76.4%) responded; 96.1% (n=74 448) within 24 hours. Overall, 4.8% (n=247) pharmacy participants reported any AEFI, compared with 6% (n=4356) non-pharmacy participants (adjusted OR: 0.87; 95% CI: 0.76 to 0.99; p=0.039). Similar proportions of AEFIs were reported in pharmacy (5.8%; n=31) and non-pharmacy participants (6; n=1617) aged over 65 years (adjusted OR: 0.94; 95% CI: 0.65 to 1.35; p=0.725). The most common AEFIs in pharmacy were: pain (2%; n=104), tiredness (1.9%; n=95) and headache (1.7%; n=88); and in non-pharmacy sites: pain (2.3%; n=1660), tiredness (1.9%; n=1362) and swelling (1.5%; n=1121).

CONCLUSIONS

High and rapid response rates demonstrate good participant engagement with active surveillance in both pharmacy and non-pharmacy participants. Significantly fewer AEFIs reported after pharmacist immunisations compared with non-pharmacy immunisations, with no difference in older adults, may suggest different cohorts attend pharmacy versus non-pharmacy immunisers. The integrated pharmacy system is rapidly scalable across Australia with global potential.

Measles, mumps, rubella prevention: how can we do better?

INTRODUCTION

Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases.

AREAS COVERED

This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them.

EXPERT OPINION

While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.

The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review

The role of pharmacists in the treatment of HIV has expanded beyond medication dispensing to include a host of cost-effective, evidence-based strategies across the HIV prevention and care continuums. However, wide-scale adoption of pharmacy-based HIV prevention and treatment interventions has been slow. We conducted a systematic review to evaluate the evidence on the role of pharmacists across the HIV prevention and care continuums. Thirty-two studies were identified, most of which provided evidence of feasibility of HIV testing and efficacy of non-prescription syringe sale services in pharmacies. However, only two studies implemented an experimental design to rigorously test pharmacy-based strategies. Notably, no pharmacy-based strategies have specifically targeted the highest HIV risk populations such as black and Latinx men who have sex with men, women, or trans populations. Efficacy trials and effectiveness studies should rigorously test existing pharmacy-based strategies to build greater support for wide-scale adoption and implementation. Moreover, in order to integrate pharmacies into the strategy to end the HIV epidemic, studies are needed to ensure that pharmacy-based HIV prevention and treatment services can reach the highest risk populations.

Perceptions, Expectations, and Experience of Physicians About Pharmacists and Pharmaceutical Care Services in Pakistan: Findings and Implications

Background: Optimal collaboration between pharmacists and other healthcare professionals such as physicians is integral in implementing pharmaceutical care. However, there are concerns regarding the role of pharmacists, especially among low- and middle-income countries. This study explored the perceptions, expectations, and experience of physicians working in various hospital settings of Punjab, Pakistan, about pharmacists and their roles.

Methods: A self-administered questionnaire consisting of four sections was administered from October to December 2020. Descriptive and inferential statistics such as Kruskal-Wallis and Mann-Whitney tests were used for data analysis using SPSS.

Results: Six hundred and seventy-eight physicians participated in this study with a response rate of 77.9%. Most of the physicians reported minimal to no interaction with pharmacists (n = 521, 76.8%). However, more than three-quarters of physicians (n = 660, 97.3%) accepted pharmacists as evidence-based sources of drug information. In addition, many physicians (n = 574, 84.7%) strongly agreed that pharmacists should attend patient care rounds to respond promptly to questions related to patient medication. A limited number of physicians (n = 124, 18.3%) assumed that pharmacists were advising their patients regarding the judicial use of their drugs. Median expectation and experience score had a significant association with age, experience, and education of physicians (P < 0.05).

Conclusions: The perception of physicians was positive toward certain roles of pharmacists, coupled with high expectations. However, their experience was low, with most of the activities of pharmacists due to inadequate interprofessional coordination.

Availability of Adult Vaccination Services by Provider Type and Setting

INTRODUCTION

Knowledge regarding the benefits for adult vaccination services under Medicaid's fee-for-service arrangement is dated; little is known regarding the availability of vaccination services for adult Medicaid beneficiaries in MCO arrangements. This study evaluates the availability of provider reimbursement benefits for adult vaccination services under fee-for-service and MCO arrangements for different types of healthcare providers and settings.

METHODS

A total of 43 Medicaid directors across the 50 U.S. states and the District of Columbia participated in a semistructured survey conducted from June 2018 to June 2019 (43/51). The frequency of Medicaid fee-for-service and MCO arrangements reporting reimbursement for adult vaccination services by various provider types and settings were assessed in 2019. Elements of vaccination services examined in this study were vaccine purchase, vaccine administration, and vaccination-related counseling.

RESULTS

Under fee-for-service, 41 Medicaid programs reimburse primary care providers for adult vaccine purchase (41/43); fewer programs reimburse vaccine administration and vaccination-related counseling (33/43 and 30/43, respectively). Similar results were observed for obstetricians-gynecologists, nurse practitioners, and pharmacies. Although 24 fee-for-service (24/43) and 23 MCO (23/34) arrangements cover adult vaccination services in most settings, long-term care facilities have the lowest reported reimbursement eligibility.

CONCLUSIONS

In most jurisdictions, vaccination services for adult Medicaid beneficiaries are available for a variety of healthcare provider types and settings under both fee-for-service and MCO arrangements. However, because provider reimbursement benefits remain inconsistent for adult vaccination counseling services and within long-term care facilities, access to adult vaccination services may be reduced for Medicaid beneficiaries who depend on these resources.

Facilitating pneumococcal vaccination among high-risk adults: Impact of an assertive communication training program for community pharmacists

BACKGROUND

Community pharmacies are vital access points to provide a range of vaccines to adults, including pneumococcal vaccines; however, despite a growth in the number of vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below the goals set by Health People 2020. Low patient awareness is a leading reason for suboptimal vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults.

OBJECTIVES

To evaluate the impact of a communication training program to improve pharmacist promotion of the pneumococcal vaccine among high-risk adults in Tennessee.

METHODS

A multiphase training program was initiated in partnership with 2 regions of a nationwide community pharmacy chain (n = 100) focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of 3 arms on the basis of training intensity: (1) no training; (2) online training only; and (3) online and in-person simulation training. The program focused on improving evidence-based, pharmacist vaccine recommendations using health behavior theories, sales techniques, and improvisation provided through online and in-person simulation training. Changes in vaccinations (compared with the same 6-month period in the previous year) and provider self-efficacy were evaluated by Mann-Whitney U tests, chi-square tests, and general linear models.

RESULTS

Completing the full training program led to nominal changes in pharmacist self-efficacy across the 6 items measured (P > 0.05). Overall counts of all pneumococcal vaccines were lower (-11.3%) across all stores in the period after training; however, a small increase (2.1%) was observed in the stores that underwent the full training, versus changes of -22.0% (P = 0.084) and -9.4% (P = 0.199) in control and online-only training comparisons, respectively.

CONCLUSIONS

Pharmacists' vaccine-related self-efficacy may be improved through an evidence-based communication training program, but a more holistic focus on all recommended adult vaccines may be necessary to realize meaningful improvements.

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.

Pharmacists self-perceived role competence in prevention and containment of COVID-19: A cross-sectional study

Introduction

The increased need for prioritized infection prevention and control (IPC) activities for the prevention and containment of COVID-19 is pivotal and timely in preventing harm caused by the COVID-19 pandemic. Little is known about pharmacists' infection IPC activities and their role competence during disease outbreaks. This study aimed to assess pharmacists' perceived role competence to perform frontline roles during the COVID-19 pandemic.

Method

A cross-sectional survey was conducted using online social media to recruit eligible participants. A validated questionnaire contained 41 items on sociodemographic characteristics, preventative behaviors, and competencies.

Results

A total of 486 participants completed the survey. Participants reported several IPC activities that could potentially prevent COVID-19 spread. The majority expressed high attitudes towards their capabilities to fulfill their healthcare roles (M = 4.43, SD = 0.46, out of 5). The vast majority of participants (97.1%) were willing to demonstrate the effective way of cleaning hands and using facemasks. Pharmacists (89.1%) showed their willingness to timely refer patients in response to their emerging needs. Gender, age groups, years of experience, monthly incomes, area of work, ability to make a referral, source of information, and self-isolation discontinuation criteria were significantly associated with pharmacists’ self-perceived role competence.

Conclusion

Pharmacists are well-positioned as access points to care and can potentially play a significant role in the containment of the COVID-19 outbreak by delivering advanced clinical and public health services. Future research efforts need to be comprehensively directed towards the advanced role of pharmacists in implementing point-of-care testing for infectious diseases.

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Several pharmacist activities proved useful in deterring the spread of COVID-19.

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COVID-19 management is enhanced by offering pharmaceutical and public health services.

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Pharmacists demonstrated their capacity in referring patients and meet their needs.

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Pharmacists emphasized that supportive care became essential for COVID-19 patients.

Influence of COVID-19 on Health-Related Quality of Life and the Perception of Being Vaccinated to Prevent COVID-19: An Approach for Community Pharmacists from Romania and Bulgaria

Community pharmacists are essential front-line health workers, involved in relieving the COVID-19 burden. Their health-related quality of life status needs to be assessed, as lower levels could affect their functioning. In order to evaluate the current status of community pharmacists’ quality of life from Romania and Bulgaria during the COVID-19 pandemic, and to identify factors associated with their decision on being vaccinated to prevent COVID-19, an online survey involving 395 community pharmacists was conducted from 15th July 2020 to 15th August 2020. The 15D instrument was used for quality-of-life assessment. The pharmacists’ recommendations for vitamin C and D intake during the COVID-19 pandemic were also analyzed in order to promote future training programs for community pharmacists. Descriptive statistics, comparative analyses between pharmacists from Romania and Bulgaria, and multiple correlation analyses were performed on the collected data. Significant differences were observed for the level of quality of life between the two groups of pharmacists according to their age; smaller values, directly correlated with their age (total 15D score and age: Spearman r = 0.168, p = 0.022), were obtained for Bulgarian pharmacists regarding sleeping, usual activities, mental function, discomfort and symptoms, depression, distress. The perception of being vaccinated did not differ between Romanian and Bulgarian pharmacists, as almost 50% agreed to vaccination (p = 0.7542). Their willingness to vaccinate was correlated with vitamin D usage (p = 0.0134), rather than with vitamin C (p = 0.4157). No other significant associations were found between willingness to get vaccinated to prevent COVID-19 and other characteristics (age, gender, income, quality-of-life markers). Evidence-based interventions are required to enhance the health-related quality of life of community pharmacists involved in the first line of the COVID-19 pandemic.

Readiness and Willingness to Provide Immunization Services after Pilot Vaccination Training: A Survey among Community Pharmacists Trained and Not Trained in Immunization during the COVID-19 Pandemic in Poland

Background: Immunization rates among the adult population in Poland are below desired targets, urging the need to expand this service in the community. During the COVID-19 pandemic, the ultimate goals for limiting the spread of the infection are vaccines against SARS-CoV-2. Pharmaceutical companies are in a race for the fastest possible way to deliver vaccines. Community pharmacists in Poland are recognised as an accessible yet underutilised group of medical professionals. Therefore, involving pharmacists in vaccinations may have beneficial results for the healthcare system. Objectives: The objectives of this study were to assess the readiness and willingness of community pharmacists following the Pharmacist Without Borders project who had either been trained or not in providing immunization services, and to identify the factors that may support the implementation of such services in Poland. Methods: This study was conducted among pharmacists between February and August 2020 in Poland. A survey was developed to determine their readiness to provide vaccination services in their pharmacies, to recognise any barriers to vaccinations, as well as the factors necessary to implement vaccination services in Polish pharmacies. Results: A total of 1777 pharmacists participated in the study, comprising 127 (7.1%) pharmacists trained in vaccinations during the Pharmacists Without Borders project and 1650 (92.9%) pharmacists not participating in the workshops. Pharmacists participating in the workshops more often indicated that providing vaccinations in community pharmacies would improve the overall vaccination rate (p = 0.0001), and that pharmacists could play an important role in advertising and promoting vaccinations (p = 0.0001). For the pharmacists not participating in the workshops, they indicated to a much greater extent possible barriers affecting the readiness to provide vaccinations in pharmacies. They most often pointed out that vaccination services would result in a significant workload increase (p = 0.0001), that pharmacies were not adapted to immunization, and that there were not enough training courses for pharmacists (p = 0.0001). Conclusion: The pharmacists working in community pharmacies indicated many advantages of vaccinations in pharmacies. This study identified barriers to the introduction of vaccinations and factors necessary to implement these services in pharmacies. The pharmacists trained during the immunization programme of the Pharmacists Without Borders project showed a greater readiness to provide immunization services.