The use of pharmacy immunization services in rural communities

Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review

CONTEXT

Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities.

OBJECTIVE

The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies.

METHODS

We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion.

RESULTS

A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them.

CONCLUSION

Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.

Shooting from the 'Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

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

INTRODUCTION

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

OBJECTIVE

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

METHOD

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

RESULT

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

CONCLUSION

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

Clinical outcomes of community pharmacy services: A systematic review and meta-analysis

Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventions included are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017), 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta-analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi-square and I-square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta-analysis, intervention groups displayed greater reductions in systolic BP (95% CI: -8.198-2.356), diastolic BP (95% CI: -3.648-0.645) and HbA1c (95% CI: -0.905-0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data.

Financial Incentive Required for Pharmacy Students to Accept a Post-Graduation Position in Rural and Undesirable Pharmacy Settings

Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. Measures of interest included: subject characteristics and preference in a variety job offers. Discrete Choice Experiment methodology of questionnaire design was used and Conditional Logit models were conducted to analyze the data to determine the financial incentive required for pharmacy students to take a post-graduate job with particular traits. Conclusions: A total of 283 students completed questionnaires from Iowa, North Dakota, South Dakota, Saskatchewan, and Manitoba. The majority of subjects were female, P3 students, and from a non-rural hometown. American students would need to be paid an additional $18,738 in salary to practice in a rural area, while Canadian students would require an additional $17,156. Canadian respondents would require an additional $7125 in salary to work in a community pharmacy with a low level of patient interaction compared to a community position with a large amount of patient interaction. Overall, pharmacy student preferences in post-graduation job attributes vary significantly between states and provinces.

Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic

Introduction:

During an influenza epidemic, where early vaccination is crucial, pharmacies may be a resource to increase vaccine distribution reach and capacity.

Methods:

We utilized an agent-based model of the US and a clinical and economics outcomes model to simulate the impact of different influenza epidemics and the impact of utilizing pharmacies in addition to traditional (hospitals, clinic/physician offices, and urgent care centers) locations for vaccination for the year 2017.

Results:

For an epidemic with a reproductive rate (R0) of 1.30, adding pharmacies with typical business hours averted 11.9 million symptomatic influenza cases, 23,577 to 94,307 deaths, $1.0 billion in direct (vaccine administration and healthcare) costs, $4.2–44.4 billion in productivity losses, and $5.2–45.3 billion in overall costs (varying with mortality rate). Increasing the epidemic severity (R0 of 1.63), averted 16.0 million symptomatic influenza cases, 35,407 to 141,625 deaths, $1.9 billion in direct costs, $6.0–65.5 billion in productivity losses, and $7.8–67.3 billion in overall costs (varying with mortality rate). Extending pharmacy hours averted up to 16.5 million symptomatic influenza cases, 145,278 deaths, $1.9 billion direct costs, $4.1 billion in productivity loss, and $69.5 billion in overall costs. Adding pharmacies resulted in a cost-benefit of $4.1 to $11.5 billion, varying epidemic severity, mortality rate, pharmacy hours, location vaccination rate, and delay in the availability of the vaccine.

Conclusions:

Administering vaccines through pharmacies in addition to traditional locations in the event of an epidemic can increase vaccination coverage, mitigating up to 23.7 million symptomatic influenza cases, providing cost-savings up to $2.8 billion to third-party payers and $99.8 billion to society. Pharmacies should be considered as points of dispensing epidemic vaccines in addition to traditional settings as soon as vaccines become available.

Support for Pharmacist-Provided HPV Vaccination: National Surveys of U.S. Physicians and Parents

Background: State laws about pharmacists providing human papillomavirus (HPV) vaccines vary considerably, limiting many pharmacists' ability to provide this important cancer prevention service. We characterized physician and parent support for pharmacist-provided HPV vaccination for adolescents who are past due for vaccination.Methods: In 2014 to 2015, we conducted two national U.S. surveys of 776 primary care physicians (PCPs) and 1,504 parents of adolescents. Respondents indicated the extent to which they supported pharmacist-provided HPV vaccination for 13- to 17-year-olds who are past due. Respondents could endorse the provision unconditionally, or only if certain conditions were met, such as pharmacists receiving proper vaccination training. We used multivariable logistic regression to assess correlates of support.Results: Most physicians (79%) and parents (81%) endorsed pharmacist-provided HPV vaccination if pharmacists had received proper vaccination training, reported vaccine doses to adolescents' PCP, and referred adolescents to PCPs for other health services. Family medicine physicians were more likely than pediatricians to support trained pharmacists providing HPV vaccination [OR = 1.62; 95% confidence interval (CI) 1.17-2.22]. Support was also higher among physicians who practiced in Western states (OR = 2.11; 95% CI, 1.30-3.40). Parents' odds of endorsing trained pharmacists provision of HPV vaccine increased with higher overall satisfaction with their pharmacy's services (OR = 1.10; 95% CI, 1.02-1.19), belief in pharmacists' competence in vaccination practices (OR = 1.42; 95% CI, 1.18-1.70), and overall vaccine confidence (OR = 1.30; 95% CI, 1.15-1.48).Conclusions: To increase support for HPV vaccination services, pharmacists should raise awareness about their immunization training and standardize vaccination protocols that ensure coordination with primary care.Impact: Stakeholders' feedback and buy-in is important to help guide expansion of HPV vaccination in pharmacies. Cancer Epidemiol Biomarkers Prev; 27(8); 970-8. ©2018 AACR.

Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists

We sought to examine whether pharmacy service quality was associated with parents' willingness to have immunizing pharmacists administer human papillomavirus (HPV) vaccine to their adolescent children. Participants were a national sample of 1504 US parents of adolescents ages 11 to 17 who completed an online survey in 2014. Analyses used structural equation modeling. Parents rated service quality and feelings of satisfaction with their pharmacies as moderate to high. Many (44%) were willing to get HPV vaccine from immunizing pharmacists for their adolescent children. Compared with parents who went to chain pharmacies, parents who went to independent pharmacies gave higher ratings of service quality (professionalism, confidentiality, milieu, all p < .001). Parents who went to clinic pharmacies, compared with parents who went to chain pharmacies gave lower ratings for milieu (p < .01). Parents who went to independent pharmacies had lower willingness to get HPV vaccine from pharmacists compared to parents who went to chain pharmacies (p = .001), but there was no difference in willingness for parents who went to clinic versus chain pharmacies. Service quality and satisfaction partially mediated the effect between independent pharmacies compared to chain pharmacies and willingness (p < .05). Parents who knew their pharmacists or expressed more confidence in HPV vaccine also had higher willingness to get their children HPV vaccine from pharmacist. Many parents were willing to go to immunizing pharmacists for their children's HPV vaccination. Pharmacies that are considering offering HPV vaccine may be able to improve vaccine uptake by increasing perception of service quality.

Routine immunization of adults by pharmacists: Attitudes and beliefs of the Canadian public and health care providers

Vaccine coverage among adults for recommended vaccines is generally low. In Canada and the US, pharmacists are increasingly becoming involved in the administration of vaccines to adults. This study measured the knowledge, attitudes, beliefs, and behaviors of Canadian adults and health care providers regarding pharmacists as immunizers. Geographically representative samples of Canadian adults (n = 4023) and health care providers (n = 1167) were surveyed, and 8 focus groups each were conducted nationwide with adults and health care providers. Provision of vaccines by pharmacists was supported by 64.6% of the public, 82.3% of pharmacists, 57.4% of nurses, and 38.9% of physicians; 45.7% of physicians opposed pharmacist-delivered vaccination. Pharmacists were considered a trusted source of vaccination information by 75.0% of the public, exceeding public health officials (68.3%) and exceeded only by doctors and nurses (89.2%). Public concerns about vaccination in pharmacies centered on safety (management of adverse events), record keeping (ensuring their family physician was informed), and cost (should be no more expensive than vaccination at public health or physicians' offices). Concerns about the logistics of vaccination delivery were expressed more frequently in regions where pharmacists were not yet immunizing than in jurisdictions with existing pharmacist vaccination programs. These results suggest that the expansion of pharmacists' scope of practice to include delivery of adult vaccinations is generally accepted by Canadian health care providers and the public. Acceptance of this expanded scope of pharmacist practice may contribute to improvements in vaccine coverage rates by improving vaccine accessibility.

Rural Disparities in Alzheimer's Disease-Related Community Pharmacy Care in the United States

PURPOSE

To examine the relationship between area population density and community pharmacy-based Alzheimer's Disease (AD)-related services: pharmacists' medication knowledge and counseling, immunizations, and in-stock cognitive enhancers in 3 predominantly rural regions of the United States.

METHODS

A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists' medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi² ) by pharmacy location to evaluate the relationship between rurality and AD-related pharmacy services. Chi-squared and logistic regression analyses were performed using Stata 10.1.

FINDINGS

Pharmacies in more rural areas (50.1-100.0, 25.1-50.0, and ≤25.0 persons/mi² ) were about 50% less likely to offer immunizations (95% CI: 0.32-0.91; 0.32-0.76; 0.28-0.80, respectively) compared to the least rural areas (>100.0 persons/mi² ). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi² ) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31-0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41-0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39-0.82) in stock.

CONCLUSIONS

We found disparities in AD-related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists' knowledge and improve pharmacy services to reduce disparities.

Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services

BACKGROUND

Community pharmacies are an increasingly important health care setting with opportunities for improving quality and safety, yet little is understood about determinants of implementation in this setting.

OBJECTIVE

This paper presents an implementation framework for pharmacy based on the Consolidated Framework for Implementation Research (CFIR).

METHODS

This study employed a critical review of 45 articles on professional services provided in community pharmacies, including medication therapy management (MTM), immunizations, and rapid HIV testing.

RESULTS

The relevant domains and associated constructs for pharmacy services were as follows. Intervention Characteristics ultimately depend on the specific service; of particular note for pharmacy are relative advantage and complexity. The former because implementation of services can pose a cost-benefit challenge where dispensing is the primary role and the latter because of the greater challenge implementing multi-faceted services like MTM compared to a discrete service like immunizations. "In terms of Outer Setting, pharmacies are affected by patient needs and acceptance, and external policies and incentives such as reimbursement and regulations. For Inner Setting, structural characteristics like pharmacy type, size and staff were important as was pharmacists' perception of their role and available resources to provide the service. Key Characteristics of Individuals include training, preparedness, and self-efficacy of the pharmacist for providing a new service. Few studies revealed relevant Process constructs, but if they did it was primarily related to engaging (e.g., champions).

CONCLUSIONS

As pharmacists' roles in health care are continuing to expand, a framework to inform implementation research in community pharmacy (and other) settings is crucially needed.

Role of non-traditional locations for seasonal flu vaccination: Empirical evidence and evaluation

This study investigated the role of non-traditional locations in the decision to vaccinate for seasonal flu. We measured individuals' preferred location for seasonal flu vaccination by examining the National H1N1 Flu Survey (NHFS) conducted from late 2009 to early 2010. Our econometric model estimated the probabilities of possible choices by varying individual characteristics, and predicted the way in which the probabilities are expected to change given the specific covariates of interest. From this estimation, we observed that non-traditional locations significantly influenced the vaccination of certain individuals, such as those who are high-income, educated, White, employed, and living in a metropolitan statistical area (MSA), by increasing the coverage. Thus, based on the empirical evidence, our study suggested that supporting non-traditional locations for vaccination could be effective in increasing vaccination coverage.

Evaluating the Impact of Pharmacies on Pandemic Influenza Vaccine Administration

OBJECTIVES

The objective of this study was to quantify the potential retail pharmacy vaccine administration capacity and its possible impact on pandemic influenza vaccine uptake.

METHODS

We developed a discrete event simulation model by use of ExtendSim software (Imagine That Inc, San Jose, CA) to forecast the potential effect of retail pharmacy vaccine administration on total weekly vaccine administration and the time needed to reach 80% vaccination coverage with a single dose of vaccine per person.

RESULTS

Results showed that weekly national vaccine administration capacity increased to 25 million doses per week when retail pharmacist vaccination capacity was included in the model. In addition, the time to achieve 80% vaccination coverage nationally was reduced by 7 weeks, assuming high public demand for vaccination. The results for individual states varied considerably, but in 48 states the inclusion of pharmacies improved time to 80% coverage.

CONCLUSIONS

Pharmacists can increase the numbers of pandemic influenza vaccine doses administered and reduce the time to achieve 80% single-dose coverage. These results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning. (Disaster Med Public Health Preparedness. 2017;11:587-593).

Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study

OBJECTIVES

This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services.

DESIGN

Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews.

SETTING

Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015.

PARTICIPANTS

Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed.

MAIN OUTCOME MEASURES

Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services.

RESULTS

15 621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016.

CONCLUSIONS

This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered.

Services provided by community pharmacies in Wayne County, Michigan: a comparison by ZIP code characteristics

OBJECTIVE

To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located.

DESIGN

Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data.

SETTING

503 pharmacies throughout the 63 ZIP codes of Wayne County, MI.

MAIN OUTCOME MEASURES

The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy.

RESULTS

The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic.

CONCLUSION

Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.

Promising alternative settings for HPV vaccination of US adolescents

Vaccination in alternative settings, defined here as being outside of traditional primary care, can help address the pressing public health problem of low human papillomavirus vaccine coverage among adolescents in the United States. Pharmacies are promising because they are highly accessible and have well established immunization practices. However, pharmacies currently face policy and reimbursement challenges. School-located mass vaccination programs are also promising because of their high reach and demonstrated success in providing other vaccines, but control by local policymakers and challenges in establishing community partnerships complicate widespread implementation. Health centers in schools are currently too few to greatly increase access to human papillomavirus vaccine. Specialty clinics have experience with vaccination, but the older age of their patient populations limits their reach. Future steps to making alternative settings a success include expanding their use of statewide vaccine registries and improving their coordination with primary care providers.

Vaccinations administered during off-clinic hours at a national community pharmacy: implications for increasing patient access and convenience

PURPOSE

Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience.

METHODS

We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am-6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours.

RESULTS

During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions.

CONCLUSIONS

A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience.

Introductory and advanced pharmacy practice experiences within campus-based influenza clinics

OBJECTIVE. To describe the development, implementation, and assessment of an introductory and an advanced pharmacy practice experience (IPPE and APPE) integrated within campus-based influenza clinics. DESIGN. The influenza clinics were designed to incorporate the learning objectives for the IPPE and APPE, and included preparatory sessions, online learning, and direct patient interactions tailored to the appropriate education level of the learner. ASSESSMENT. The clinics provided influenza vaccinations to 2,292 and 2,877 individuals in 2010 and 2011, respectively. The clinics allowed for experiential education of 39 students earning a total of 467 IPPE and APPE hours in 2010 and 58 students earning a total of 656 IPPE and APPE hours in 2011. Third-year students were assessed before and after completing the IPPE, and improvement was seen in knowledge and self-ratings of perceptions and attitudes toward administering immunizations. CONCLUSIONS. Integrating pharmacy practice experiences within campus-based influenza clinics was an effective way to provide students with direct patient care experience and preventive health services knowledge.

How to enhance public health service utilization in community pharmacy?: general public and health providers' perspectives

BACKGROUND

Community pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized.

OBJECTIVES

To explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use.

METHODS

The study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n=16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n=9), GPs (n=2), and STs (n=3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically.

RESULTS

All 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization.

CONCLUSIONS

Community pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services.

Individual- and neighborhood-level characteristics associated with support of in-pharmacy vaccination among ESAP-registered pharmacies: pharmacists' role in reducing racial/ethnic disparities in influenza vaccinations in New York City

New York State (NYS) passed legislation authorizing pharmacists to administer immunizations in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies. The sample consists of 437 pharmacists, non-pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff who expressed support of in-pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39-2.04). While pharmacy staff who worked in neighborhoods with a high percent of minority residents were less likely to express support of in-pharmacy vaccination, those in neighborhoods with a high percent of foreign-born residents were marginally more likely to express support of in-pharmacy vaccination. While educational campaigns around the importance of vaccination access may be needed among some pharmacy staff and minority community residents, we have provided evidence supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality.

Receipt of influenza and pneumonia vaccinations: the dual disparity of rural minorities

OBJECTIVES

To examine the receipt of age-appropriate influenza and pneumococcal polysaccharide vaccinations (PPV), with particular attention to rural minority persons.

DESIGN

Data were drawn from the 2005 Behavioral Risk Factor Surveillance System. The dependent variables were self-reported receipt of annual influenza immunizations in adults aged 50 and older (n=177,417) or lifetime pneumococcal immunizations in adults aged 65 and older (n=81,762). The main independent variables were residence and race.

MEASUREMENTS

All data are self-reported. Multivariate analysis controlled for selected personal and county-level characteristics. Analyses were conducted in 2009/10.

RESULTS

Forty-two percent of adults aged 50 and older reported an influenza vaccination; 31.1% of rural African Americans reported an influenza vaccination, and 64.6% reported a PPV. White and African-American rural residents reported lower vaccination rates. Adjusted analysis indicated an interaction between race and rurality. White rural residents were more likely to be vaccinated than other whites, whereas rural African Americans were less likely to be vaccinated than urban African Americans.

CONCLUSION

This study confirms previous findings while finding an interactive effect between rurality and race. The results indicated the importance of provider availability to delivery. Alternative delivery methods may be an effective solution to improve delivery rates.

How effectively can health care settings beyond the traditional medical home provide vaccines to adolescents?

OBJECTIVES

Our goal was to evaluate the capacity of various health care settings to supplement the activities of the traditional medical home by delivering vaccines to adolescents.

METHODS

A group of experts in the fields of adolescent-immunization delivery and the provision of preventive care in various health care settings summarized the available literature, considered setting-specific factors, and assessed the ability of various health care settings beyond the traditional medical home to conform to the immunization quality standards set by the National Vaccine Advisory Committee, report vaccination information for the quantitative assessment of vaccine-coverage rates, be likely to offer vaccines to adolescents, and be viewed by adolescents as acceptable sites for receiving vaccinations.

RESULTS

Seven candidate settings were evaluated: pharmacies, obstetrics-gynecology practices, sexually transmitted disease clinics, hospital emergency departments, family planning clinics, teen clinics, and local public health department immunization clinics. The panel concluded that all could safely provide vaccinations to adolescents but that vaccination efforts at some of the settings could potentially have a markedly greater impact on overall adolescent-immunization rates than could those at other settings. In addition, for adolescent-vaccination services to be practical, candidate settings need to have a clear interest in providing them. Conditional on that, several issues need to be addressed: (1) funding; (2) orienting facilities to provide preventive care services; (3) enhancing access to immunization registries; and (4) clarifying issues related to immunization consent.

CONCLUSIONS

With supporting health policy, health education, and communication, health care settings beyond the traditional medical home have the potential to effectively augment the vaccination efforts of more traditional settings to deliver vaccines to adolescents. These health care settings may be particularly well suited to reach adolescents who lack access to traditional sources of preventive medical care or receive fragmented medical care.

Pharmacist involvement with immunizations: a decade of professional advancement

OBJECTIVE

To review achievements in pharmacist-administered immunizations, emphasizing the period 1995 to 2004.

DATA SOURCES

Published articles identified through PubMed (1995-2004) using the search terms pharmacist, pharmacy, and vaccine, immunization, or shots. Additional sources were identified from personal bibliographies collected by the authors during this decade, as well as the bibliographies of the retrieved articles. The later two sources resulted in manuscripts of primarily historical significance.

STUDY SELECTION

More than 300 manuscripts were identified. The authors selected 15 studies that most clearly document the effect of pharmacist-administered immunizations for review.

DATA EXTRACTION

By the authors.

DATA SYNTHESIS

While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, only 10 years have passed since pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine administration in 1994. On November 1, 1996, the American Pharmaceutical (now Pharmacists) Association (APhA) began its nationally recognized training program for pharmacists, Pharmacy-Based Immunization DELIVERY: A National Certificate Program for Pharmacists. By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement.

CONCLUSION

Pharmacists have made significant strides in immunizations over the past decade. Limited activities in the hospital sector have been particularly well documented, as have the perceptions of patients regarding acceptance of pharmacists as immunizers. The activities of community pharmacists are less well documented. More research is needed into novel approaches to pharmacist involvement in public health-focused immunization initiatives, along with continued research evaluating the current practice of pharmacist-administered immunizations.