Pharmacists and immunizations: a national survey

Patient characteristics associated with the use of pharmacist-administered vaccination services and predictors of service utilization

BACKGROUND

Data on the impact of pharmacists as vaccinators are available; however, research on understanding the characteristics of users of pharmacist-administered vaccinations is scarce.

OBJECTIVES

This study aimed to identify the characteristics of the users of pharmacist-administered vaccinations and recognize predictors of utilizing these services.

METHODS

Data were obtained from a cross-sectional online survey, and the sample size was 26,173 respondents from all over the United States. The outcome measure was the previous use of pharmacist-administered vaccination. Independent variables were demographic factors, health-related factors, and previous utilization of pharmacy products and services. Chi-square test and multivariable logistic regression analyses were conducted to examine the factors associated with the use of this service. P values, odds ratios (ORs), and 95% CIs were computed and reported.

RESULTS

About 31% of respondents reported previous use of pharmacist-administered vaccination. The gender of respondents was mainly female (71.2%), and the race was mainly white (80.7%). Chi-square analysis showed a statistically significant association of service use with age, education, geographic region, use of other pharmacy services and products, type of pharmacy, and the number of chronic diseases (P < 0.05). Logistic regression analysis showed a statistically significant association with the number of chronic diseases (OR 1.085 [95% CI 1.049-1.122]), level of education (1.352 [1.35-1.28]), race (0.901 [0.840-0.969]), and proximity to pharmacy (0.995 [0.992-0.997]). Age, type of pharmacy, and previous use of other pharmacist-provided services and products also showed statistically significant associations (P < 0.05).

CONCLUSION

The use of pharmacist-administered vaccination has been increasing over the past years. The service has many advantages compared with other vaccination service providers and associated with higher vaccination rates among people with older age, higher education, and a higher number of chronic diseases. With proper training and education, pharmacists are unique in improving vaccination services and public health in general.

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

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

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

OBJECTIVES

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

DESIGN

Randomized controlled trial.

SETTING AND PARTICIPANTS

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

OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Pharmacy Technician-Administered Vaccines: On Perceptions and Practice Reality

Doucette and Schommer recently surveyed U.S. community pharmacy technicians on their willingness to perform tasks including the administration of vaccines. They found that 47.1% of technicians reported they were “unwilling” to administer a vaccine, although this finding must be placed into proper context. The first nationwide survey of U.S. pharmacist perceptions on immunizations in 1998 revealed only 2.2% of pharmacist respondents had administered adult vaccines and only 0.9% had administered childhood vaccines. They also found pharmacists to be “slightly negative on administering immunizations” with many perceived barriers. Nonetheless, pharmacist-provided immunizations have been an unqualified public health success. The theory of planned behavior (TPB) predicts intention from attitude and perceived behavioral control, among other factors. Given low involvement, exposure, and perceived behavioral control to administer vaccinations, technicians’ attitudes or willingness to participate from the Doucette and Shommer study can be regarded as quite positive. Given the results of a successful pilot project in Idaho and that subjective norms and perceived behavioral control will likely shift upward, one can only expect technicians’ willingness to participate in vaccinations to become more favorable and ultimately become a success.

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

BACKGROUND

The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated.

METHODS

Data from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated.

RESULTS

High percentages (70.0%-97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS.

CONCLUSION

Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.

Pharmacists as immunizers, their pharmacies and immunization services: A survey of Ontario community pharmacists

Background

To improve patient access to the influenza vaccine in Ontario, pharmacists have been authorized to administer the vaccine since 2012. A survey was conducted to describe pharmacist immunizers, their pharmacies and immunization services.

Methods

Ontario community pharmacists completed an anonymous online survey regarding influenza immunization. Descriptive, comparative and multivariate statistics were used to analyze data on pharmacists' personal demographics, current workplace characteristics, immunization certification status and past and anticipated experience vaccinating.

Results

Of the 4307 community pharmacists contacted, 18.4% (n = 780) completed the survey. Most (81.3%, n = 603) were certified to administer vaccines, with those practising in urban pharmacies twice as likely to be certified compared to pharmacists practising in rural pharmacies (odds ratio = 2.04; 95% confidence interval, 1.04 to 4.01, p = 0.04). In the past influenza season, 70% of pharmacists had administered over 50 vaccines and 37% worked at pharmacies that had administered more than 300 vaccines. Respondent-provided profiles of immunization services described partnerships with public health, a variety of approaches for in-pharmacy and external advertising and patient vaccine access mainly through walk-in.

Discussion

Ontario community pharmacists demonstrate strong engagement with this expanded scope and there is further capacity for immunization service provision through engaging rural pharmacies, addition of other vaccines and leveraging the positive relationship with public health. Patients and the public benefit from easy access to the service and the additional in-store and external promotion of influenza vaccination that is provided by pharmacists and pharmacies.

Conclusion

These provincial benchmarking data provide direction for maintaining and expanding community pharmacist-provided influenza immunization.

Opportunities and Challenges of Adolescent and Adult Vaccination Administration Within Pharmacies in the United States

Pharmacies have been endorsed as alternative vaccine delivery sites to improve vaccination rates through increased access to services. Our objective was to identify challenges and facilitators to adolescent and adult vaccination provision in pharmacy settings in the United States. We recruited 40 licensed pharmacists in states with different pharmacy vaccination laws. Eligible pharmacists previously administered or were currently administering human papillomavirus (HPV); tetanus, diphtheria, and pertussis (TDAP); or meningitis (meningococcal conjugate vaccine [MCV4]) vaccines to adolescents aged 9 to 17 years. Pharmacists participated in a semistructured survey on in-pharmacy vaccine provision. Pharmacists commonly administered vaccinations to age-eligible adolescents and adults: influenza (100%, 100%), pneumococcal (35%, 98%), TDAP (80%, 98%), MCV4 (60%, 78%), and HPV (45%, 53%). Common challenges included reimbursement/insurance coverage (28%, 78%), education of patients/parents (30%, 40%), and pharmacists' time constraints (28%, 35%). Three-quarters of pharmacists reported that vaccination rates could be increased. National efforts should expand insurance coverage for vaccine administration reimbursement and improve data information systems to optimize provision within pharmacies.

Parental acceptance of human papillomavirus vaccinations and community pharmacies as vaccination settings: A qualitative study in Alabama

Purpose

To determine parents’ knowledge and attitudes regarding human papillomavirus (HPV) vaccinations in their adolescent children and to describe parents’ perceptions of adolescent vaccinations in community pharmacies.

Methods

In-depth interviews were completed with parents or guardians of children ages 11–17 years from Alabama's Lee and Macon counties. One-hour long, open-ended telephonic or in-person interviews were conducted until the saturation point was reached. Using ATLAS.ti software and thematic analysis, interview transcripts were coded to identify themes.

Results

Twenty-six parents were interviewed, most of whom were female (80.8%) and white (50%). A total of 12 themes were identified. First, two themes emerged regarding elements facilitating children's HPV vaccination, the most common being positive perception of the HPV vaccine. Second, elements hindering children's vaccination contained seven themes, the top one being lack of correct or complete information about the HPV vaccine. The last topic involved acceptance/rejection of community pharmacies as vaccination settings, and the most frequently cited theme was concern about pharmacists’ clinical training.

Conclusions

Physician-to-parent vaccine education is important, and assurances of adequate pharmacy immunization training will ease parents’ fears and allow pharmacists to better serve adolescents, especially those who do not see physicians regularly.

•

Physicians play a crucial role in parents’ HPV vaccination decisions.

•

Parents are reluctant to use pharmacists as HPV vaccine providers.

•

Parents are concerned about pharmacists’ training and pharmacy infrastructure.

•

Community pharmacists must work in conjunction with physicians.

Community pharmacies as sites of adult vaccination: A systematic review

Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative approaches to immunization delivery may help address under-vaccination among adults. This systematic review assesses the feasibility, acceptability, and effectiveness of community pharmacies as sites for adult vaccination. We searched 5 electronic databases (PubMed, EMBASE, Scopus, Cochrane, LILACS) for studies published prior to June 2016 and identified 47 relevant articles. We found that pharmacy-based immunization services (PBIS) have been facilitated by state regulatory changes and training programs that allow pharmacists to directly provide vaccinations. These services are widely accepted by both patients and pharmacy staff, and are capable of improving access and increasing vaccination rates. However, political and organizational barriers limit the feasibility and effectiveness of vaccine delivery in pharmacies. These studies provide evidence to inform policy and organizational efforts that promote the efficacy and sustainability of PBIS.

Barriers to Implementing a Pharmacist-Run Immunization Service, as Perceived by Pharmacists, in a Community Pharmacy Chain

Background:

Thousands of people die each year from vaccine-preventable diseases. Pharmacists can be a valuable resource in aiding the success of immunizations.

Objective:

To determine the barriers to implementing a program utilizing pharmacists as immunizers, as perceived by pharmacists, in a supermarket pharmacy chain.

Methods:

A 15 question survey regarding the perceived barriers to implementing a pharmacist-run immunization program was distributed to 60 pharmacists in a supermarket chain in northwestern Ohio. The responses were tabulated using a 5 point Likert scale. The data were analyzed utilizing the Statistical Package for Social Sciences.

Results:

Of the 60 pharmacists who received the survey, 43 completed the questionnaire (response rate 72.0%). A majority of the pharmacists surveyed believed that patient privacy was an issue in administering adult immunizations in a community pharmacy. The majority of pharmacists were concerned about the risk of adverse reactions to the vaccines and the need for a quick response to control these reactions. Twenty-five pharmacists believed that the prescription volume at their pharmacy limited them from having time to immunize. Twenty-one pharmacists cited cost as the main determining factor in a pharmacy immunization program.

Conclusions:

Many barriers to implementing a pharmacist-run immunization program exist. The future success of such an immunization program rests on overcoming the perceived barriers in a formal and timely manner.

National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study

Background

Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs.

Aim

To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations.

Design and setting

A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales.

Method

Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model.

Results

The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk.

Conclusion

Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome.

Pharmacist self-reported antidepressant medication counseling

OBJECTIVES

To identify the extent of pharmacists' self-reported antidepressant counseling (SRAC) and to identify factors that may affect pharmacists' decisions to provide antidepressant counseling.

DESIGN

Cross-sectional study.

SETTING

Alabama community pharmacies in 2011.

PARTICIPANTS

Full-time pharmacists from 600 community pharmacies.

INTERVENTION

Self-administered survey; three mail contacts with alternate electronic surveys were used.

MAIN OUTCOME MEASURES

Pharmacists' SRAC behavior and its relationship with pharmacists' illness perceptions of depression, self-efficacy, and organizational and environmental influences.

RESULTS

600 surveys were sent; 22 were undeliverable, 1 was partially completed (<80% questions answered), and 118 were completed (20.6% overall response rate). Pharmacists reported low rates of involvement in antidepressant counseling; 61% reported assessing patient knowledge and understanding of depression, and 36% discussed options for managing adverse effects with no more than a few patients. More than one-quarter (28.6%) never asked patients whether they had barriers to taking antidepressants. Pharmacists' perceptions regarding consequences, control/cure, and the episodic nature of depression, as well as their self-efficacy, had significant relationships ( P < 0.05) with pharmacists' involvement in antidepressant counseling.

CONCLUSION

Low rates of pharmacists' involvement in antidepressant counseling were reported. Pharmacists must become more involved in counseling patients about their antidepressant medications and overcoming barriers preventing greater involvement.

Publicly funded remuneration for the administration of injections by pharmacists: An international review

BACKGROUND

The administration of injections has become an increasingly common addition to pharmacists' scope of practice. Four Canadian provinces, all US states and a number of other countries have regulations allowing pharmacists to administer injections. However, the extent to which such services are remunerated is unknown.

METHODS

We contacted regulatory and advocacy organizations within those jurisdictions where pharmacists are authorized to administer injections to identify publicly funded programs that pay pharmacists for these services, as well as details of the eligible drugs/vaccines. Patient or private insurer payment programs were excluded.

RESULTS

Of the 281 organizations we contact-ed, 104 provided information on a total of 34 pharmacist vaccination programs throughout Canada, the United States, England, Wales and Ireland. Converted to 2013 Canadian dollars, remuneration averages $13.12 (SD $4.63) per injection (range, $4.14-$21.21). All regions allow pharmacists to bill for administration of the influenza vaccine, while some states allow for a number of other vaccines. Alberta has the broadest range of injections eligible for remuneration.

DISCUSSION

Despite evidence of increased vaccination rates in areas allowing pharmacist administration of injections, the availability of publicly funded remuneration programs and the fee offered vary by more than 5-fold across North America and the United Kingdom.

CONCLUSION

Pharmacist-administered injections have great public health potential. The range of injections eligible for remuneration should be expanded to include a wide range of vaccines and other injectable drugs, and remuneration should be sufficient to encourage more pharmacists to provide this service.

Health literacy: use of the Four Habits Model to improve student pharmacists' communication

OBJECTIVE

To assess whether student pharmacists' communication skills improved using the Four Habits Model (FHM) at the St. Louis College of Pharmacy.

METHODS

During the Fall of 2009 and 2010, student pharmacists in the third professional year learned and practiced the FHM. They were given feedback by faculty on three of the four Habits, used the FHM for self and peer assessment, and were formally evaluated on all four Habits during a standardized patient encounter.

RESULTS

Student pharmacist performance significantly improved from baseline during both Fall 2009 and Fall 2010 in the majority of the Habits assessed.

CONCLUSION

Use of the FHM in pharmacy education can improve a student pharmacists' ability to display the four Habits of communicating and developing relationships with patients. Tailoring of the FHM to pharmacy encounters will further enhance the utility of this communication framework.

PRACTICE IMPLICATIONS

Use of the FHM enhances the measurement and assessment of the relational aspects of student pharmacist-patient communication skills. Consistent use of the FHM over time is likely necessary to fully develop and retain communication skills. The overall goal is to improve patient's health literacy and appropriate medication use by improving communication and the pharmacist-patient relationship.

Risks, benefits, and issues in creating a behind-the-counter category of medications

OBJECTIVE

To examine the issues surrounding the development and implementation of a behind-the-counter (BTC) category of medications.

DATA SOURCES

Testimony from organizations submitting comments to the Food and Drug Administration (FDA) panel hearings in November 2007, the 2009 final report of the U. S. General Accounting Office regarding a BTC drug category, literature review of research that has been conducted, experiences from other countries, and publically available information from agencies in charge of regulating medications similar to BTC.

SUMMARY

Based on evidence attained from the current work, the following six recommendations regarding a BTC category of medications are provided. (1) Demonstration needs to occur that the risks and/or costs of BTC are outweighed by benefits, positive measurable outcomes, and financial savings to society. (2) Sufficient resources, including personnel, equipment, and facilities, need to be available for the appropriate provision of BTC services and to ensure ongoing monitoring and controls. (3) An appropriate compensation structure needs to be developed. (4) Encounters and outcomes should be documented in an electronic record, the information should be shared with other health care providers involved in patients' care, and interprofessional collaboration and communication should occur. (5) Criteria for designating candidates for transition, ongoing review for safety, and reverse transition must be developed. (6) Applicable lessons learned from other countries should be incorporated into BTC strategies. In addition to implementation recommendations, we also summarize additional evidence that needs to be gathered to optimize the BTC model.

CONCLUSION

Based on the accumulated evidence, comments to FDA's request, and information from other countries, implementation of a BTC model probably is feasible in the United States. However, the optimal model remains uncertain and various aspects of a program need to be prioritized and rigorously tested.

Asthma friendly pharmacies: a model to improve communication and collaboration among pharmacists, patients, and healthcare providers

Pharmacists, with expertise in optimizing drug therapy outcomes, are valuable components of the healthcare team and are becoming increasingly involved in public health efforts. Pharmacists and pharmacy technicians in diverse community pharmacy settings can implement a variety of asthma interventions when they are brief, supported by appropriate tools, and integrated into the workflow. The Asthma Friendly Pharmacy (AFP) model addresses the challenges of providing patient-focused care in a community pharmacy setting by offering education to pharmacists and pharmacy technicians on asthma-related pharmaceutical care services, such as identifying or resolving medication-related problems; educating patients about asthma and medication-related concepts; improving communication and strengthening relationships between pharmacists, patients, and other healthcare providers; and establishing higher expectations for the pharmacist's role in patient care and public health efforts. This article describes the feasibility of the model in an urban community pharmacy setting and documents the interventions and communication activities promoted through the AFP model.

Assessing Pharmacists' Attitudes regarding Delivery of the Pandemic Influenza Vaccine in British Columbia

Background:

In response to the clear indication that the second wave of the pandemic (H1N1) 2009 would arrive in North America during fall 2009, the Ministry of Health Services in British Columbia proposed expanding pharmacists' scope of practice to include administering vaccinations. This change in regulations was prompted by the anticipated need to provide millions of doses of the pandemic (H1N1) influenza vaccine in a short period of time.

Objectives:

To determine pharmacists' willingness and preparedness to deliver vaccines, especially the pandemic (H1N1) influenza vaccine, as well as their preferences related to providing this service.

Methods:

A survey was developed to elicit pharmacists' opinions concerning administration of vaccines. Staff pharmacists and pharmacy managers and owners licensed to practice in British Columbia were invited to complete the online survey. The survey results were analyzed descriptively.

Results:

In total, 151 pharmacists participated in the study. The majority of respondents were men (84 [55.6%]) and most had practised for at least 5 years (108 [71.5%]). Most respondents (123 [81.5%]) were interested in administering vaccines to their clients, including the pandemic (H1N1) influenza vaccine (113 [74.8%]). In general, respondents preferred to vaccinate adults rather than children and understood the importance of documentation, reporting of adverse events and reporting to their local health authorities. More than half of participants (84 [55.6%]) felt that they were prepared to provide vaccine services in time for the pandemic (H1N1) vaccination program in fall 2009. The majority of these were prepared to offer vaccination services during daytime hours (91 [74.0%]), and some were willing to do so during the evenings (43 [35.0%]) and on weekends (40 [32.5%]). Ninety (73.2%) of the participants thought they had adequate space to administer vaccinations and maintain patient confidentiality and 111 (90.2%) indicated that they had adequate space to store the vaccines in their refrigerators, but only 82 (66.7%) had adequate storage space in their freezers.

Conclusion:

Pharmacists in British Columbia were willing to offer vaccination services to their clients. Given this willingness and a general level of preparedness, pharmacists who have undergone appropriate training should be allowed to vaccinate against seasonal and pandemic influenza and to offer pneumococcal vaccine in their pharmacies.

Pharmacy characteristics, vaccination service characteristics, and service expansion: an analysis of sustainers and new adopters

OBJECTIVE

To compare earlier (sustainers) and later (new) adopters in terms of pharmacy characteristics and characteristics of in-house vaccination services and to identify how sustainers modified their in-house vaccination services over time.

DESIGN

Nonexperimental multistage study.

SETTING

Washington State during 2003, 2004, and 2006-2007.

PARTICIPANTS

Community pharmacies included in this study's analyses must have participated in all data collection stages and provided in-house vaccination services during the third stage. Based on key informants' self-reports, those who had provided in-house services before or since 2003 were sustainers and those who started their services after 2004 were new adopters.

INTERVENTION

Mixed-mode survey.

MAIN OUTCOME MEASURES

Pharmacy characteristics and characteristics of in-house vaccination services offered in 2003 and 2006 were measured in terms of service accessibility, scope, and supportive personnel.

RESULTS

A total of 37 sustainers and 27 new adopters met the inclusion criteria. The majority of independent and supermarket pharmacies were sustainers, whereas the majority of chain and mass merchant pharmacies were new adopters. In-house services offered by sustainers were broader in service accessibility and scope and involved a greater number of pharmacists trained in immunization delivery than services offered by new adopters in the same year. Further, when comparing sustainers' in-house services offered in 2003 and 2006, the 2006 services were expanded to provide year-round services, involved a greater number of settings, included services to adolescents, and involved a greater number of trained pharmacists.

CONCLUSION

Community pharmacies started their in-house vaccination services on a small scale and later expanded to a larger scale. Pharmacies with expanded in-house services can make greater contributions to their business, their patients, and the profession by bringing in additional revenues, improving vaccination rates among high-risk patients, and facilitating the growth of pharmacy-based services.

Sustainability of pharmacy-based innovations: the case of in-house immunization services

OBJECTIVE

To examine the effect of organization-level factors on sustainability of pharmacy-based in-house immunization services.

DESIGN

Cross-sectional study.

SETTING

Washington State community pharmacies in 2006.

PARTICIPANTS

Key informants of 490 community pharmacies.

INTERVENTION

Mixed-mode survey; five mail and telephone contacts were used.

MAIN OUTCOME MEASURES

Effectiveness of champions (i.e., influential individuals within the host organization who actively and continuously promote the service), formal evaluation process, degree of modifications made to in-house services, degree of compatibility between in-house services and the host pharmacy, and sustainability of in-house immunization services were measured and included in the proposed model. Using survey responses, factor analysis and path analysis were performed to determine the relationships among these variables.

RESULTS

Of the 490 survey instruments sent, 1 was undeliverable, 2 were incomplete, and 206 were completed (42.1% response rate). A total of 104 pharmacies that reported offering immunization services in 2006 were included in the analysis. Compatibility, which was defined as the fit between in-house immunization services and the host pharmacy, was the key to sustainability of immunization services. To enhance compatibility between in-house services and the host pharmacy, two pathways were found. First, in-house services underwent formal evaluations and subsequent modifications were made to the services. The second pathway bypassed the adaptation process. Through the second pathway, an operational champion implemented in-house services in a way that was already compatible with the host pharmacy.

CONCLUSION

Organizational leaders and practitioners had the potential to sustain in-house services. The key factors included in the model should be incorporated as an integral part of programs planning to foster sustainability of in-house immunization services.

Forward and backward transitions in pharmacy-based immunization services

BACKGROUND

Community pharmacies can engage in immunization services by contracting with an external workforce (outsourced mechanism) or staff pharmacists (in-house mechanism) to deliver the services. Because an outsourced mechanism generally requires lower organizational commitment, pharmacies often start with an outsourced mechanism. Later, these pharmacies can have 1 of the following transitions: sit on a fence by continuing with an outsourced mechanism, move backward by abandoning any immunization services, or move forward by implementing an in-house mechanism.

OBJECTIVES

Using Rogers' Diffusion of Innovations model and Behavioral Theory of the Firm as guidance, this study identified the associations between perceived characteristics of immunization services and backward/forward transitions.

METHODS

A cross-sectional mail survey was conducted to collect data from key informants of Washington State community pharmacies during May-July 2004 (response rate=46.9%). A total of 106 pharmacies were included in the analysis. Based on pharmacy's immunization service transitions, these pharmacies were identified as Fence sitters, Backward movers, or Forward movers. Relationships between these transitions, pharmacy characteristics, and perceived characteristics of immunization services were analyzed using bivariate and multinomial logistic regression techniques.

RESULTS

Backward and Forward movers had less positive assessments of outsourced services when compared with Fence sitters. Backward and Forward movers differed in their perceptions of in-house services; Backward movers generally perceived no differences between these 2 services, whereas Forward movers generally perceived in-house services to be superior to outsourced services. Furthermore, the odds of being a Forward mover increased as perceived technical and social benefits of outsourced services decreased, perceived compatibility of in-house services increased, and perceived complexity of in-house services decreased.

CONCLUSIONS

Perceived characteristics of outsourced and in-house innovations were associated with backward and forward transitions. Findings can be used to guide the development of strategies for facilitating organizational change and preventing the abandonment of immunization services.

Needs assessment study for community pharmacy travel medicine services

BACKGROUND

Community pharmacists in the UK currently provide limited travel medicine services. An enhanced service could offer the traveling public general advice, provision of immunizations, and malaria prophylaxis. The assessment of need for a travel vaccine service from community pharmacies is key to the decision to develop the service.

METHOD

The needs assessment used a questionnaire survey of potential travelers recruited from community pharmacies and the regional travel clinic.

RESULTS

In total, 151 completed questionnaires were received (response rate 40%); nearly three times as many replies were from females (74%) than males (26%). Details for 230 different proposed visits abroad and 174 different past visits were analyzed. General medical practice (54.3%) and community pharmacies (36.4%) were rated as providing the most useful advice. Most respondents (76.4%) required advice on vaccines, 53.9% on malaria prophylaxis, and 54.9% on bite prevention. Many (58.9%) agreed, or strongly agreed, that they would use the community pharmacy to provide travel immunizations, while 43% (strongly) agreed that they would be prepared to pay to obtain travel medicine services including immunizations. The median amount that participants were prepared to pay for a full travel assessment was pound 10, pound 13 for the administration of typhoid vaccine, pound 70 for a course of rabies vaccine, and pound 25 for malaria tablets for Kenya. Nearly three quarters (74.8%) agreed, or strongly agreed, that the community pharmacy would provide a convenient location from which to obtain travel services and 70.2% that the pharmacy could provide a one-stop shop for travel medicine services.

CONCLUSIONS

Members of the traveling public do visit community pharmacies, and most people are traveling for holiday purposes. The results suggest that travelers would be prepared to use the community pharmacy to provide travel advice and immunizations.

Involvement of Immunization-Certified Pharmacists with Immunization Activities

BACKGROUND

Immunization certification courses allow pharmacists to directly administer vaccines to their patients. However, the demographics and level of immunization involvement of immunization-certified pharmacists compared with those noncertified are unknown.

OBJECTIVE

To document the demographics, professional activities, and job satisfaction of immunization-certified pharmacists compared with pharmacists not certified for immunization.

METHODS

In a cross-sectional pilot study, immunization-certified pharmacists were compared with noncertified pharmacists via a postal-mailed questionnaire. The questionnaire consisted of demographic and practice site characteristics, involvement in immunization services, and a job satisfaction survey.

RESULTS

Response rates were 48% (n = 101) and 36% (n = 158) for immunization-certified and noncertified pharmacists, respectively. Significantly more certified pharmacists were involved in immunizations (99% vs 24%; p < 0.001). Desire to improve the health care of the public and personal satisfaction were important factors that encouraged pharmacists to become certified to administer vaccines. Seventy-four percent of immunization-certified pharmacists directly administered the vaccines, primarily influenza (96%), pneumococcal (77%), hepatitis (55%), and diphtheria, pertussis, tetanus (19%). Adequate training, time, support from management and staff, and liability coverage were important factors that allowed pharmacists to incorporate immunizations into their practice. No significant differences in job satisfaction were observed between immunization-certified and noncertified pharmacists.

CONCLUSIONS

Immunization-certified pharmacists are using their skills to administer vaccines to patients within their communities. Efforts to increase the number of these pharmacists throughout the US should be undertaken.

The role of pharmacists in the delivery of influenza vaccinations

OBJECTIVES

The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines.

METHODS

Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association.

RESULTS

Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines.

CONCLUSIONS

Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older.

Pharmacists’Opinions Regarding Level of Involvement in Emergency Preparedness and Response

OBJECTIVE

To assess opinions of pharmacist-members of the American Pharmacists Association Academy of Pharmacy Practice and Management (APhA-APPM) regarding the appropriate level of pharmacists' involvement in emergency preparedness and response activities and to determine whether opinions differed according to demographic characteristics.

DESIGN

Cross-sectional, descriptive, Web-based survey.

SETTING

United States.

PARTICIPANTS

Five hundred eighteen APhA-APPM member-pharmacists.

MAIN OUTCOME MEASURES

Responses to survey questions.

RESULTS

Respondents to our survey indicated that pharmacists should have a high level of involvement in emergency preparedness and response activities. Traditional pharmacy practice activities (such as medication preparation and dispensing) and patient education were the most highly supported roles for pharmacists. Newer activities such as surveillance, vaccine administration, and mobilization were also strongly supported. Demographic characteristics, such as age, sex, degree, state of residence, practice setting, and employment setting, did not influence respondents' opinions. The only characteristic that influenced pharmacist opinions was previous participation in local and/or state emergency preparedness and response activities. Compared with other respondents, pharmacists who participated in these activities gave higher ratings to these possible roles for pharmacists: surveillance, triage/evaluation, community planning and preparation, mobilization, and training of others.

CONCLUSION

Pharmacist-members of APhA-APPM who responded to this survey believe that participating in public health activities related to emergency preparedness and response is important for members of the pharmacy profession.

Pharmacy and immunization services: pharmacists' participation and impact

OBJECTIVES

To conduct a follow-up to the National Pharmacist Immunization Survey of 1998 to determine changes in pharmacist involvement in immunizations and obstacles to pharmacy-based immunization services and to assess the descriptive information about pharmacy-based immunization services provided.

DESIGN

Cross-sectional mail survey.

SETTING

United States.

PARTICIPANTS

A randomly selected national sample of 6,000 pharmacists.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

An updated version of the 1998 study questionnaire was used to collect data about pharmacists' current involvement in adult or childhood immunizations, perceived obstacles to such involvement, and characteristics of pharmacist-administered immunization services.

RESULTS

Four mailings in fall 2001 yielded a response rate of 21.2% (1,266 completed, usable surveys out of 5,958 deliverable surveys). Immunization activities that reportedly increased during this period, compared with results from the 1998 survey, include counseling about adult immunizations (increase from 11.9% to 14.7%), nurse-administered childhood immunizations (6.3% to 7.8%), nurse-administered adult immunizations (16.2% to 30.2%), pharmacist-administered childhood immunizations (0.9% to 1.3%), pharmacist-administered adult immunizations (2.2% to 6.8%), and immunization promotion (18.9% to 27.3%). Only counseling for childhood immunizations appears to have decreased slightly, from 13.4% to 8.9%. Willingness to provide all of the above immunization services also increased during the 1998-2001 period. In addition to flu shots and pneumococcal vaccines, pharmacists were administering vaccines for hepatitis A and B, Lyme disease, tetanus, and chicken pox, but flu shots accounted for the majority of immunizations being administered.

CONCLUSION

Pharmacist involvement in childhood and adult immunizations has increased significantly in the last few years. Pharmacists perceived obstacles to their involvement in immunizations as less problematic.

The impact of critical care pharmacists on enhancing patient outcomes

The highly specialized knowledge and skills needed to care for critically ill patients requires a multidisciplinary team approach. Pharmacists are integral members of this team. They make valuable contributions to improve clinical, economic, and humanistic outcomes of patients. The purpose of this article is to review the literature pertaining to pharmacists' contributions within a multidisciplinary intensivist-led intensive care unit (ICU) team. Pharmacist interventions include correcting/clarifying orders, providing drug information, suggesting alternative therapies, identifying drug interactions, and therapeutic drug monitoring. Pharmacist involvement in improving clinical outcomes of critically ill patients is associated with optimal fluid management and substantial reductions in the rates of adverse drug events, medication administration errors, and ventilator-associated pneumonia. Furthermore, economic evaluations of clinical pharmacy services in the ICU consistently reveal the potential for considerable cost savings.

Pharmacy immunization partnerships: a rural model

OBJECTIVES

To describe the Pharmacy Immunization Project, a pharmacy/county health department (CHD) partnership model for immunizing infants and adults in rural areas, and to develop service procedures and disseminate lessons learned for adapting the model to different settings.

SETTING

Independent community pharmacies in five contiguous rural counties in West Virginia.

PRACTICE DESCRIPTION

Participating pharmacies varied markedly in space, prescription volume, and population of service areas.

PRACTICE INNOVATION

Childhood and adult immunization service.

INTERVENTIONS

Pharmacists partnered with nurses from CHDs to offer year-round immunizations at times when other providers were typically closed. Working under standing orders of the CHD medical directors, nurses also conducted routine well-baby examinations in the pharmacy. Promotions involved direct mailing, posters, fliers, direct communication, and ads in newspapers, radio, and TV.

MAIN OUTCOME MEASURES

Pharmacists' and CHDs' continued willingness to participate, use of the service by local citizens, and feedback from participants and other health care providers and the West Virginia Immunization Program (WVIP).

RESULTS

All sites except one continued their participation through the life of the project. The one exception was a pharmacy with few infant patients, which discontinued participation during year 4 of the project. Remaining sites were used and well accepted by the community. The WVIP remains a loyal supporter, and no problems arose with local health care providers.

CONCLUSION

The model appears adaptable to urban as well as rural practice and to chain as well as independent practice in states not authorizing pharmacists to administer vaccines, for pharmacists who for other reasons prefer not to administer, and for those who prefer to offer adult immunization on a seasonal basis. From the CHD perspective, the partnership model is useful in establishing "satellite" locations to target hard-to-reach patients. Recommendations regarding agreements and responsibilities are available, as are lessons learned during project development.