Pharmacy-based immunization in rural USA during the COVID-19 pandemic: A survey of community pharmacists from five southeastern states

INTRODUCTION

Immunization rates for seasonal and non-seasonal vaccines dropped during the COVID-19 pandemic. Little is known about the extent to which community pharmacies in the USA continued to serve as immunization sites during the pandemic. This study compared 1) the types and perceived changes in non-COVID-19 vaccine doses administered at rural community pharmacies in 2020 (during the pandemic) to 2019 (pre-pandemic) and 2) the delivery of non-COVID-19 immunization services in 2020 to 2019.

METHODS

A mixed-mode (paper/electronic) survey of a convenience sample of 385 community pharmacies operating in rural settings and have administered ≥1 vaccine in 2019 and 2020 was distributed in May-August 2021. Survey development was informed by relevant literature, pre-tested with three individuals, and pilot-tested with 20 pharmacists. Non-response bias was assessed, and survey responses were analyzed using descriptive and bivariate statistics.

RESULTS

Of the 385 community pharmacies, 86 qualified pharmacies completed the survey (Response Rate = 23.8%). The percentage of pharmacies offering a given vaccine in 2019 and 2020 were similar; with one exception, a higher percentage of pharmacies reported having MMR administered for adults in the pharmacy in 2020 (McNemar's test; p-value = 0.0253). For each given vaccine, the majority of respondents did not perceive a change in the number of doses administered in 2020 compared to 2019. Further, the majority reported no difference in how they delivered immunization services during and pre-pandemic. However, a small percentage of respondents (6.0-22.0%) adapted their services by adopting several measures to ensure the safety and continuity of immunizations during the pandemic.

CONCLUSION

Findings highlight the importance of community pharmacies as immunization sites during the pandemic. Community pharmacies continued immunization delivery at community pharmacies during the pandemic with almost no noticeable change to types and doses of vaccines compared to pre-pandemic nor the process of vaccine delivery.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research

Background

To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.

Methods

A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.

Results

Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.

Conclusions

This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.

Trial registration

A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876).

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.

Pharmacy Technicians' Willingness to Perform Emerging Tasks in Community Practice

New tasks are being developed for pharmacy technicians in community practice. The objectives of this study were to (1) assess the willingness of community pharmacy technicians to perform new tasks, and (2) to identify factors affecting technicians in assuming new tasks in community pharmacy practice. An online survey asked about the respondent characteristics, involvement in pharmacy technician tasks, willingness to perform emerging pharmacy technician tasks, and influences on pharmacy technicians’ performance of emerging tasks. Descriptive statistics were calculated for all items. A total of 639 usable surveys from community pharmacy technicians were used in the analyses. The respondents reported a mean of 11.5 years working as a pharmacy technician, with 79.2% working full time. Technicians reported high willingness to perform four emerging tasks, moderate willingness for six tasks, and low willingness to perform two tasks. The low willingness tasks were administering a vaccination and drawing a blood sample with a finger stick. Four workplace influences on willingness to perform emerging tasks were insufficient staffing, insufficient time to complete additional tasks, employers not classifying technicians based on specialized skills, and usually feeling stress at work. It appears likely that pharmacy technicians will be willing to perform the new tasks needed to support the emerging patient care services in community pharmacies.

Developing a competency framework for pharmacy technicians: Perspectives from the field

BACKGROUND

Within the last decade and given the context of ever-growing complexity in pharmaceutical care the new profession of Pharmacy Technicians (PT) was added to the pharmacy team. Until now, pharmaceutical organizations worldwide are searching for the best way to educate and employ future PTs.

OBJECTIVE

This empirical study set out to gain insight into the knowledge, skills and attitudes required to perform as a PTs. A further aim was to develop a PT competency framework on the basis of experiences and opinions of stakeholders from the Dutch pharmaceutical field.

METHODS

A multi-method qualitative research design was used to develop a competency framework between 2015 and 2017. Data were collected using focus group interviews. Iterative thematic analysis led to an initial framework, which was refined using a modified Delphi-method. A competency domain was considered relevant if a minimum of 70% consensus was reached.

RESULTS

Both PTs (n = 27) and pharmacists (n = 12) participated in the focus groups. The Delphi-panel consisted of PTs (n = 8), pharmacists (n = 12) and representatives of other stakeholders like patient organizations, health policy makers and all levels of pharmacy education (n = 14). The developed competency framework comprises 6 domains: Communication in patient care, Interdisciplinary collaboration, Pharmaceutical expertise, Organization of care practice, Collaborative leadership and Personal development. A detailed description about the practical implications of each domain was added to the framework.

CONCLUSION

The PT competency framework provides a solid foundation for both PT training and curriculum development and is based on several rounds of scientific research. The proposed competency framework may help understand the PT role and how to best prepare for practice within pharmaceutical care.

Application of process mapping to understand integration of high risk medicine care bundles within community pharmacy practice

OBJECTIVE

The Scottish Patient Safety Programme - Pharmacy in Primary Care collaborative is a quality improvement initiative adopting the Institute of Healthcare Improvement Breakthrough Series collaborative approach. The programme developed and piloted High Risk Medicine (HRM) Care Bundles (CB), focused on warfarin and non-steroidal anti-inflammatories (NSAIDs), within 27 community pharmacies over 4 NHS Regions. Each CB involves clinical assessment and patient education, although the CB content varies between regions. To support national implementation, this study aims to understand how the pilot pharmacies integrated the HRM CBs into routine practice to inform the development of a generic HRM CB process map.

METHODS

Regional process maps were developed in 4 pharmacies through simulation of the CB process, staff interviews and documentation of resources. Commonalities were collated to develop a process map for each HRM, which were used to explore variation at a national event. A single, generic process map was developed which underwent validation by case study testing.

RESULTS

The findings allowed development of a generic process map applicable to warfarin and NSAID CB implementation. Five steps were identified as required for successful CB delivery: patient identification; clinical assessment; pharmacy CB prompt; CB delivery; and documentation. The generic HRM CB process map encompasses the staff and patients' journey and the CB's integration into routine community pharmacy practice. Pharmacist involvement was required only for clinical assessment, indicating suitability for whole-team involvement.

CONCLUSIONS

Understanding CB integration into routine practice has positive implications for successful implementation. The generic process map can be used to develop targeted resources, and/or be disseminated to facilitate CB delivery and foster whole team involvement. Similar methods could be utilised within other settings, to allow those developing novel services to distil the key processes and consider their integration within routine workflows to effect maximal, efficient implementation and benefit to patient care.

Disparities in the Use of Immunization Services Among Underserved Minority Patient Populations and the Role of Pharmacy Technicians: A Review

Objective: To provide a review of the issues surrounding the lack of use of immunizations and immunization services among underserved minority patients and outline the role of pharmacy technicians in facilitating the utilization of vaccination services. Data Sources: Articles were identified through searches in May 2017 using MEDLINE/PubMed (1946-2017) with the following search terms: pharmacy technicians, immunizations, and pharmacy-based immunization services. Articles were also identified utilizing search terms such as "immunization disparities." Additionally, immunization data and vaccination resources from government websites such as the Centers for Disease Control and Prevention and the US Department of Health and Human Services were used. Study Selection and Data Extraction: Articles and reports that discuss the challenges and barriers associated with use of vaccinations in minority patient populations were considered for inclusion. Additionally, literature that report challenges in community pharmacy where pharmacy-based immunization services provide less vaccinations to minority patients compared to other patient populations were reviewed. Data Synthesis: Cross-sectional studies that provide insight into vaccine disparities were reviewed. Roles for pharmacy technicians are highlighted that include nurturing relationships with their patients and engaging patients about vaccines during service provision. Conclusions: Pharmacy personnel, including pharmacy technicians, are in a position to reduce barriers associated with disparities in the uptake of immunization services in the community pharmacy setting.

Cross-Sectional Survey of Perceived Barriers Among Community Pharmacists Who Do Not Immunize, in Wayne County, Michigan

Introduction

The goal of the study was to identify perceived barriers to implementation of vaccination services encountered by independent and small-chain community pharmacies in an urban setting.

Methods

Pharmacists in independent and small-chain pharmacies located in 29 Michigan ZIP codes were visited and asked to complete a 5- to 10-min semi-structured interview.

Results

A total of 93 independent and 12 small-chain pharmacies participated (n = 105; 61%). The pharmacies filled an average of 700 prescriptions each week with 1.1 pharmacist full-time equivalents and 57 h of technician time. The most common services that participating pharmacies provided were dispensing outpatient medication (99%), medication therapy management (MTM, 65.7%), disease management or coaching (54.3%), point-of-care testing (34.3%), and dispensing medications to inpatient facilities (16.2%). Only seven pharmacies (6.7%) administered vaccinations. When pharmacists were asked to identify what it would take to start to administer vaccines, the most common responses were increased demand from patients (37.1%), adequate time (19%), appropriate space (17.1%), appropriate amount of staff (14.3%), change in attitudes or beliefs of the owner or pharmacists at that pharmacy (13.3%), increased profit related to vaccines (11.4%), and increased awareness among patients about the importance of vaccines (11.4%). The majority of pharmacies (65.3%) reported that only one factor would need to change to start to administer vaccines.

Conclusion

Independent and small-chain community pharmacies in an urban, primarily low-income area identified several barriers that have prevented implementation of vaccination services. However, the majority of pharmacies reported that only one factor would need to change in order to begin to administer vaccines. Interventional efforts necessary to address commonly cited barriers may include providing education to pharmacists about the need for community pharmacy-based immunization programs in addition to services provided by physician offices, as well as the importance of proactively providing immunization-related recommendations to patients.