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Waite NM, Houle SKD, Toppari K, Pereira JA. Willingness of Canadian community pharmacists to adopt a proactive life-course approach to vaccination services. J Am Pharm Assoc (2003) 2024:102073. [PMID: 38513979 DOI: 10.1016/j.japh.2024.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Most Canadian jurisdictions authorize pharmacists to administer vaccines, with differences in vaccine and patient age eligibility. Vaccination rates could be further optimized if pharmacists took a more proactive role in life-course vaccine screening and administration. Health professional vaccine fatigue following the COVID-19 pandemic may negatively impact service delivery. OBJECTIVES To assess vaccine fatigue among Canadian pharmacists, understand their willingness to provide proactive life-course vaccination services and identify associated vaccine practice facilitators. METHODS One-on-one interviews were conducted with pharmacists recruited through a national community pharmacist Facebook group. Purposive sampling was used to select a diverse sample considering gender, province, and years of practice. Online interviews were conducted using a semi-structured guide with questions about vaccination experiences, perceptions of assuming a more proactive vaccinator role for adults and children, and current level of fatigue related to offering vaccination services. Interviews were audio-recorded, transcribed, and coded independently by 2 researchers; content analysis was used to identify themes. RESULTS In spring 2023, interviews were conducted with 24 pharmacists from 5 Canadian provinces. Participants were receptive to a more proactive vaccinator role, feeling that vaccine fatigue had lessened, but strongly advocated for system and practice modifications to facilitate successful implementation. They emphasized the need for patient vaccination history access, the ability to administer all publicly funded vaccines, and fair compensation. Participants requested the development of electronic tools that connected to pharmacy systems that helped them navigate complex vaccine guidelines and clinical decision making, and the required documentation/billing. They also spoke of logistical concerns related to the incorporation of vaccination into their workflow and adequate staffing. Most participants were willing to vaccinate younger children if legislated age limits were lowered, provided they were trained and compensated appropriately. CONCLUSION Pharmacists are interested in furthering their vaccination services offerings, including proactive screening and vaccination of young children.
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Houle SK, Alsabbagh MW, Waite NM. Herpes zoster and human papillomavirus vaccination opportunities identified using electronic prompts at the time of scheduling influenza or COVID-19 vaccines. Can Pharm J (Ott) 2023; 156:257-264. [PMID: 38222890 PMCID: PMC10786011 DOI: 10.1177/17151635231188343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/14/2023] [Indexed: 01/16/2024]
Abstract
Background Due to workload and competing priorities, vaccination-related interactions in community pharmacies tend to be more reactive than proactive. The aim of this study is to determine the proportion of users of a web-based scheduling system for influenza and COVID-19 vaccines who may be eligible for herpes zoster or human papillomavirus (HPV) vaccination and interested in discussing these vaccines with a pharmacist. Methods Individuals scheduling an influenza or COVID-19 vaccine at a pharmacy using the MedEssist platform between October 2021 and March 2022 were asked about their vaccination status against HPV (if aged 9-45) or herpes zoster (if aged ≥50). Those who were unvaccinated or unsure were asked to indicate their willingness to discuss this with a pharmacist. Logistic regression was performed to identify patient characteristics associated with responses to these screening questions. Results Among 36,659 bookings by those aged 9 to 45 and 55,728 by those aged ≥50 that included responses to screening questions, 70.1% and 55.5% were potentially unvaccinated against HPV and herpes zoster, respectively, with approximately 1 in 5 also indicating willingness to have a discussion with the pharmacist. Those scheduling appointments for COVID-19 vaccines were significantly less likely to be vaccinated against HPV or herpes zoster and less willing to discuss this with a pharmacist than those seeking influenza vaccination. Discussion Automated prompts while booking influenza or COVID-19 vaccinations have the potential to identify vaccine-willing individuals who may benefit from further discussion on their vaccination needs. Conclusion Community pharmacies can leverage available technology to support the efficient and effective identification of individuals eligible for vaccination.
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Affiliation(s)
| | | | - Nancy M. Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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AlShurman BA, Tetui M, Nanyonjo A, Butt ZA, Waite NM, Vernon-Wilson E, Wong G, Grindrod K. Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context. Vaccines (Basel) 2023; 11:vaccines11040782. [PMID: 37112694 PMCID: PMC10143674 DOI: 10.3390/vaccines11040782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.
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Affiliation(s)
- Bara’ Abdallah AlShurman
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
| | - Moses Tetui
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
- Department of Epidemiology and Global Health, Umeå University, 907 37 Umeå, Sweden
| | - Agnes Nanyonjo
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln LN6 7TS, UK
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
| | - Nancy M. Waite
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
| | | | - Ginny Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
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Waite NM, Pereira JA, Houle SKD, Gilca V, Andrew MK. The impact of influenza on the ability to work, volunteer and provide care: results from an online survey of Canadian adults 50 years and older. BMC Public Health 2022; 22:2119. [PMCID: PMC9673206 DOI: 10.1186/s12889-022-14581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Influenza is associated with a decline in functional abilities among Canadian older adults, although specific impacts on daily life have not been fully explored.
Methods
In August 2019 and May 2020, we conducted surveys of Canadian adults 50-64 years and 65 years and older through an online market research platform. The survey included questions about the impact of diagnosed influenza or self-reported influenza-like-illness (ILI) on working, volunteering and caregiving.
Results
We surveyed 1006 adults in the 50-64 year age group about the 2018/19 season and 1001 about the 2019/20 season. In the 65 years and older age group, we surveyed 3548 and 3500 individuals about the 2018/19 and 2019/20 influenza seasons, respectively. In each season, nearly two-thirds of individuals 50-64 years with influenza/ILI were employed; 51.7% reported absenteeism in 2018/19 and 53.6% in 2019/20. Of the 20% of individuals 65 years and older who were employed, 47.0% of those with influenza/ILI were absent while ill in 2018/19 (39.8% in 2019/20). In 2018/2019, 29.6% of respondents 50-64 years old with influenza/ILI identified as volunteers (29.3% in 2019/2020). In both seasons, nearly half were unable to do so while ill. Of the 164 (32.7%) individuals 65 years and older who volunteered during the 2018/19 season, 80 (48.8%) did not while ill; 224 (37.3%) respondents volunteered in the 2019/20 season, and half were absent while ill. Of those 50-64 years with influenza/ILI, 97 (42.2%) and 57 (22.2%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19 and 2019/20, 40 (41.2%) and 28 (49.1%) caregivers were unable to provide care when ill, respectively. Of those with influenza/ILI in the 65 years and older age group, 123 (24.6%) and 162 (27.0%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19, 18 (14.6%) caregivers with influenza/ILI did not provide care while ill (42 [25.9%] in 2019/20).
Discussion
In Canadian older adults, influenza and ILI had notable impacts on ability to volunteer and provide care across two recent seasons. Optimization of influenza prevention in this population may yield important societal benefits.
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Houle SKD, Waite NM, Tsuyuki RT. Taking our best shot: Pharmacy’s vaccination success story. Can Pharm J (Ott) 2022; 155:293-295. [DOI: 10.1177/17151635221128223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Houle SKD, Timony P, Waite NM, Gauthier A. Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario. Can Pharm J (Ott) 2022; 155:258-266. [PMID: 36081916 PMCID: PMC9445507 DOI: 10.1177/17151635221115183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Pharmacist-administered immunizations have been associated with improved vaccination rates; however, little is known about whether areas with little to no access to this service (“vaccination deserts”) exist. The objective of this work is to determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario. Methods: Ontario College of Pharmacists registry data were used to identify patient care–providing pharmacists in community pharmacies and their ability to administer injections. Their number of hours worked was converted into full-time equivalents (FTEs), assuming 40 hours per week represents 1 FTE. Practice site(s) were mapped by postal code and presented by Public Health Unit (PHU) area. Communities within PHUs were further categorized as urban or rural and northern or southern, with ratios of FTEs per 1000 population calculated for both injection-trained and non-injection-trained pharmacists. Results: In total, 74.6% of Ontario’s practising community pharmacists are authorized to provide injections. Northern PHUs had slightly better access to pharmacist injectors (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41 FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist immunizers, while PHUs with greater land area were more likely to not have any immunizing pharmacists present ( p < 0.001 for all). Discussion: As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-based immunizations and collaboration with public health and primary care providers to address them (e.g., through mobile vaccination clinics) will be required to ensure equitable access. Can Pharm J (Ott) 2022;155:xx-xx.
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Timony P, Houle SKD, Gauthier A, Waite NM. Geographic distribution of Ontario pharmacists: A focus on rural and northern communities. Can Pharm J (Ott) 2022; 155:267-276. [PMID: 36081922 PMCID: PMC9445509 DOI: 10.1177/17151635221115411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Canadians living in rural and northern communities face particular health needs and challenges in accessing primary care services. Ontario pharmacists are increasingly able to optimize patient care with a broadening scope of practice; this was highlighted during the COVID-19 pandemic. This study explores the geographic distribution of pharmacists to evaluate their potential to deliver health care in rural and northern Ontario communities. Methods: A secondary analysis of the Ontario College of Pharmacists’ registry data was undertaken, with all Part A pharmacists who had at least 1 patient care practice site included in the analysis. Full-time equivalent (FTE) hours worked at each practice site were calculated and compared with the population distribution. Ratios of FTEs per 1000 residents by census subdivision (which represents communities) were calculated and compared by geography, north vs south and urban vs rural (further subdivided by metropolitan-influenced zones). Results: The greatest availability of pharmacist FTEs was found in urban communities (with slightly better availability in the north), whereas the lowest availability was found in the most rural communities. A more granular observation revealed that northern communities were more likely to have no local pharmacist access (72%) compared with southern communities (24%). Discussion: Rural and northern communities are underserved. Novel approaches to overcoming the rural pharmacist care gap include rural practice incentives, targeted enrollment of rural students, increased rural exposure in pharmacy schools and the utilization of new technologies such as telepharmacy and drone medication deliveries.
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Nasreen S, Gebretekle GB, Lynch M, Kurdina A, Thomas M, Fadel S, Houle SKD, Waite NM, Crowcroft NS, Allin S. Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review. Vaccine 2022; 40:4380-4393. [PMID: 35781171 DOI: 10.1016/j.vaccine.2022.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Meghan Lynch
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Kurdina
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine Thomas
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Houle SKD, Avdiaj B, Moroz SE, Waite NM. Experiential education supervisors as assessors of pharmacy student injection technique. Curr Pharm Teach Learn 2022; 14:372-378. [PMID: 35307099 PMCID: PMC9760392 DOI: 10.1016/j.cptl.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Due to the COVID-19 pandemic, students at the University of Waterloo in spring 2020 enrolled in the injections training curriculum were unable to complete the practical assessment component under the usual in-person model. Therefore, an alternative assessment strategy needed to be adopted to meet these curricular outcomes. EDUCATIONAL ACTIVITY AND SETTING To allow students to complete their training and apply this skill during co-operative work placements in fall 2020, pharmacist supervisors (preceptors) who were authorized to administer injections were asked to evaluate the practical assessment on behalf of the university. Students were mailed supplies to use for practice and assessment, and preceptors were provided the grading rubric and a copy of the didactic training materials for their reference. To obtain feedback on the process and identify areas for improvement, students and supervisors were invited to complete a brief survey containing both Likert scale and open-ended questions upon completion of the assessment. FINDINGS By fall 2020 term end, 69 of 121 students successfully completed the practical assessment component at a workplace. Survey responses indicated that, despite some challenges accommodating the assessment within a busy pharmacy's existing workflow and identifying volunteers to receive the injections, the modified assessment was well received. SUMMARY Supervisors can be effective adjuncts to in-class instruction and assessment of injection technique. Even when initial assessments can take place at the university, providing supervisors with access to training materials and rubrics can reinforce these skills for students immediately prior to their implementation into practice.
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Affiliation(s)
- Sherilyn K D Houle
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Besjana Avdiaj
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Sarah E Moroz
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Nancy M Waite
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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DeMarco M, Carter C, Houle SKD, Waite NM. The role of pharmacy technicians in vaccination services: a scoping review. J Am Pharm Assoc (2003) 2021; 62:15-26.e11. [PMID: 34663566 DOI: 10.1016/j.japh.2021.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs. PURPOSE This research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date. METHODS In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer. RESULTS A total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction. CONCLUSION This review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.
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Chaudhry M, He N, Waite NM, Houle SKD, Kwong JC, Cadarette SM. The Ontario Pharmacy Evidence Network Atlas of Community Pharmacy Influenza Immunizations. Can Pharm J (Ott) 2021; 154:305-311. [PMID: 34484480 PMCID: PMC8408905 DOI: 10.1177/17151635211034207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Maha Chaudhry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Nancy He
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | | | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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Oh BY, Violette R, Grindrod KA, Waite NM, Houle SK. Pharmacy students' perceived willingness and ability to negotiate for paid co-operative education positions. Exploratory Research in Clinical and Social Pharmacy 2021; 2:100026. [PMID: 35481113 PMCID: PMC9030280 DOI: 10.1016/j.rcsop.2021.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/01/2022] Open
Abstract
Background Evidence of a gender wage gap has been identified across many professions, with some evidence in pharmacy. Negotiation is one potential strategy to address this gap and it is underutilized, especially among women. No studies to date have examined pharmacy student perceptions of negotiation when applying for co-operative education positions – a potential sign of willingness to negotiate for entry-level positions upon graduation. Objectives To examine pharmacy students' comfort with and ability to engage employers in negotiation over wage and other work-related considerations for mandatory and paid co-operative education work terms at the University of Waterloo (Waterloo, Ontario, Canada). Methods Two focus groups, one for female and one for male students, were performed with students who had completed at least one co-operative education placement. Focus groups aimed to elucidate students perceived ability to negotiate with potential employers, to identify strategies that educators can employ to better support students through the hiring and negotiation process, and to elicit student perceptions on the gender wage gap in pharmacy. Focus groups were audio recorded and transcribed verbatim, and data were coded inductively by two independent reviewers, employing thematic analysis. Results Three major and two minor themes were identified: Preservation of the relationship; Power differential and perceived ability to negotiate; Institutional support and training; Negative experience with negotiation and wage gaps; and the presence of a gendered approach to negotiation. Pharmacy students rarely engage in negotiation during co-operative hiring processes at the University of Waterloo, with some female students expressing hesitation to negotiate due to concerns about being perceived as “bossy”. Students of both genders felt poorly equipped to engage in negotiation with a potential employer, and lacked confidence in initiating such a conversation. Conclusions Students identified a number of factors which influence their ability and desire to negotiate wages during co-op placement, including the requirements and logistics of placements, the perceived power imbalance between students and potential employers, and a concern that any wage negotiation may overshadow the value placed by students on the opportunities to provide patient care. Educators can play a role in equipping students, especially female students, with tools to enter into conversations on wages with potential employers.
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Waite NM, Pereira JA, Houle SKD, Gilca V, Andrew MK. COVID-19's Impact on Willingness to Be Vaccinated against Influenza and COVID-19 during the 2020/2021 Season: Results from an Online Survey of Canadian Adults 50 Years and Older. Vaccines (Basel) 2021; 9:vaccines9040346. [PMID: 33916364 PMCID: PMC8065823 DOI: 10.3390/vaccines9040346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/25/2022] Open
Abstract
There is considerable overlap in age-related risk factors for influenza and COVID-19. We explored the impact of the pandemic on anticipated influenza and COVID-19 vaccination behaviour in the 2020/2021 season. In May 2020, we conducted online surveys of Canadian adults 50 years and older via a market research panel platform, as part of a series of annual surveys to understand experiences with influenza. Given the current pandemic, respondents were also asked about COVID-19’s impact on their vaccination decision-making for the 2020/2021 season. Of 1001 respondents aged 50–64 years, 470 (47.0%) originally intended on receiving the influenza vaccine and still planned to do so, while 200 (20%) respondents who had planned to abstain now reported willingness to receive the vaccine due to COVID-19. In the 65+ age group, 2525 (72.1%) reported that they had planned to be vaccinated and that COVID-19 had not changed their mind, while 285 individuals (8.1%) reported that they had initially planned to forgo the vaccine but now intended to receive it. Reasons for this change included COVID-19’s demonstration of the devastating potential of viruses; and to protect against influenza, and decrease vulnerability to COVID-19. If the COVID-19 vaccine was available, 69.1% of 50–64 year olds and 79.5% of those 65 years and older reported they would opt to receive it. The COVID-19 pandemic has been a sobering demonstration of the dangers of infectious disease, and the value of vaccines, with implications for influenza and COVID-19 immunization programs.
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Affiliation(s)
- Nancy M. Waite
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada;
- Correspondence:
| | | | | | - Vladimir Gilca
- Institut National de Sante Publique du Quebec, Laval University, Quebec City, QC G1E 7G9, Canada;
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS B3H 2E1, Canada;
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Pullagura GR, Violette R, Houle SKD, Waite NM. Exploring influenza vaccine hesitancy in community pharmacies: Knowledge, attitudes and practices of community pharmacists in Ontario, Canada. Can Pharm J (Ott) 2020; 153:361-370. [PMID: 33282027 DOI: 10.1177/1715163520960744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Vaccine hesitancy (VH) remains a prime contributor to poor influenza vaccine uptake. This study explores the knowledge, attitudes and practices of community pharmacists toward influenza VH, including their personal influenza immunization attitudes and behaviours. Methods A web-based cross-sectional survey questionnaire was administered to community pharmacists practising in Ontario, Canada. A 38-question survey tool explored 5 domains, including pharmacists' personal attitudes and behaviour toward influenza immunization, their self-reported knowledge of influenza, its vaccine and vaccine hesitancy, and their attitudes, practices and experiences with influenza VH at the community pharmacy. The data were analyzed descriptively. Results A total of 5530 survey invitations were e-mailed, and 885 responses were collected (response rate 16%). Two-thirds (n = 568, 65.7%) of the respondents reported receiving the influenza vaccine in the preceding season. The most frequent reasons for personal influenza immunization were prevention of disease transmission to patients, friends and family, and contribution to herd immunity. In addition to their confidence and perceived ability to identify and address influenza VH, respondents' self-reported knowledge across a 15-item Likert questionnaire was high. Respondents reported coming across an average of 16 (SD 28) individuals hesitant to receive the influenza vaccine each week. Regular workload (n = 419, 65.6%) and insufficient time (n = 406, 65.3%) were reported as the most limiting barriers to engagement in influenza vaccine conversations. Conclusion Facilitating optimal practice scope for pharmacists, and capitalizing on the convenience and accessibility of the community pharmacy setting, presents a promising means to address influenza VH. However, barriers to pharmacist-initiated engagement on influenza vaccine must be explored and addressed. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
| | | | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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15
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination during pregnancy: Canadian maternity care providers' opinions and practices. Hum Vaccin Immunother 2020; 16:2789-2799. [PMID: 32271655 DOI: 10.1080/21645515.2020.1735225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Eliana Castillo
- Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Institute for Clinical Evaluative Sciences and University of Toronto , Toronto, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada.,Research Institute, Children's Hospital of Eastern Ontario , Ottawa, Canada
| | - William Fisher
- Department of Psychology, Western University , London, Canada
| | - Arnaud Gagneur
- Département des soins de santé communautaire, Université de Sherbrooke , Sherbrooke, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada.,Centre de recherche de l'hôpital Charles Le Moyne , Longueuil, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University , Antigonish, Canada
| | - Scott A Halperin
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre , Halifax, Canada
| | - Shannon MacDonald
- Faculty of Nursing, School of Public Health, University of Alberta , Edmonton, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo , Waterloo, Canada
| | - Nancy M Waite
- Department of Pharmacy, University of Waterloo , Waterloo, Canada
| | | | - Holly O Witteman
- Département de médecine familiale et de médecine d'urgence, Université Laval , Québec, Canada
| | - Mark Yudin
- Department of Obstetrics and Gynecology, University of Toronto , Toronto, Canada
| | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
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16
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Al Hamarneh YN, Rosenberg-Yunger Z, Saxena A, Waite NM, Dolovich L, Tsuyuki RT. Patient-oriented pharmacy practice research: Why should we care? Can Pharm J (Ott) 2020; 153:133-136. [PMID: 32528592 DOI: 10.1177/1715163520909122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Fonseca J, Violette R, Houle SK, Dolovich L, McCarthy LM, Waite NM. Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies - An implementation method. Res Social Adm Pharm 2020; 17:572-577. [PMID: 32487368 DOI: 10.1016/j.sapharm.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Community pharmacists' optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties. PROJECT AIMS To build community pharmacies' capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting. METHODS Community pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process. INTENDED OUTCOMES To assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.
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Affiliation(s)
- Joseph Fonseca
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada
| | - Richard Violette
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada; School of Human Services and Social Work, Griffith University, 68 University Dr, Meadowbrook, Queensland, 4131, Australia
| | - Sherilyn Kd Houle
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada
| | - Lisa Dolovich
- OPEN, Ontario Pharmacy Evidence Network, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada; Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Lisa M McCarthy
- OPEN, Ontario Pharmacy Evidence Network, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; Women's College Research Institute, 76 Grenville St, Toronto, ON, N5G 1N8, Canada
| | - Nancy M Waite
- University of Waterloo School of Pharmacy, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada; OPEN, Ontario Pharmacy Evidence Network, Canada.
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18
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Pullagura GR, Violette R, Houle SK, Waite NM. Shades of gray in vaccination decisions – Understanding community pharmacists’ perspectives of, and experiences with, influenza vaccine hesitancy in Ontario, Canada. Vaccine 2020; 38:2551-2558. [DOI: 10.1016/j.vaccine.2020.01.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
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19
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Waite NM, Johnson MD, Webster NR, Fong IW. Poor Response to Oral Ciprofloxacin in the Treatment of Peritonitis in Patients on Intermittent Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301300110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population. Design Open nonrandomized prospective study. Setting Nephrology Peritoneal Dialysis Unit in a tertiary care, teaching hospital of the University of Toronto. Patients Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following: 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of >100!IJl, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria. Interventions Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days. Main Outcome Measures Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration. Results Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured. Conclusions Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis related Gram-positive bacterial peritonitis.
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Affiliation(s)
- Nancy M. Waite
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael D. Johnson
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Nancy R. Webster
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ignatius W. Fong
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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20
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Isenor JE, Kervin MS, Halperin DM, Langley J, Bettinger JA, Top KA, Lalji F, Slayter K, Kaczorowski J, Bowles SK, Waite NM, Halperin SA. Pharmacists as immunizers to Improve coverage and provider/recipient satisfaction: A prospective, Controlled Community Embedded Study with vaccineS with low coverage rates (the Improve ACCESS Study): Study summary and anticipated significance. Can Pharm J (Ott) 2020; 153:88-94. [PMID: 32206153 DOI: 10.1177/1715163519900221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer E Isenor
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Melissa S Kervin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Donna M Halperin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Joanne Langley
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Julie A Bettinger
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Karina A Top
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Fawziah Lalji
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Kathryn Slayter
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Janusz Kaczorowski
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Susan K Bowles
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Nancy M Waite
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Scott A Halperin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
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21
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Houle SKD, Waite NM. Pharmacists as immunizers: Boosting opportunities for patient care. Can Pharm J (Ott) 2019; 152:388-389. [DOI: 10.1177/1715163519878138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nancy M. Waite
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
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22
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Fonseca J, Pearson Sharpe J, Houle SKD, Waite NM. Time for harmonization: Pharmacists as immunizers across Canadian jurisdictions. Can Pharm J (Ott) 2019; 152:395-400. [PMID: 31762852 DOI: 10.1177/1715163519879179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph Fonseca
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | | | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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Poudel A, Lau ETL, Deldot M, Campbell C, Waite NM, Nissen LM. Pharmacist role in vaccination: Evidence and challenges. Vaccine 2019; 37:5939-5945. [PMID: 31474520 DOI: 10.1016/j.vaccine.2019.08.060] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
Vaccines prevent an estimated 2.5 million deaths worldwide each year and are amongst the most cost-effective preventive measures against infectious diseases. Despite the effectiveness and availability of vaccines in many parts of the world, vaccination rates and service uptake remains suboptimal among both healthcare providers and the public. Pharmacists as established advocates, educators as well as qualified providers of vaccinations have a significant role to play in promoting and supporting the uptake of vaccination. Challenges and barriers to pharmacist vaccination are multifactorial, which needs effective strategies to address. Overcoming these barriers will increase the role of pharmacists as vaccinators that ultimately increases public access to vaccination and accurate and reliable information about vaccines.
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Affiliation(s)
- Arjun Poudel
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Esther T L Lau
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Megan Deldot
- Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada.
| | - Lisa M Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
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McCarthy LM, Bojarski EA, Waite NM, Dolovich LR. Lessons learned from 3 attempts to use data sources to evaluate pharmacist prescribing in Ontario. Can Pharm J (Ott) 2019; 152:234-240. [PMID: 31320957 DOI: 10.1177/1715163519852975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa M McCarthy
- Women's College Research Institute, Women's College Hospital (McCarthy, Bojarski), Toronto.,Leslie Dan Faculty of Pharmacy (McCarthy, Dolovich), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,School of Pharmacy, University of Waterloo (Waite), Waterloo.,Department of Family Medicine, McMaster University (Dolovich), Hamilton, Ontario
| | - Elizabeth A Bojarski
- Women's College Research Institute, Women's College Hospital (McCarthy, Bojarski), Toronto.,Leslie Dan Faculty of Pharmacy (McCarthy, Dolovich), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,School of Pharmacy, University of Waterloo (Waite), Waterloo.,Department of Family Medicine, McMaster University (Dolovich), Hamilton, Ontario
| | - Nancy M Waite
- Women's College Research Institute, Women's College Hospital (McCarthy, Bojarski), Toronto.,Leslie Dan Faculty of Pharmacy (McCarthy, Dolovich), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,School of Pharmacy, University of Waterloo (Waite), Waterloo.,Department of Family Medicine, McMaster University (Dolovich), Hamilton, Ontario
| | - Lisa R Dolovich
- Women's College Research Institute, Women's College Hospital (McCarthy, Bojarski), Toronto.,Leslie Dan Faculty of Pharmacy (McCarthy, Dolovich), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,School of Pharmacy, University of Waterloo (Waite), Waterloo.,Department of Family Medicine, McMaster University (Dolovich), Hamilton, Ontario
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25
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Pullagura GR, Waite NM, Houle SKD, Violette R, Wong WWL. Cost-utility analysis of offering a novel remunerated community pharmacist consultation service on influenza vaccination for seniors in Ontario, Canada. J Am Pharm Assoc (2003) 2019; 59:489-497.e1. [PMID: 30979576 DOI: 10.1016/j.japh.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/01/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the availability of free and accessible influenza vaccine to all Ontarians, uptake has remained suboptimal. Although reasons to not receive the vaccine vary widely, health care provider recommendations remain the most effective strategy to positively influence vaccination decisions. OBJECTIVES This study aimed to predict the relative quality of life, costs, and cost-effectiveness of introducing a remunerated community pharmacist consultation service on influenza vaccination for Ontarians aged ≥ 65 years. METHODS A cost-utility analysis was performed from a third-party public payer perspective over 1 year. The delivery of consultation services by community pharmacists on influenza vaccination, billable at CAD $15 was compared with current standard practices (absence of remunerated consultations). Model inputs were derived primarily from existing literature. The impact of parameter uncertainties was assessed through deterministic and probabilistic sensitivity analyses. RESULTS The provision of influenza vaccine consultation services was predicted to prevent 2407 cases of mild influenza and 3 influenza-related deaths at an additional cost of CAD $2.03 per person over current practices. The incremental costs per quality-adjusted life-year (QALY) gained for the enhanced care strategy compared with standard care was CAD $2087. The interpretation of the base-case result was found to be robust across all sensitivity analyses. The projected additional costs of implementing pharmacist consultations in Ontario was estimated at CAD $1.15 million per year, and the anticipated benefits included a gain of 507 QALY per year. CONCLUSION Pharmacist-delivered consultation services on influenza vaccination are cost-effective and lead to improved clinical outcomes for Ontario seniors. Introduction of such services offers a promising strategy to address challenges related to poor vaccine uptake in this group.
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Waite NM, Cadarette SM, Campitelli MA, Consiglio GP, Houle SKD, Kwong JC. Characteristics of patients vaccinated against influenza in physician offices versus pharmacies and predictors of vaccination location: a cross-sectional study. CMAJ Open 2019; 7:E421-E429. [PMID: 31227484 PMCID: PMC6588543 DOI: 10.9778/cmajo.20180189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about those vaccinated against influenza after pharmacists were added to the Ontario Universal Influenza Immunization Program, in 2012. Our aim was to identify characteristics of patients vaccinated against influenza and predictors of vaccination at a physician's office versus a community pharmacy. METHODS We conducted a cross-sectional study of Ontario residents who had a record of receipt of an influenza vaccine between October and March in the 2013/14 and 2015/16 influenza seasons in Ontario using health administrative databases. We used Poisson regression models to estimate associations between baseline characteristics and the receipt of influenza vaccination in a community pharmacy. All analyses were stratified by age group (≤ 65 yr or ≥ 66 yr). RESULTS Overall, we found a 7.9% decrease in vaccinations administered in 2015/16 (2 454 178) compared to 2013/14 (2 677 278). The number of patients vaccinated in community pharmacies increased between the 2 periods (757 729 [28.3%] in 2013/14 v. 859 794 [35.0%] in 2015/16). Living in nonurban areas or higher-income neighbourhoods, not identifying as an immigrant, not having a diagnosis of diabetes or hypertension, and receiving a pharmacist service on the same day as the vaccination were predictors of being vaccinated in a pharmacy, regardless of age group. Among patients aged 66 or more, those who had a hospital admission in the previous year were more likely to be vaccinated in a pharmacy than in a physician's office (adjusted incidence rate ratio [IRR] 1.08, 95% confidence interval [CI] 1.06-1.09), whereas those with higher annual medication costs were more likely to be vaccinated in a physician's office. The location of the previous season's vaccination predicted the current season's place of vaccination (age ≥ 66 yr: physician's office: adjusted IRR 0.56 [95% CI 0.56-0.57], pharmacy: adjusted IRR 2.37 [95% CI 2.35-2.39]; age ≤ 65 yr: physician's office: adjusted IRR 0.57 [95% CI 0.57-0.57], pharmacy: adjusted IRR 2.19 [95% CI 2.18-2.20]). INTERPRETATION For the 2013/14 and 2015/16 influenza seasons, the influenza vaccine was administered more frequently in physician offices than in community pharmacies, but the proportion of patients vaccinated in community pharmacies increased between the 2 periods. Physicians and pharmacists can encourage patients to take advantage of the availability of influenza vaccines across various settings.
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Affiliation(s)
- Nancy M Waite
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont.
| | - Suzanne M Cadarette
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont
| | - Michael A Campitelli
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont
| | - Giulia P Consiglio
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont
| | - Sherilyn K D Houle
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont
| | - Jeffrey C Kwong
- School of Pharmacy (Waite, Houle), University of Waterloo, Kitchener, Ont.; Leslie Dan Faculty of Pharmacy (Cadarette, Consiglio), University of Toronto; ICES (Cadarette, Campitelli, Consiglio, Kwong); Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination Against Influenza in Pregnancy: A Survey of Canadian Maternity Care Providers. J Obstet Gynaecol Can 2018; 41:479-488. [PMID: 30409569 DOI: 10.1016/j.jogc.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers' knowledge, attitudes, and practices regarding influenza vaccination in pregnancy. METHODS A cross-sectional Web-based questionnaire was sent during July and August 2017 to family physicians, obstetricians-gynaecologists, midwives, pharmacists, and nurses who care for pregnant individuals. A multivariable logistic regression model was used to determine variables independently associated with providers' recommendation of the influenza vaccine in pregnancy. RESULTS The analysis included 1061 providers. Most participants (85%) reported being vaccinated against influenza themselves, and 72% reported recommending the influenza vaccine to all of their pregnant patients during the previous influenza season. Participants' attitudes regarding influenza vaccination during pregnancy were generally positive: 64% strongly agreed that pregnant individuals are at an increased risk of complications from influenza, and 69% strongly agreed that it is safe to vaccinate pregnant individuals against influenza. The main determinants of participants' recommendations for influenza vaccination to all pregnant patients were following official recommendations on influenza vaccination, discussing vaccines with most or all pregnant individuals seen in their practice, and being vaccinated themselves during the previous influenza season. CONCLUSION Enhancing influenza vaccine uptake in pregnancy is largely dependent on maternity care providers' recommendations. This study provides valuable insight on providers' knowledge, attitudes, and practices.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC.
| | | | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Manale Ouakki
- Institut national de santé publique du Québec, Québec, QC
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | | | - Eliana Castillo
- Cumming School of Medicine, University of Alberta, Edmonton, AB
| | | | - S Michelle Driedger
- Department of Community Health Science, University of Manitoba, Winnipeg, MB
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - William Fisher
- Department of Psychology, Western University, London, ON
| | - Arnaud Gagneur
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Maryse Guay
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | | | | | | | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, ON
| | | | | | | | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
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Waite NM, McCarthy L, Milne E, Hillier C, Houle SK, Dolovich L. Perceived preparedness for full-scope pharmacist services among recent Doctor of Pharmacy graduates from Ontario schools of pharmacy. J Am Pharm Assoc (2003) 2018; 58:630-637. [DOI: 10.1016/j.japh.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
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O'Reilly DJ, Blackhouse G, Burns S, Bowen JM, Burke N, Mehltretter J, Waite NM, Houle SK. Economic analysis of pharmacist-administered influenza vaccines in Ontario, Canada. Clinicoecon Outcomes Res 2018; 10:655-663. [PMID: 30498367 PMCID: PMC6207261 DOI: 10.2147/ceor.s167500] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the impact of pharmacist administration of influenza vaccine in Ontario on: 1) vaccination-associated costs related to the number of people vaccinated; 2) annual influenza-related outcomes and costs; and 3) change in productivity costs. Methods Using available data for Ontario, the total number of vaccinations given by providers in the 2011/12 influenza season (pre) was compared to the 2013/14 influenza season (post). Vaccine costs and provider fees for administration were assigned for both periods. An economic model was created to estimate the impact of the change in influenza vaccination volume on influenza-related outcomes and on the health care costs associated with treating influenza-related outcomes. Productivity costs due to both time off work due to getting vaccinated and influenza illness were considered. One-way sensitivity analysis was used to assess parameter uncertainty. Results The number of vaccinations received by Ontarians increased by 448,000 (3% of the population), with pharmacists vaccinating approximately 765,000 people/year. The increased cost to the Ontario Ministry of Health and Long-term Care was $6.3 million, while the money saved due to reduced influenza-related outcome costs was $763,158. Productivity losses were reduced by $4.5 million and $3.4 million for the time invested to get vaccinated and time off work due to influenza illness, respectively. Conclusion After two influenza seasons, following the introduction of pharmacist-administered influenza vaccinations, there was a net immunization increase of almost 450,000, which potentially saved $2.3 million in direct health care costs and lost productivity in the province.
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Affiliation(s)
- Daria J O'Reilly
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, .,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada,
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, .,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada,
| | - Sheri Burns
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada,
| | - James M Bowen
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, .,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada,
| | - Natasha Burke
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, .,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada,
| | - Jeff Mehltretter
- Neighbourhood Pharmacy Association of Canada, Toronto, ON, Canada
| | - Nancy M Waite
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Sherilyn Kd Houle
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
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Affiliation(s)
- Nancy M. Waite
- Nancy M. Waite, Leslie Dan Faculty of Pharmacy, University of Toronto; Claude Mailhot, Faculté de pharmacie, Université de Montréal; Sharon Mitchell, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; Monique Richer, Faculté de pharmacie, Université de Laval
| | - Claude Mailhot
- Nancy M. Waite, Leslie Dan Faculty of Pharmacy, University of Toronto; Claude Mailhot, Faculté de pharmacie, Université de Montréal; Sharon Mitchell, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; Monique Richer, Faculté de pharmacie, Université de Laval
| | - Sharon Mitchell
- Nancy M. Waite, Leslie Dan Faculty of Pharmacy, University of Toronto; Claude Mailhot, Faculté de pharmacie, Université de Montréal; Sharon Mitchell, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; Monique Richer, Faculté de pharmacie, Université de Laval
| | - Monique Richer
- Nancy M. Waite, Leslie Dan Faculty of Pharmacy, University of Toronto; Claude Mailhot, Faculté de pharmacie, Université de Montréal; Sharon Mitchell, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; Monique Richer, Faculté de pharmacie, Université de Laval
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Sarrafizadeh M, Waite NM, Hobson EH, Migden H. Pharmacist-facilitated enrollment in medication assistance programs in a private ambulatory care clinic. Am J Health Syst Pharm 2004; 61:1816-20. [PMID: 15462253 DOI: 10.1093/ajhp/61.17.1816] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Efforts to reduce patients' out-of-pocket expenses for prescription drugs by incorporating pharmaceutical manufacturer assistance programs (PMAPs) into a private ambulatory care facility's pharmaceutical services are described. SUMMARY From March 2001 through March 2002, the clinic's pharmacist prospectively evaluated patients for PMAP enrollment. The pharmacist completed the pharmaceutical manufacturer's application forms for patients identified as candidates for PMAP assistance and helped them obtain documentation. Some companies sent medications directly to patients, and others sent them to the clinic, where they were stored until the patients picked them up. The patients informed the pharmacist when refills were needed, which allowed the pharmacist to review patient records, verify compliance, and ensure proper follow-up. Forty-four patients were enrolled in 22 PMAPs during the year. The mean +/- S.D. annual household income for all patients was 15,631 dollars +/- 7,845 dollars. A total of 115 medication orders were processed for the patients. The mean +/- S.D. number of medications per patient obtained through PMAPs was 2.5 +/- 1.8, and the mean +/- S.D. number of refills was 1.8 +/- 1.0. The total cost of the medications was 48,143 dollars. The pharmacist needed an average of 15-20 minutes to perform the initial patient interview, 10-15 minutes to complete each initial application, and 5-15 minutes to complete a renewal application. Total pharmacist time needed to process each medication order was estimated at about one hour per year. CONCLUSION A pharmacist in a private ambulatory care facility helped patients enroll in PMAPs and reduced the patients' expenses for prescription drugs.
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Abstract
STUDY OBJECTIVE To evaluate and improve adherence to American Diabetes Association guidelines for prophylactic aspirin therapy in ambulatory patients with diabetes using a pharmacy-directed intervention. DESIGN Unblinded, single intervention. SETTING Rural, primary care clinic. SUBJECTS Eighty-five patients with a diagnosis of diabetes mellitus. INTERVENTION Patients with diabetes were identified from database searches and routine clinic visits. Medical records were screened for aspirin use, allergies, adverse events, and contraindications. During routine clinic visits or structured telephone interviews, patients with indications for aspirin therapy were advised to begin enteric-coated aspirin 81 mg/day A follow-up survey assessed adherence. MEASUREMENTS AND MAIN RESULTS At baseline, 28 (33%) of 85 patients were receiving aspirin therapy An additional 8 patients had contraindications to aspirin, and 2 patients had no indications for aspirin therapy Aspirin was recommended to 27 patients during clinic interventions and to 15 patients during telephone interventions. Two patients declined the recommendation. At the completion of this intervention, 70 (82%) of 85 patients were receiving daily aspirin or had accepted the recommendation to begin therapy. CONCLUSIONS A pharmacy-directed intervention increased prophylactic aspirin therapy in patients with diabetes from 33% of patients at baseline to 82% at the end of the study The intervention, which has a simple, patient-focused design, serves as a template for improving aspirin prophylaxis among patients with diabetes in other ambulatory settings.
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Affiliation(s)
- John J Faragon
- Department of Pharmacy Practice, Albany College of Pharmacy, Albany, New York 12208, USA.
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Abstract
The frequency with which various types of documents were written on-the-job by Pharm. D. clerkship preceptors was studied, along with the value that these documents added to their professional practice. A survey was mailed in April 1999 to 129 practicing pharmacists serving as preceptors for Albany College of Pharmacy Pharm. D. clerkship rotations. The survey asked recipients to indicate the frequency with which they wrote each of 23 types of documents and how valuable it was to their practice. In addition, participants were invited to identify documents they wrote that were not on the list. Sixty-six preceptors returned usable surveys (response rate, 51%). Sixty-four (97%) had either direct or indirect patient care responsibilities. Four types of documents (memorandum or letter, pharmacy care plan, progress notes, and patient consultation notes) were written daily, weekly, or monthly. Sixteen of the 23 document types were rated as highly valuable; of these, most were written at least quarterly and 1 was written daily. The respondents indicated 15 additional types of documents they generated in their practice; 11 of these were rated as being of high or highest value. Clerkship preceptors reported writing numerous types of documents. Document types that were written most often were generally considered valuable to the respondents' practice.
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Abstract
The range of writing tasks undertaken by students during doctor of pharmacy clerkship rotations was studied. Data collection involved a review between August and November 1998 of writing samples selected by postbaccalaureate Pharm. D. students at Albany College of Pharmacy for inclusion in their required writing portfolios. The first 200 samples (accounted for by 35 students each submitting two documents for each of three clerkship rotations) were reviewed. Of these, 198 were coded to identify the four rhetorical components of clerkship location, document type, intended audience, and rhetorical purpose. Institutional sites served as the clerkship location for 164 (82.8%) of the 198 documents analyzed. The documents were placed in 28 categories; 5 of these accounted for 126 (63.6%) of the documents: 45 inservice presentations, 32 summaries, 18 patient case write-ups, 16 formulary reviews, and 15 newsletters. Students wrote most frequently to health care providers (34.8%), other pharmacists (32.3%), and teachers (16.7%), with the most frequent rhetorical purposes being informing (73.2%) and demonstrating (14.6%). Analysis of writing samples prepared by pharmacy students during clerkship rotations revealed a variety of clerkship sites, document types, audiences, and rhetorical purposes.
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Affiliation(s)
- Eric H Hobson
- Department of Humanities and Social Sciences, Albany College of Pharmacy, 106 New Scotland Avenue, Albany, NY 12208, USA.
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Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved influenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy 2001; 21:1115-22. [PMID: 11560201 DOI: 10.1592/phco.21.13.1115.34624] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To increase the rate of influenza vaccinations in high-risk patients by means of a pharmacist-managed immunization campaign. DESIGN Unblinded, single intervention. SETTING Rural primary care clinic. PATIENTS Six hundred fifty-seven patients at high risk for contracting influenza according to criteria established by the Centers for Disease Control and Prevention. INTERVENTION High-risk patients identified by chart review were mailed an education packet on influenza immunization. Vaccinations were given in specially designated clinics and during routine clinic visits. Campaign success and reasons why patients remained unvaccinated were determined by follow-up surveys. MEASUREMENTS AND MAIN RESULTS The influenza vaccination rate increased from 28% at baseline (before program initiation) to 54% after program initiation. Unvaccinated patients were younger and resided in more urban areas than vaccinated patients; vaccinated patients had a higher frequency of cardiovascular disease or diabetes mellitus. Vaccinated patients consistently identified the education packet and their health care providers as primary motivators for vaccination. CONCLUSION Our pharmacist-managed vaccine program increased the influenza immunization rate in high-risk patients.
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Affiliation(s)
- J A Van Amburgh
- From School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Triller DM, Hamilton RA, Briceland LL, Waite NM, Audette CM, Furman CA. Home care pharmacy: extending clinical pharmacy services beyond infusion therapy. Am J Health Syst Pharm 2000; 57:1326-31. [PMID: 10918922 DOI: 10.1093/ajhp/57.14.1326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies. Initial experiences of this pilot project are described. Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a long-term home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted. Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.
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Affiliation(s)
- D M Triller
- Department of Pharmacy Practice, Albany College of Pharmacy, NY 12208, USA.
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Waite NM, Webster N, Laurel M, Johnson M, Fong IW. The efficacy of exit site povidone-iodine ointment in the prevention of early peritoneal dialysis-related infections. Am J Kidney Dis 1997; 29:763-8. [PMID: 9159313 DOI: 10.1016/s0272-6386(97)91130-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infections are the main complications of peritoneal dialysis, and currently there is no established method for prevention. A prospective, randomized, single-blind study was performed to evaluate the efficacy of regular application of povidone-iodine ointment at the catheter site (during the entire time on the study) in peritoneal dialysis. One hundred twenty patients were randomized; three were excluded for not completing the study. Sixty-one patients received application of povidone-iodine and 56 patients received standard care. Povidone-iodine ointment was effective in delaying infectious complications, with a lower proportion of treated patients having infections (exit site and peritonitis) within 140 days of starting dialysis compared with the controls (P = 0.04, Wilcoxon test). This protective benefit was lost after 140 days on dialysis. Staphylococcus aureus infections developed in only two (3.3%) of the treated patients compared with 10 (21.4%) of the controls (P = 0.009), despite the higher rate of S aureus nasal carriage in the treated group (22 of 61 patients [36%] v 14 of 56 patients [25%]).
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Affiliation(s)
- N M Waite
- Department of Pharmacy, St Michael's Hospital, Toronto, Ontario, Canada
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Waite NM, Thomson LG, Goldstein MB. Successful vaccination with intradermal hepatitis B vaccine in hemodialysis patients previously nonresponsive to intramuscular hepatitis B vaccine. J Am Soc Nephrol 1995; 5:1930-4. [PMID: 7620090 DOI: 10.1681/asn.v5111930] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Seventy-seven chronic hemodialysis patients were vaccinated against hepatitis B virus with an intramuscular (im) hepatitis B vaccine (HBV), 40 micrograms at 0, 1, 2, and 6 months. Fifty-seven patients (74%) developed antibodies (anti-HBs). The im-responsive patients were significantly younger than the nonresponsive patients (P < 0.05). Nineteen of the 20 im nonresponders received HBV intradermally (id), 5 micrograms every 2 wk until anti-HBs developed; the 20th patient died before receiving the id vaccine. Three patients were lost to follow-up. Fifteen (94%) of the 16 developed anti-HBs after 5.2 +/- 4.7 months. The peak anti-HBs titers were 726 +/- 426 (im) and 211 +/- 260 (id) IU/L (P < 0.05). Twelve (21%) of the 57 im-responsive patients and 8 (53%) of the 15 id-responsive patients had anti-HBs less than 20 IU/L at 18 and 8 months postvaccination, respectively (P < 0.05). Further preliminary data indicate that more prolonged id vaccination can increase both the titer and the duration of anti-HBs in im-nonresponsive patients.
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Affiliation(s)
- N M Waite
- St. Michael's Hospital, Toronto, Ontario, Canada
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Waite NM, Rybak MJ, Krakovsky DJ, Steinberg JD, Warbasse LH, Edwards DJ. Influence of subject age on the inhibition of oxidative metabolism by ciprofloxacin. Antimicrob Agents Chemother 1991; 35:130-4. [PMID: 2014968 PMCID: PMC244953 DOI: 10.1128/aac.35.1.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Case reports suggest that the magnitude of inhibition of oxidative metabolism produced by ciprofloxacin may be greater in elderly subjects. We examined the effect of oral ciprofloxacin on antipyrine disposition in 13 young (ages, 23 to 34 years) and 9 elderly (ages, 65 to 82 years) healthy volunteers. Ciprofloxacin decreased antipyrine oral clearance in young and elderly subjects (P less than 0.05), with the average decreases being similar in both groups (23.3% for the young subjects and 27.9% for the elderly subjects). Ciprofloxacin concentrations in serum were significantly higher (mean, 57%) in the elderly. The formation clearance of 4-hydroxyantipyrine and 3-hydroxymethylantipyrine was also significantly decreased in both groups of subjects; however, norantipyrine formation, accounting for 15 to 20% of antipyrine clearance, was reduced only in the elderly. These results suggest that elderly subjects are not more sensitive to the inhibitory effect of ciprofloxacin on antipyrine metabolism. However, careful clinical monitoring is necessary with all patients, irrespective of age, taking ciprofloxacin concomitantly with drugs primarily eliminated by the cytochrome P-450 system.
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Affiliation(s)
- N M Waite
- College of Pharmacy & Allied Health Professions, Wayne State University, Detroit, Michigan 48202
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Waite NM, Edwards DJ, Arnott WS, Warbasse LH. Effects of ciprofloxacin on testosterone and cortisol concentrations in healthy males. Antimicrob Agents Chemother 1989; 33:1875-7. [PMID: 2610498 PMCID: PMC172780 DOI: 10.1128/aac.33.11.1875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Several inhibitors of oxidative drug metabolism inhibit the synthesis of endogenous compounds such as testosterone and cortisol. Since ciprofloxacin is a potent inhibitor of the metabolism of a number of drugs, we studied its effect on serum testosterone and cortisol concentrations in eight healthy male subjects. Blood samples were collected over a 12-h period under baseline conditions and following the first and final doses of ciprofloxacin (500 mg orally every 12 h for 4 days). No significant differences in concentrations or area under the concentration-time curve were found when baseline values were compared with those observed for either testosterone or cortisol after ciprofloxacin administration. These results suggest that ciprofloxacin is unlikely to have either antiandrogenic side effects or clinical utility in lowering testosterone or cortisol concentration.
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Affiliation(s)
- N M Waite
- College of Pharmacy and Allied Health Professions, Wayne State University, Detroit, Michigan 48202
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Edwards DJ, Waite NM, Svensson CK. Effect of enoxacin and 4-oxo-enoxacin on antipyrine disposition in the rat. Drug Metab Dispos 1988; 16:653-5. [PMID: 2903039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- D J Edwards
- College of Pharmacy and Allied Health Professions, Wayne State University, Detroit, MI 48202
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