Vaccinations: Pharmacists Shot at Improving Community Health

NOVEMBER 17, 2016
Mohamed Jalloh, PharmD
Each year, more than 80,000 Americans die of vaccine-preventable infections despite the wide availability of vaccines.1,2 Many patients are inadequately vaccinated due to lack of access to vaccinations, poor relationships with their health care providers, or negative attitudes toward immunizations.3 To address these concerns, pharmacists, who are highly accessible and trusted by patients, have been indirectly enlisted to help improve vaccination rates.4

Pharmacy-based immunization services have significantly improved vaccination rates. In a letter to pharmacists, Rear Admiral Anne Schuchat, MD, assistant surgeon general and principal deputy director of the CDC, lauded pharmacists for significantly improving vaccination rates among patients over the past 20 years.4 However, for some vaccinations, rates are still below 50%. For example, in 2014, only 35.8% of adults 18 and older received the flu vaccine, indicating that a high percentage of adults remained vulnerable to the influenza virus.5 Therefore, innovative strategies should be implemented to improve vaccination rates among patients.

PHARMACY VACCINATION MODELS
Appointment-based services are purported to effectively increase vaccination rates by scheduling vaccinations to improve pharmacy workflow. This model can be useful for very busy pharmacies by helping to predict patient volume and the types of immunizations needed.6 However, this model can place a threshold on the number of patients who can be vaccinated in a given time period.

The walk-in–based model may be useful for pharmacies with smaller volumes because this model is more likely to disturb larger pharmacy workflow due to the randomness with which patients may require services.

Implementation
Pharmacists and other staff can call patients to schedule appointments. They can also help to synchronize medication refills with scheduled immunization appointments in order to decrease subsequent trips to the pharmacy.6

REACHING OUT TO THE COMMUNITY
Pharmacists can provide mobile or offsite clinics to improve immunization rates. They have historically reached out to organizations, such as school systems, apartment complexes, and churches, to ensure greater access to immunizations. For example, one North Carolina pharmacy administered more than 12,000 immunizations by offering offsite clinics at such locations as local businesses, school systems, and health fairs.7

Implementation
Pharmacists can consider contacting the human resources departments or main offices of organizations such as school systems and apartment complexes to set up immunization services.7 When preparing to provide offsite services, pharmacists must ensure that the relevant immunization materials (eg, privacy wall, sharps container, alcohol swabs) are in mobile containers to facilitate transportation.

FUTURE INITIATIVES
There is a growing need for accessibility to immunization services. To ensure pharmacists can continue to provide high-quality immunization services, they must be educated on best practices, reimbursement design, and seamless integration of these services into their practices. Pharmacists should ensure they have thorough knowledge of immunizations and seek training if they do not. The American Pharmacists Association has a comprehensive immunization certificate program to ensure that pharmacists are fully trained.8

END NOTE
Pharmacists continue to be one of the most accessible health care professionals, making them a key medium for vaccine administration. Whether to follow an appointment model or a walk-in model depends on patient load and availability of vaccines. Pharmacists should consider conducting immunization clinics at various locations, such as school systems, community centers, and houses of worship (if permitted), to improve access to immunizations.
 
Mohamed Jalloh, PharmD, is an associate professor in the Clinical Sciences Department at Touro University, California, and a community pharmacist for Walgreens.

References
  1. Bridges CB, Fukuda K, Uyeki TM, Cox NJ, Singleton JA; Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2002;51(RR-3):1-31.
  2. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46(RR-8):1-24.
  3. Pattin A, Rowe Z, Kilgore PE, Farhat N, Kaurala S, Kaljee L. Engagement in a diverse urban community to describe community residents’ perceptions of pharmacists as immunizers. Innovations in Pharmacy website. http://pubs.lib.umn.edu/innovations/vol7/iss2/5. Accessed September 26, 2016.
  4. Schuchat A. Letter to pharmacists. Pharmacist.com website. pharmacist.com/sites/default/files/files/CDC_Dear_Pharmacists_Letter_AS_09282015.pdf. Published September 28, 2015. Accessed September 26, 2016.
  5. Health, United States, 2015. CDC website. cdc.gov/nchs/ hus/index.htm. Accessed September 26, 2016.
  6. Watson LL, Bluml BM. Pharmacy’s appointment based model. American Pharmacists Association Foundation website. aphafoundation.org/sites/default/files/ckeditor/files/ABMImplementationGuide-FINAL-20130923.pdf. Published July 2013. Accessed September 26, 2016.
  7. Collins S. APHA recognizes 2016’s immunization champions. Pharmacy Today website. pharmacytoday.org/article/S1042-0991(16)30381-4/fulltext. Published June 2016. Accessed September 26, 2016.
  8. Goad JA, Bach AT. The role of community pharmacy-based vaccination in the USA: current practice and future directions. Integrated Pharmacy Research and Practice. Published July 2015. https://works.bepress.com/goad/21/. Accessed September 26, 2016. 


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