Jeannette Y. Wick, RPh, MBA

Debilitating and degenerative, chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disease affecting 1.6 per 100,000 Americans annually. It most closely resembles Guillain-Barré syndrome and causes extremity nerve damage that reduces functioning. If untreated, about 30% of patients become wheelchair dependent. However, 70% to 90% of afflicted individuals can find some improvement with immunotherapy. CIDP was a session topic at the 2019 NASP Annual Meeting and Expo.

Two speakers gave a comprehensive presentation. Luigi Brunetti, PharmD, MPH, associate professor of pharmacy at Rutgers, The State University of New Jersey, emphasized that patients with CIDP have unique physical needs. Therefore, health care providers who see these patients need an empathetic, informed, team-based approach to care management. Although a neurologist usually leads the care team, patients also need support in the form of financial resources, health plan involvement, and a broad array of medical care.

Immunoglobulin is the only steroid-sparing lifelong treatment available at this time. Dr Brunetti indicated that if improvements are observed after patients are treated with immunoglobulin, mainly that they stabilize, experts propose various ways of continuing therapy. One leading researcher indicates that 75% of patients prescribed a 2-g/kg induction dose of intravenous immunoglobulin (IVIG) followed by IVIG 1 g/kg every 3 weeks for a maintenance dose remained stable without relapse. Another found that subcutaneous (SC) administration has been as effective in maintaining stability. In addition, it is convenient for some patients, and they report fewer adverse effects, less travel time, an absence of venous access problems, fewer “wearing off” fluctuations, and less time missed from work.

Dr Brunetti discussed the specialty pharmacist’s responsibilities. For this indication, immunoglobulin dosages, administration schedules, and infusion flow rates are different from those administered to patients with other diseases. Key points were the necessity of close monitoring to ensure that patients use appropriate amounts, providing vial sizes that reduce waste, and establishing an administration schedule that maximizes benefit and reduces costs. He stressed that patients with thrombosis, renal insufficiency, or renal failure must be monitored closely when using immunoglobulin products. Many prescribers and pharmacists are accustomed to using immunoglobulin products for other indications, but they need to be cautious because CIDP requires unique dosing and administration rates.

Amy Clarke, RN IgCN, director of Clinical Program Services, Nursing at Diplomat Specialty Infusion, discussed the economic implications important to specialty pharmacy. Research has found only a small difference in cost between the IVIG and SC immunoglobulin (SCIG). Outpatient immunoglobulin treatment is covered in the pharmacy budget, adding an element of increased control when clinicians employ drug utilization management. IV administration in a health care setting often falls into the buy-and-bill method of paying under the medical budget; this allows providers to add a percentage of the product’s cost onto the reimbursement, in addition to charging fees for providing services incident to the product. Regardless of where patients receive treatment, specialty pharmacists need to heighten their vigilance at transitions of care.

Ms Clarke stressed that for IV administration, patients need adequate venous access and clinicians need to monitor for infections in the port as well as in immunocompromised patients. For SC administration, patients need to have adequate SC tissue and be able to manipulate the syringe. Clinicians should assess the likelihood that the patient will adhere to treatment.

In summary, Ms Clarke reviewed key points. She came back to the session’s primary message: Appropriate use and accurate dosing of IVIG and SCIG for the treatment of CIDP are complicated and require meticulous risk assessment. Comorbidities, age, and the patient’s previous experience are considerations, as are premedication needs. Product selection must consider sodium and sugar content, pH, osmolarity, and concentration. There are also various means of administration, ancillary supplies, and possible challenges. Home care models differ, too, as do inpatient policies. Specialty pharmacists need to be aware of differences in approaches to care, identify steps in processes that create risk, and ensure that everyone is on the same page.

Articles

Debilitating and degenerative, chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disease affecting 1.6 per 100,000 Americans annually.

Appropriate Use of Immunoglobulin in Managing Chronic Inflammatory Demyelinating Polyneuropathy

Itching, burning, and stinging are hallmark symptoms of psoriasis, an immunemediated disease that causes red scaly patches on the skin. Raised and uncomfortable, these patches generally appear on the outside of the elbows, knees, or scalp but can cause more extensive dermal involvement. In about 30% of individuals who develop psoriasis, clinicians will diagnose psoriatic arthritis. Like psoriasis, psoriatic arthritis is chronic, but it inflames the joints and locations where tendons and ligaments connect to bone. It is associated with swelling, pain, fatigue, and joint stiffness, which interfere with activities of daily living.

At the recent National Association of Specialty Pharmacy Annual Meeting and Expo in Washington, DC, Jamie McConaha, PharmD, NCTTB, BCACP, CDE, associate professor of pharmacy practice at Duquesne University Mylan School of Pharmacy, and April Jones, PharmD, CSP, clinical specialty pharmacist at Vanderbilt University Medical Center, engaged specialty pharmacists in a concise but thorough presentation on these 2 diseases.

Dr McConaha noted that approximately 2% of Americans have psoriasis. It is bimodal in its onset, peaking at around 20 to 30 years of age, with the second onset peak after age 50 and before age 60 years. In the majority of patients, psoriasis precedes psoriatic arthritis, but other times both occur simultaneously or psoriatic arthritis precedes skin psoriasis. She emphasized that every time a patient who has psoriasis is seen by a health care provider, screening for psoriatic arthritis is essential.

In addition to covering the classification system used by most clinicians, she covered nail manifestations (pitting, distal onycholysis, and yellow-brown dyschromia) that are common, presenting in 50% of patients who have psoriasis and in more than 80% of patients who have psoriatic arthritis. Of great interest to the audience was her discussion of medical comorbidities. These patients are prone to develop metabolic syndrome, cardiovascular disease, and Crohn disease.

In discussing treatment options, Dr McConaha emphasized that ignoring the psychosocial aspects of psoriasis and psoriatic arthritis is akin to ignoring an elephant in the room. Health care providers need to assess patients for anxiety and depression precipitated by embarrassment and lack of self-esteem.

Treatment goals established for patients with psoriatic disease include reduction of pain, improvement of all signs and symptoms, optimization of functional capacity and quality of life, and inhibition of joint damage progression. Traditionally, a limited number of medications have been available, but recently, several biologics have been developed that inhibit interleukin (IL)-17 or IL-12/23. Among the former are secukinumab, ixekizumab, and brodalumab; in the latter group are ustekinumab, tildrakizumab, guselkumab, and risankizumab. After reviewing the data supporting efficacy, she noted that all interleukin blockers have some safety concerns, including risk of serious infection, reactivation of tuberculosis, exacerbation of inflammatory bowel disease, and hypersensitivity. She also warned against administering live vaccines to patients using these medications.

Finally, Dr McConaha reminded participants that it’s impossible to determine if the patient is responding to these biologics until they have been on treatment for at least 12 weeks. She also noted that patients considered obese or overweight may require higher doses. In addition, patients in whom one agent failed to produce a response may respond to another, and patient preference is an important consideration when selecting an agent.

Dr Jones then took the lectern to discuss the economics of psoriatic disease. As a lifelong, chronic condition, it can be costly. People who have psoriasis or psoriatic arthritis spend approximately $27,123 in annual medical costs compared with $5301 in people who do not have these diseases.

Early, accurate diagnosis following established guidelines can reduce the direct costs (emergency department visits or hospitalization, lab work and imaging, medication, and doctor visits) and indirect costs (absenteeism and presenteeism, poor quality of life). She compared costs associated with biologics with costs with conventional disease-modifying drugs, demonstrating that patients find biologics effective and are more likely to adhere to them, which may justify their cost.

Dr Jones summarized the specialty pharmacist’s role. In addition to drug procurement and Risk Evaluation and Mitigation Strategy (REMS) program management, initial counseling, and ongoing clinical monitoring, pharmacists need to be involved in vaccine management. Promotion of medication adherence is also a primary domain for specialty pharmacists. One of the biologics, brodalumab, currently includes a REMS program. It has a black box warning in its labeling because it has been associated with suicidal ideation and behavior.

Of particular interest was Dr Jones’s discussion of special circumstances. She reminded participants that patients who are experiencing bacterial, fungal, or viral illnesses should stop biologic therapy and resume it only when they have been feverfree, symptom-free, and treatment-free for at least 24 hours. These biologics also need to be halted 2 to 4 weeks before surgery if the patient is on an injectable and 1 to 2 days before if the patient is on oral medication. Therapy can resume based on surgical outcomes and after sufficient wound healing.

Overall, this session gave an in-depth review of the biologics now available for psoriasis and psoriatic arthritis. Both session speakers emphasized that these medications have the potential to help patients achieve clear or almost clear skin and prevent progression of psoriatic arthritis.

At the recent National Association of Specialty Pharmacy Annual Meeting and Expo in Washington, DC, Jamie McConaha, PharmD, NCTTB, BCACP, CDE, associate professor of pharmacy practice at Duquesne University Mylan School of Pharmacy, and April Jones, PharmD, CSP, clinical specialty pharmacist at Vanderbilt University Medical Center, engaged specialty pharmacists in a concise but thorough presentation on psoriasis and psoriatic arthritis. 

Biologics Expand Treatment Options in Psoriatic Disease

Atopic dermatitis (AD), often referred to as eczema, occurs in a range of severities. Even in its mildest form, it can be annoying and intrusive. In its moderate to severe form, AD can be life-changing. Symptoms include sore, itchy, and painful skin, which can cause patients to experience sleep disturbances, withdraw from social activities, and miss school and work. Among the approximately 15% to 30% of infants and children who develop AD, about 20% will continue to experience symptoms through adolescence. Adolescents have unique concerns and adherence issues, and that was the topic of a presentation given by Steven A. Scott, PharmD, associate professor of pharmacy practice at Purdue University College of Pharmacy, and Cari W. Pao, PharmD, MSHCM, MBA, senior clinical director of health outcomes, at the recent National Association of Specialty Pharmacy Annual Meeting and Expo in Washington, DC.

Dr Scott reminded reminded audience participants that AD is part of a triad of atopic diseases. Many adolescents who have AD will also have asthma and allergic rhinitis. Researchers have identified a genetic predisposition, but there are numerous AD triggers. Environmental irritants and allergens can cause or contribute to AD, and harsh soaps and detergents are particularly irritating. A variety of inflammatory mediators including interleukin (IL)-4, IL-5, and IL-13 have been implicated in the pathogenesis of AD, too.

The presentation of AD in adolescents is somewhat different than in infants and children. The face, neck, and cheeks are less prominent sites of inflammation, and the flexor surfaces of the arms and legs are much more likely to be involved. By the time individuals have had AD for several years, they experience excoriation and lichenification from chronic scratching. Dr Scott noted another significant change between AD in children and AD in adolescents and adults: When AD continues into adolescence and beyond, the likelihood that it will be moderate or severe increases.

Dr Scott indicated that adolescents face unique quality-of-life issues. Often, they deal with significant social pressures and body image concerns. Sleep disruptions, stress and anxiety, and activity impairment are particularly difficult for teens. He stressed that it is critical to use a stepwise approach to management of AD, with the basis of the approach being consistent use of emollients.

The most important treatment outcome for adolescents with AD is symptomatic relief to control itching. Once itching is under control, patients want skin lesions to heal. Therefore, the treatment team needs to remind patients that they must avoid or minimize triggers to prevent future exacerbations. These goals are best accomplished with, again, emollients; topical corticosteroids; and, sometimes, one of the several topical corticosteroid alternatives. Options include calcineurin inhibitors and crisaborole.

In patients for whom these options do not work or those with more severe illness, clinicians will consider phototherapy, oral systemic drugs, and injectable biologics. Systemic agents (azathioprine, apremilast, cyclosporine, methotrexate, and mycophenolate mofetil) present some risk of potential adverse drug reactions and require frequent monitoring. None of these has FDA approval for AD, and at this time, the FDA has approved only 1 biologic, dupilumab. Dr Scott reviewed its mechanism of action, which is IL-4 and IL-13 directed. Dupilumab is indicated in the adolescent population (patients must be at least 12 years of age), and it can be used as add-on maintenance treatment. It is also approved for moderate to severe asthma and chronic rhinosinusitis with nasal polyps. Dr Scott noted that the newer agents, although more costly, have also been associated with fewer adverse effects and less frequent monitoring than the older, systemic drugs.

Dr Pao led the second half of the presentation with a discussion on the economic impact of AD, indicating that its incidence has increased 2- to 3-fold in industrial nations over the past few decades. She underscored that it is critical to talk to patients about AD because it is largely underdiagnosed in adolescents and adults. In her dissection of the various cost contributors to AD, Dr Pao discussed the indirect costs related to lost workdays, sick days, and loss of productivity. She covered a study by the National Health Interview Survey that found that people with AD have out-of-pocket costs between $371 and $489 higher than individuals who do not have AD. This condition is more costly than diabetes or hypertension, as patients must absorb costs related to office visits, prescription medications, and OTC skin care products. In addition, these patients are more likely to be hospitalized than patients with psoriasis.

Patients face numerous barriers related to medication access and pharmacists are critical to help overcome these. Dr Pao indicated that most payers cover biologics if clinicians follow step therapy, but they do limit dupilumab’s use to individuals with moderate to severe AD. The typical records required for dupilumab therapy are documentation of a 4-week trial of a moderate to high potency topical corticosteroid followed by 6 weeks using an alternative agent. She stressed that it’s critical to document intolerance, inadequate response, or a contraindication to these therapies.

Dr Pao rounded out the session by discussing the pharmacist’s responsibilities in this disease. She encouraged pharmacists to discuss drug treatments and adverse effects thoroughly with patients and review how to take, apply, or inject medications. When dispensing topicals, pharmacists should ensure the proper amount of tubes are dispensed for the intended body surface. She stressed that patients need to know what to do if they miss a dose, and be familiar with storage and stability requirements, especially with the biologics. Finally, pharmacists need to ensure that patients are aware that the bathing and cleansing routines recommended early in the course of their disease need to be followed throughout life and that chronic use of emollients is a necessity.

Adolescents with atopic dermatitis have unique concerns and adherence issues.

Atopic Dermatitis: Sleep Disruptions, Stress, Anxiety, and Activity Impairment Are Difficult for Adolescents

Allergic contact dermatitis (ACD) affects more than 14 million people in the United States with an estimated economic burden of $3 billion per year.

The American Contact Dermatitis Society (ACDS) designates an Allergen of the Year annually to promote public awareness of the nominated allergen. The chosen allergen usually has the most significant clinical effects, is underrecognized, has a novel cause of ACD, or has become obsolete.

For 2019, the ACDS flipped its approach and selected parabens as the “Nonallergen” of the Year. The choice, announced in 2018, was made to clear some of the misconceptions about parabens among consumers and to increase awareness of the low rate of associated ACD .

The 4 most common parabens used are methylparaben, ethylparaben, propylparaben and butylparaben. Parabens are commonly used as preservatives in cosmetics, dermatological topical preparations, oral and parenteral medications, and in food products.

In the United States, parabens are allowed in cosmetics at concentrations up to 0.4% used alone; up to 0.8% when used as combination parabens; in medications at no more than 0.1%; and in food products at 0-10mg/kg of body weight. Parabens are metabolized to a water-soluble metabolite 4-hydroxybenzoic acid and eliminated in the urine. They have excellent coverage against fungi and gram-positive bacteria. Parabens are chemically inert, have no odor or taste and have high stability making it an ideal preservative.

Paraben use is not without controversy. Parabens have been reported on for unsubstantiated claims of endocrine disruption and an alleged association with breast cancer. Parabens have a chemical structure similar to estrogen and theoretically, they can mimic its effects. Data showing estrogenic effects of parabens are confined to 

 studies have shown that parabens’ estrogenic potency is very weak. Parabens are 10,000-fold less potent than 17β-estradiol9—the major female steroid hormone&mdash;and has a maximum potency of 1/4000 that of estrogen.

The controversy regarding parabens and breast cancer has been fueled by the presence of parabens in human breast tumors, but parabens are widely used and present in several tissues. There are no studies that demonstrate that parabens cause harmful effects in humans. Based on available scientific data, the FDA has classified parabens as “generally regarded as safe” since the 1970s.

Retail health care providers are likely to field questions regarding paraben use and its safety. They have to remind patients that parabens are noncarcinogenic, nontoxic, used in low concentrations in cosmetics, excreted in the urine, and do not accumulate in the body. Patients must be made aware that “natural” does not always mean safe.

Without the use of preservatives, cosmetics, pharmaceuticals and food products can become contaminated with mold bacteria and fungi and increase risk of infections. Parabens have a low rate of associated ACD at 0.6% positive reaction rate when patch testing with 12% paraben mix.

Fransway AF, Fransway PJ, Belsito DV, et al. Parabens. 

. 2019;30(1):3-31. doi:10.1097/DER.0000000000000429

Parabens are commonly used as preservatives in cosmetics, dermatological topical preparations, oral and parenteral medications, and in food products.

When is an Allergen Not an Allergen? Combating Misinformation about Parabens

Irritable bowel syndrome (IBS) is a chronic, relapsing functional gastrointestinal (GI) disorder.

 Patients who develop IBS report abdominal pain and altered bowel habits (

 with no identifiable cause. Patients may report a predominance of diarrhea (IBS-D) or constipation (IBS-C), but both may occur in an individual patient. Some patients report only abdominal pain and bloating (IBS-PB).

 IBS prevalence (all types) is estimated at 10% to 20% of the US population and at any time, up to 2% of the population experiences active symptoms.

 Women are up to 3 times more likely to develop IBS than men in the United States, and those with the condition are at increased risk of ectopic pregnancy and miscarriage.

 Many adult patients report that they have experienced symptoms since childhood. Onset before 35 years of age is common.

The etiology of IBS has not yet been identified. Examination of the large and small bowels has revealed altered GI motility. This delays meal transit in patients who report constipation but accelerates transport in patients who report diarrhea. Patients with IBS also have visceral hyperalgesia. Microscopically, some bacterial overgrowth and microscopic inflammation has been identified in patients who have IBS.

In addition, IBS is associated with psychopathology. Patients with IBS tend to have a higher incidence of anxiety disorder, catastrophizing, major depression, panic disorder, and somatoform disorders than the general population.

 A major concern in patients with IBS is suicidal attempts or ideation.

 Clinicians should heighten awareness around this risk.

Patients need to know 2 things: Symptoms tend to be chronic and exacerbate from time to time, and individuals need to avoid stressors and triggers.

 Patients with IBS need 3 types of support.

First, they need support to address the common psychological comorbidities. Cognitive behavioral therapy and judicious use of antidepressants may reduce symptoms or strengthen coping skills.

Second, they need advice about dietary measures that can ameliorate or prevent symptoms. Fiber supplementation can improve constipation and diarrhea, but it may cause bloating or distention. Clinicians should note that a Cochrane systematic review of bulking agents and fiber in IBS found that these medications had no benefit.

Regardless, many patients report improvement.

Third, additional dietary recommendations include staying adequately hydrated, limiting fermentable oligo-, di-, and monosaccharides and polyols, and supplementing calcium for patients who avoid lactose entirely.

Pharmacologic treatment is considered adjunct to lifestyle management and must be symptom directed.

 Clinicians can choose among anticholinergics, antidiarrheals, bulk-forming laxatives, chloride channel activators, guanylate cyclase C agonists, prokinetics, serotonin receptor antagonists, and tricyclic antidepressants. The choice of the drug(s) used depends on the patient’s symptoms, preference, and previous responses.

 shows the typical approach to treatment; note that the stepwise approach is deceptively simple, and no comparative effectiveness studies support its structure.

 For many patients, it will take time and trial and error to find the most successful strategy.

In the past several years, the FDA has approved many agents to treat IBS. 

With recent developments, the likelihood of successful treatment for patients with any type of IBS is greater than ever before. Pharmacists need to take note of specific indications, the most common adverse reactions, and potential drug interactions. Given time and trial of multiple interventions, most patients will learn to live successfully with IBS and control its exacerbations.

Jeannette Y. Wick, RPh, MBA, FASCP, is assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

Definition and facts for irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts. Published November 2017. Accessed April 2, 2017.

Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. 

. 2017;15(1):35. doi: 10.1186/s12955-017-0611-2.

Ballou S, Keefer L. The impact of irritable bowel syndrome on daily functioning: characterizing and understanding daily consequences of IBS. 

Khashan AS, Quigley EM, McNamee R, McCarthy FP, Shanahan F, Kenny LC. Increased risk of miscarriage and ectopic pregnancy among women with irritable bowel syndrome. 

. 2012;10(8):902-909. doi: 10.1016/j.cgh.2012.02.014.

Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S; American Gastroenterological Association. American Gastroenterological Association Institute Guideline on the pharmacological management of irritable bowel syndrome. 

. 2014;147(5):1146-1148. doi: 10.1053/j.gastro.2014.09.001. 

Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. 

. 2006;131(4):1003-1010. doi: 10.1053/j.gastro.2006.07.015.

Chumpitazi BP, Weidler EM, Lu DY, Tsai CM, Shulman RJ. Self-perceived food intolerances are common and associated with clinical severity in childhood irritable bowel syndrome. 

. 2016;116(9):1458-1464. doi: 10.1016/j.jand.2016.04.017.

Symptoms and causes of irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes. Published November 2017. Accessed April 2, 2017.

Sherwin LB, Leary E, Henderson WA. The association of catastrophizing with quality-of-life outcomes in patients with irritable bowel syndrome. 

. 26(8):2161-2170. doi: 10.1007/s11136-017-1554-0. 

Ballou S, Bedell A, Keefer L. Psychosocial impact of irritable bowel syndrome: a brief review. 

. 2015;6(4):120-123. doi: 10.4291/wjgp.v6.i4.120.

Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. 

. 2011;(8):CD003460. doi: 10.1002/14651858.CD003460.pub3.

Gibson PR. Use of the low-FODMAP diet in inflammatory bowel disease. 

. 2017;32(suppl 1):40-42. doi: 10.1111/jgh.13695.

Miheller P, Gesztes W, Lakatos PL. Manipulating bone disease in inflammatory bowel disease patients. 

Kuritzky L. Hot topics in primary care: individualizing pharmacologic management of irritable bowel syndrome. 

Xifaxan [prescribing information]. Bridgewater, NJ: Salix Pharmaceuticals Inc; 2004. www.accessdata.fda.gov/drugsatfda_docs/label/2010/022554lbl.pdf. Accessed May 25, 2018.

Viberzi [prescribing information]. Madison, NJ: Allergan USA Inc; 2018. allergan.com/assets/pdf/viberzi_pi. Accessed May 25, 2018.

Linzess [prescribing information]. Irvine, CA: Allergan USA Inc; 2017. allergan.com/assets/pdf/linzess_pi. Accessed May 25, 2018.

Amitiza [prescribing information]. Deerfield, IL: Takeda Pharmaceuticals America Inc; 2006. general.takedapharm.com/amitizapi. Accessed May 25, 2018.

Lotronex [prescribing information]. Roswell, GA: Sebela Pharmaceuticals Inc; 2016. lotronex.com/hcp/. Accessed May 25, 2018.

Zheng Y, Yu T, Tang Y, et al. Efficacy and safety of 5-hydroxytryptamine 3 receptor antagonists in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. 

. 2017;12(3):e0172846. doi: 10.1371/journal.pone.0172846.

Irritable bowel syndrome is a chronic, relapsing functional gastrointestinal disorder.

Irritable Bowel Syndrome: Newer Drugs Provide Relief

Sixty-seven million at-risk Americans remain unvaccinated for pneumococcal disease. More than one-half of individuals who develop pneumococcal disease in the United States are unvaccinated adults. Pharmacists in Rhode Island set out to raise awareness of the pneumococcal vaccination using a statewide pharmacist-led initiative.

In a state that had higher rates of invasive pneumococcal disease than the regional and national average, pharmacists created an educational campaign to increase knowledge and awareness of pneumococcal immunization recommendations.

The researchers conducted their statewide study—published in the 

Journal of the American Pharmacists Association

—by creating an up-to date vaccination pathway guide. This pathway guide helped providers increase their knowledge about patient populations for which the Advisory Committee on Immunization Practices recommends the vaccines.

In addition to increasing provider knowledge, the researchers conducted public education campaigns by:

placing public service announcements were made on radio stations

conducting participation and outreach at public health events

creating pneumococcal vaccination patient handouts for patients, and

 making wallet-sized cards for patients that record vaccination status for multiple immunizations and important medical information.

Now it all boils down to whether this multifaceted intervention approach works for immunizations. And the short answer is yes!

Researchers saw a significant increase in vaccinations (3.9%), a 5% decrease in patient mortality in the hospital, and an overall decrease in the number of pneumococcal cases. Before the study was conducted, Rhode Island had about 20 more cases of invasive pneumococcal disease than the national average. Post-intervention, the number of cases was at a similar rate.

What can pharmacists do to mitigate the large disparity in vaccination rates? Follow Rhode Island's lead. Pharmacists need to raise disease awareness. Face-to-face education for prescribers is critical. Pharmacists must also create and distribute patient resources broadly, emphasizing the danger of being unvaccinated and who should receive a vaccine.

Active outreach makes our communities safe.

Caffrey AR, DeAngelis JM, Ward KE, et al; Rhode Island Pharmacy Pneumococcal Vaccination Education Group. A pharmacist-driven academic detailing program to increase adult pneumococcal vaccination

 (2003). 2017 Sep 23. pii: S1544-3191(17)30838-5. doi: 10.1016/j.japh.2017.08.010. [Epub ahead of print]

Sixty-seven million at-risk Americans remain unvaccinated for pneumococcal disease