Our pharmacist team at Osterhaus Pharmacy has been providing immunizations to our patients for the past 2 decades. However, in the past 3 years we have become more proactive in our approach to discussing immunizations. Today, when patients come to pick up their prescriptions, we print out a vaccination history and forecast and include it with their medications. This information is generated from our state’s immunization information system (IIS); similar systems are available in all 50 states. The vaccination history and forecast print-out help facilitate a discussion about immunizations. Previously, we would simply initiate a conversation without this patient-specific information, but what we quickly learned is that most patients will report they are up-to-date with their immunizations when they are not.

Compared with childhood vaccination rates, adult vaccination rates are lower and considerably below the goals of Healthy People 2020. A review of the data shows that only the herpes zoster vaccination rate for adults 60 years of age and older exceeded its target (30%), with a rate of 30.6%. Most other vaccination rates fall well below the goals. For example, fewer than 45% of adults received the annual influenza vaccine, yet the Healthy People 2020 goal is 70%.1,2

Numerous studies have shown the positive impact a pharmacist can have on improving adult immunization rates.3,4 As community pharmacists, we are among the most accessible health care providers; 93% of patients live within 5 miles of a community pharmacy.5 Therefore, we are well positioned to continue to make an impact on vaccination rates if we initiate conversations with our patients and help them develop an action plan to become fully immunized.

The Pharmacy Quality Alliance Adult Immunization Task Force advises that “all health care providers should assess adult patients for their immunization status at every patient encounter. Therefore, every health care provider, including pharmacists, carries the responsibility to screen patients in an effort to increase vaccination rates and to improve overall health.”6

We have the opportunity to empower patients to take a proactive role in their health care through immunization awareness. As pharmacists, we can incorporate a review of immunization history into our patient care process. We can also facilitate education about the need for the vaccine and the risks each disease may carry. In addition, we can encourage our patients to carry their immunization record with them, just as they would a medication list. The Immunization Action Coalition is a readily accessible website with a multitude of resources including a downloadable history form.7 Additionally, phone apps such as My Immunizations App and MyIR are available to assist with patient record-keeping. Some states allow patient access to their IIS.

Despite the benefits of the IIS, pharmacists need to be aware of its limitations. First and foremost, not all health care professionals are required to enter immunizations into the system, and so the information may not be fully up-to-date. This creates a need to coordinate immunization information among the patient, the pharmacy, and other health care providers to produce an accurate immunization history. Furthermore, most systems forecast age-related immunization schedules and neglect conditions such as pregnancy or chronic disease (ie, asthma, diabetes) recommendations. Additionally, when new recommendations are released from the CDC’s Advisory Committee on Immunization Practices (ACIP), there may be lag time before the IIS is updated. Therefore, it is important for pharmacists to keep up with current CDC and ACIP guidelines and schedules. These schedules are available by the CDC online at cdc.gov/vaccines/schedules/hcp/imz/adult.html. Being prepared with information about the effectiveness of a particular vaccination and potential patient risk can be beneficial when discussing indicated vaccinations with patients who are hesitant to vaccinate.

What’s the best approach to getting started? It’s 1 patient, 1 conversation at a time.

Gain access to your state’s IIS in order to have your patient’s immunization history readily available. Assessing the immunization history should be part of your patient care process, regardless of whether or not your pharmacy administers vaccinations. Review your pharmacy’s workflow process to incorporate this assessment. Below is a step-by-step guide.

Step 1: Begin with patients who request a vaccination. Assess their history to discuss any past due or additional vaccinations indicated for the patient. Assist the patient in updating their immunization record or provide a printout from IIS.

Step 2: Expand to include immunization assessment as part of medication therapy management (MTM) services. This should be completed for patients involved in MTM-based platforms, appointment-based model programs, and medication sync programs. Print out their vaccination forecast to have it available when the patient picks up their medications, noting past due or upcoming vaccinations.

Step 3: Make assessing immunization histories part of your dispensing workflow. Look at high-risk patients, ie, those who smoke, are 65 years or older, or have chronic conditions. Think critically about the information provided by the IIS. Use this as a starting point, in combination with the patient’s medication profile, to determine which vaccinations are recommended.

Documentation of immunizations by all health care professionals in any setting is key. When we have access to up-to-date immunization histories, we can make better recommendations and avoid unnecessary vaccinations. Educating patients about the importance of having their immunization history accessible electronically or via wallet card helps provide accurate information. Document historical immunizations if your state’s IIS offers the ability to do so.

At Osterhaus Pharmacy, we encourage our patients to request that their health care providers enter their vaccinations in the IIS. In addition, we utilize the electronic patient chart within our dispensing system to document patient interactions, which allows continuity of care among our pharmacy team members. The chart includes patient responses to immunization inquiries, highlights opportunities to educate patients at future encounters, and creates scheduling reminders for upcoming vaccinations.

An estimated 40,000 to 50,000 adults die annually from vaccine-preventable diseases in the United States.8 Treating patients who are not properly vaccinated give rise to health care costs of $10 billion annually.9 Pharmacists are obligated to improve outcomes and reduce health care costs by discussing with patients their immunization history, encouraging patients to keep an up-to-date immunization record, and helping them make informed decisions about available immunizations. Remember: 1 patient, 1 conversation at a time.
 
Tammy S. Bullock, PharmD, BCACP, is the clinical pharmacy coordinator at Osterhaus Pharmacy in Maquoketa, Iowa.

Matthew C. Osterhaus, BSPharm, is co-owner of Osterhaus Pharmacy in Maquoketa, Iowa.


REFERENCES
  1. Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations — United States, 2015. MMWR Surveill Summ. 2017;66(11):1-28. doi: 10.15585/mmwr.ss6611a1.
  2. Tanzi MG. Adult vaccination rates show modest, but far from optimal, gains. Pharm Today. 2017;23(8):43. pharmacytoday.org/article/S1042-0991(17)31108- 8/fulltext?rss=yes. Accessed October 17, 2018.
  3. Patel AR, Breck AB, Law MR. The impact of pharmacy-based immunization services on the likelihood of immunization in the United States. J Am Pharm Assoc (2003). 2018;58(5):505-514.e2. doi: 10.1016/j.japh.2018.05.011.
  4. Baroy J, Chung D, Frisch R, Apgar D, Slack MK. The impact of pharmacist immunization programs on adult immunization rates: a systematic review and meta-analysis. J Am Pharm Assoc (2003). 2016;56(4):418-426. doi: 10.1016/j. japh.2016.03.006.
  5. NACDS 2010-2011 Chain Pharmacy Industry Profile illustrates pharmacy value. Drug Topics website. https://www.drugtopics.com/top-news/nacds-2010-2011-chain-pharmacy-industry-profile-illustrates-pharmacy-value. Published September 21, 2010. Accessed July 23, 2019.
  6. Pharmacy Quality Alliance Adult Immunization Task Force. Recommendations for improving adult vaccination rates and reporting within community pharmacy practice. Pharmacy Quality Alliance website. pqaalliance.org/ assets/library/White%20Paper%20-%20Adult%20Immunization%20Recommendations_FINAL_09_28_2016.pdf. Published September 2016. Accessed July 16, 2019.
  7. Clinic tools: documenting vaccinations. Immunization Action Coalition website. immunize.org/clinic/documenting-vaccination.asp. Updated March 16, 2018. Accessed July 16, 2019.
  8. Levi J, Schaffner W, Cimons M, Guidos R, Segal LM; Trust for America’s Health, Infectious Disease Society of America (IDSA), Robert Wood Johnson Foundation. Adult Immunization: Shots to Save Lives [issue brief]. Washington DC: Trust for America’s Health; 2010. [Healthy Americans website. www.tfah.org/report-details/adult-immunization-shots-to-save-lives/. Published February 2010. Accessed July 16, 2019.
  9. US Department of Health and Human Services (DHHS) National Vaccine Advisory Committee. Report of The Workgroup on Adult Immunization: The Action Plan. National Vaccine Program Office website. hhs.gov/nvpo/nvac/ adult4.html. Reviewed March 28, 2016. Accessed July 16, 2019.