Pharmacist TOC Service Closes Adult Vaccine Gaps in Safety-Net Hospital

Most adults admitted to a safety-net hospital and referred to a pharmacist-directed transitions of care (PharmTOC) consult service were not up to date on recommended vaccinations—including pneumococcal vaccination—according to a study published in the Journal of the American Pharmacists Association. The findings suggest that building vaccine screening directly into inpatient pharmacy workflows can identify gaps that might otherwise go unaddressed until, or beyond, discharge.¹

Vaccination Gaps Were the Norm, Not the Exception

Investigators evaluated 147 adult patients referred to the PharmTOC service, incorporating a review of influenza, pneumococcal, and COVID-19 vaccination status into the standard workflow. Just 17.0% of patients were up to date on all eligible vaccinations at the time of the pharmacist review. Pharmacists also collected social determinants of health (SDoH) data on all patients and interviewed those who were not up to date to understand their reasons for vaccine hesitancy.¹

Pneumococcal disease remains a substantial burden in adults, particularly those aged 65 years and older, and inpatient encounters represent an opportunity to close gaps that community-based screening alone may miss.^2,3

Most Patients Accepted Vaccination When Offered

Of the 118 patients offered vaccination based on identified gaps, 79 (66.9%) accepted at least 1 recommended vaccine, and 68 (57.6%) accepted every vaccine recommended to them. Among those who assented, 46 (58.2%) received at least 1 vaccine prior to discharge, meaning pharmacists were able to close a meaningful share of gaps within the same hospitalization rather than relying on a future outpatient visit.¹

Lack of confidence in vaccines was the most frequently cited reason for declining, and pharmacist-delivered education was associated with a modest reduction in documented vaccine hesitancy. On multivariable logistic regression, male sex and younger age were independently associated with vaccine noncompliance, pointing to specific subgroups where counseling may need to be more targeted or repeated.¹

What This Means for Pharmacists Building Vaccine Screening Into Practice

The results reinforce that adult vaccination gaps, including for pneumococcal disease, are common and often go unaddressed until a patient is already unwell enough to be hospitalized. Pharmacists in health-system and transitions-of-care roles are well positioned to layer vaccine assessment onto existing consult workflows without waiting for a separate immunization visit. That means that checking pneumococcal vaccination status alongside other routine medication reconciliation tasks, using age- and risk-based criteria to flag eligible patients, and being ready to address specific, common objections—chiefly confidence in vaccine safety and effectiveness—rather than treating hesitancy as a dead end.^1-3

Because current pneumococcal vaccine recommendations differ based on a patient’s prior vaccination history and risk factors, accurate documentation and a brief, structured hesitancy conversation, as this PharmTOC model demonstrates, can meaningfully move patients from unvaccinated to vaccinated before they ever leave the building.^1,2

REFERENCES

1. Cavaretta M, Abouelela R, Ferraro N, Wagner J, Gallagher J. Closing adult vaccination gaps through a pharmacist-directed transitions of care service in a safety-net hospital. J Am Pharm Assoc. 2026;103515. doi:10.1016/j.japh.2026.103516

2. Nissim Y, Adkins KM, Chahine EB. Adult pneumococcal immunizations: a practical guide for pharmacists. Pharmacy Times. September 15, 2026. Accessed September 18, 2026. https://www.pharmacytimes.com/view/adult-pneumococcal-immunizations-a-practical-guide-for-pharmacists

3. Grijalva CG, Halpern L. Q&A: understanding pneumococcal disease burden and vaccine opportunities. Pharmacy Times. April 17, 2026. Accessed September 18, 2026. https://www.pharmacytimes.com/view/q-a-understanding-pneumococcal-disease-burden-and-vaccine-opportunities