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Medscape Pharmacists

MEDLINE Abstracts
Pharmacists as Immunization Providers

What's the latest in the role of pharmacists as immunization providers? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Pharmacists. [Medscape Pharmacists, 2001]

Pharmacy Immunization Partnerships: A Rural Model

Rosenbluth SA, Madhavan SS, Borker RD, et al
J Am Pharm Assoc. 2001; 41:100-7

Objectives: To describe the Pharmacy Immunization Project, a pharmacy/county health department (CHD) partnership model for immunizing infants and adults in rural areas, and to develop service procedures and disseminate lessons learned for adapting the model to different settings.
Setting: Independent community pharmacies in five contiguous rural counties in West Virginia.
Practice Description: Participating pharmacies varied markedly in space, prescription volume, and population of service areas.
Practice Innovation: Childhood and adult immunization service.
Interventions: Pharmacists partnered with nurses from CHDs to offer year-round immunizations at times when other providers were typically closed. Working under standing orders of the CHD medical directors, nurses also conducted routine well-baby examinations in the pharmacy. Promotions involved direct mailing, posters, fliers, direct communication, and ads in newspapers, radio, and TV.
Main Outcome Measures: Pharmacists' and CHDs' continued willingness to participate, use of the service by local citizens, and feedback from participants and other health care providers and the West Virginia Immunization Program (WVIP).
Results: All sites except one continued their participation through the life of the project. The one exception was a pharmacy with few infant patients, which discontinued participation during year 4 of the project. Remaining sites were used and well accepted by the community. The WVIP remains a loyal supporter, and no problems arose with local health care providers.
Conclusion: The model appears adaptable to urban as well as rural practice and to chain as well as independent practice in states not authorizing pharmacists to administer vaccines, for pharmacists who for other reasons prefer not to administer, and for those who prefer to offer adult immunization on a seasonal basis. From the CHD perspective, the partnership model is useful in establishing "satellite" locations to target hard-to-reach patients. Recommendations regarding agreements and responsibilities are available, as are lessons learned during project development.

Pharmacists and Immunizations: A National Survey

Madhavan SS, Rosenbluth SA, Amonkar M, et al
J Am Pharm Assoc. 2001; 41:32-45

Objectives: To obtain information about pharmacists' current involvement in and willingness to provide immunization services, and to assess perceived barriers to providing immunization services.
Design: Cross-sectional mail survey.
Setting: National.
Patients Or Other Participants: Random sample of 5,342 pharmacists from chain, independent, mass merchandiser/grocery, primary care clinic, and health maintenance organization settings.
Interventions: None.
Main Outcome Measures: Responses to survey on pharmacy-based immunization services--current involvement, willingness to get involved, perceived obstacles, and patients' interest.
Results: Three mailings yielded a response rate of 25.3% (1,348 responses). Only 53.1% of respondents knew correctly whether their state allowed pharmacists to administer immunizations. Although a significant number of pharmacists were involved in immunization activities, such as counseling and promotion, only 2.2% and 0.9% of respondents were involved in actual administration of adult and childhood immunizations, respectively. In general, men, independents, owners/partners, and pharmacists who had attended immunization-related educational programs were more willing to provide immunization services than were women, chain and staff pharmacists, and educational program nonattendees. Pharmacists who had attended immunization-related educational programs also perceived pharmacist- and patient-related factors as less problematic for pharmacy-based immunization services than did nonattendees.
Conclusion: This survey provides a baseline measure of the nature and extent of pharmacist involvement in immunizations that can be used now and in future years. The profession can use the findings on pharmacists' willingness to provide immunization services and their perception of obstacles to such services as a basis for targeted educational and promotional programs and materials.

Patients' Acceptance of Traditional and Nontraditional Immunization Providers

Ernst ME, Bergus GR, Sorofman BA
J Am Pharm Assoc. 2001; 41:53-9

Objective: To examine patients' acceptance and reported use of traditional and nontraditional immunization providers and settings.
Design: Survey.
Setting: Stratified sample of private family physician clinics, family medicine residency training programs, community pharmacies that provide immunizations under standing order protocols, and nonimmunizing community pharmacies, all located in Iowa.
Patients Or Other Participants: Individuals presenting for medical care or pharmacy services.
Interventions: Not applicable.
Main Outcome Measures: Sources of past immunizations, 'access to immunizations, importance of immunization records, and future use of different health care providers and settings for immunizations. Univariate and multivariate analyses were performed to examine the relationships between patient demographics and recruitment site on the question responses.
Results: 420 surveys were returned (67% response rate). Respondents frequently received immunizations at sites other than physician offices. Younger patients and those living in smaller towns were more likely to report receiving an immunization from a nonphysician. Patients recruited in immunizing pharmacies more often reported previous immunization by a pharmacist (P < .001), most often for influenza. Respondents often reported that it was more convenient to receive an immunization outside a physician office. Greater support was noted for receiving adult immunizations from nonphysicians and in nontraditional settings, whereas traditional settings and providers (physician offices, community health departments) were preferred for childhood immunizations.
Conclusion: Iowans report accessing different health care providers and settings for their routine immunizations. In general, they are more likely to support using traditional immunization providers and settings for childhood immunizations but are less exclusive about where they receive adult immunizations. Pharmacists should consider focusing initial efforts on administering adult immunizations, due to greater patient acceptance of nontraditional immunizers for adult immunizations.

Building a Year-Round Immunization Program

Goode JV, Marquess JG, Crawford S
J Am Pharm Assoc. 2000; 40(5 Suppl 1):S32-3

Each year, an estimated 55,000 to 80,000 people die from vaccine-preventable diseases. More pharmacists are needed to advocate, facilitate, and deliver immunizations throughout the year. Pharmacists who want to develop a year-round immunization program should begin by developing a comprehensive business plan. By implementing a successful year-round immunization program, pharmacists can reduce morbidity and mortality from a range of vaccine-preventable infections.

Health-System Pharmacists' Role in Immunizing Adults Against Pneumococcal Disease and Influenza

Grabenstein JD, Bonasso J
Am J Health Syst Pharm. 1999; 56(17 Suppl 2): pS3-22

The role of pharmacists in immunizing adults against pneumococcal disease and influenza is discussed. Pneumococcal disease and influenza each cause up to 40,000 deaths annually in the United States. Vaccination against these diseases is encouraged for all people 65 years of age or older and for those with certain chronic diseases or immunosuppression. Influenza virus vaccine should also be given to residents of long-term-care facilities, many pregnant women, and health care workers. Pneumococcal vaccine is usually given once in a lifetime; influenza virus vaccine is given annually in the fall. Advocacy of immunization is consistent with the precepts of pharmaceutical care, and pharmacists can promote immunization by assuming the roles of educator, facilitator, and immunizer. Despite lack of specific mention of it in accreditation standards, health-system personnel have a duty to vaccinate adults, just as they do pediatric patients. Pharmacists should review immunization records with patients periodically and at the time of immunization. As with other drug products, formulary decisions and the distribution, storage, and handling of vaccines are important pharmacist responsibilities. Pharmacoeconomic studies have demonstrated the value of pneumococcal and influenza virus vaccines. Medicare covers these vaccines under Part B. Pharmacists have an important role to play in promoting adult immunizations against pneumococcal disease and influenza.

Pharmacists as Vaccine Advocates: Roles in Community Pharmacies, Nursing Homes, and Hospitals

Grabenstein JD
Vaccine. 1998; 16(18):1705-10

Pharmacists increasingly take on immunization roles for their communities: advocates, facilitators and immunizers. Between 50 and 94% of people who receive a pharmacist's recommendation to be immunized accept that recommendation. Over 5 million doses of influenza vaccine per year are administered in pharmacies. In 25 states, pharmacists are authorized to administer immunizations. More than 1000 pharmacists were trained to immunize in 1997. Consultant pharmacists can recommend vaccines in nursing facilities in the course of monthly drug regimen reviews. People have exceptional access to pharmacist at a wide variety of hours. Pharmacy-based immunization training incorporates safeguards that mimic or exceed quality standards in public-health clinics.

Implementation of a Pharmacy-Based Immunization Program in a Supermarket Chain

Weitzel KW, Goode JV
J Am Pharm Assoc. 2000; 40(2):252-6

Objective: To describe procedures for implementing a pharmacy-based immunization program in a supermarket chain.

Setting: Supermarket chain pharmacy.
Practice Description: Ukrop's is a local supermarket chain with 27 stores in the greater area of Richmond, Fredericksburg, and Williamsburg, Virginia, 19 of which have pharmacies. Ukrop's offers enhanced patient care services including immunizations, diabetes, asthma, hypertension, hyperlipidemia monitoring, and smoking cessation. All pharmacies offer adult immunizations and host periodic diabetes, hypertension, and hyperlipidemia screening events.
Practice Innovation: Adult immunization program.
Interventions: Each pharmacy offered influenza and pneumococcal vaccinations on a walk-up basis during pharmacy hours and during clinics held at least 3 days per week. Immunizations were also offered periodically at off-site locations. Distribution of letters and chart stickers to patients' physicians, and even partnership with a physician to establish the immunization protocol, helped increase awareness of the pharmacy immunization services. This service involved a core group of immunizing pharmacists who developed a policies and procedures manual, distributed the vaccine, and handled additional staffing requirements.
Main Outcome Measures: Number of adult influenza and pneumococcal vaccinations administered by pharmacists.
Results: Between September and December 1998, Ukrop's pharmacists administered 5,137 influenza vaccinations and 613 pneumococcal vaccinations. Between September 1999 and January 2000, Ukrop's pharmacists administered 18,000 influenza vaccinations and 1,200 pneumococcal vaccinations.
Conclusion: In addition to immunizing thousands of people in its first year, the program served as a successful marketing tool to increase awareness of enhanced pharmacy services in the community and among local physicians. Administration of vaccines increased pharmacists involvement with and enthusiasm for enhanced patient care services and generated a revenue stream for the pharmacies.