Table 5.

Patient-related and organizational barriers to pneumococcal immunization services (N = 91).

	n (%) a
Patient-related barriers
Patients refusing vaccine because they do not think they need it	3.1 (1.1)
Patients being too busy to discuss the vaccine with the pharmacist	2.7 (1.1)
Patient’s insurance coverage	2.6 (1.3)
Patients refusing the vaccine because they are concerned about immediate adverse reactions	2.6 (1.0)
Patients refusing because they do not trust vaccines	2.6 (1.2)
Patients refusing the vaccine because they feel they are not susceptible to pneumococcal disease	2.4 (1.1)
Patients refusing the vaccine because they are concerned about its long-term safety	2.2 (1.0)
Patient preferring to go to a non-pharmacy setting, such as medical clinic, for the vaccine	2.1 (1.0)
Patients refusing the vaccine because they feel pneumococcal disease is not a severe illness	2.1 (1.1)
Patients refusing because they have not heard about the vaccine	2.1 (1.0)
Patients refusing the vaccine because they are concerned about its efficacy	2.0 (1.0)
Organizational barriers
Inadequate reimbursement for vaccine products	3.1 (1.5)
Inadequate reimbursement for vaccine administration	3.0 (1.5)
Cost of stocking the vaccine	2.5 (1.4)
Lack of a system to routinely screen patients for needed vaccines	2.3 (1.2)
Lack of time to counsel about the vaccine	2.0 (1.1)
Lack of a system to track multiple doses	2.0 (1.0)
Difficult to determine patient eligibility	1.9 (1.0)
Lack of support from other pharmacy personnel for immunization services	1.6 (1.0)
Lack of time to administer the vaccine	1.6 (0.9)
Lack of time to process vaccine reimbursements	1.6 (0.9)
Lack of staff certified to administer the vaccine	1.6 (0.9)
Lack of time to prepare the vaccine for administration	1.5 (0.8)
Difficult to integrate vaccine procedures into dispensing workflow	1.5 (0.9)
Vaccine is not usually in stock when needed	1.5 (0.9)
Difficult to access state immunization registry	1.4 (0.9)
Pharmacy unprepared to manage an adverse vaccine reaction	1.3 (0.7)

^a Response categories ranging from 1 to 5 (1 = not at all a barrier; 5 = an extreme barrier).