. 2019 Jul 12;10(3):10.24926/iip.v10i3.940. doi: 10.24926/iip.v10i3.940

Table 1. Clinical.

Name of Study and Description	Type of Study / Objectives	Methods	Results	Implications
Vaccinations administered during off-clinic hours. Increasing patient access and convenience.⁷ Goad Ja et al. Ann Fam Med. 2013;11(5):429-36	Retrospective review. Objective: Analyze the types of vaccine administered and patient pharmacies population vaccinated during off clinic hours in a nationally community pharmacy.	One-year vaccination review chain pharmacy. Categorized by traditional hours (9am-6m) vs. off clinic hours (evening, holidays, weekends). Compared demographic and types of vaccines.	Pharmacist administered 6,250,402 vaccinations. 30.5% provided during off clinic hours. Patients had higher odds of off-clinic vaccination if they were younger than 65, male, reside in urban area, and did not have chronic conditions. 17.5% of all vaccines administered during lunch hours (11 am -1 pm). Patients are more likely to use off clinic hours if they were vaccinated in states that authorize pharmacist to all CDC-recommended vaccines vs. states that authorize pharmacist to administer influenza, pneumonia and zoster (OR = 1.0044; 95% CI, 1.040-1.049).	The typical off clinic hour user, male, young, heather patient, reside highlighter more likely to be vaccinated during off-clinical hours. Community pharmacies are expanding the access and convenience of vaccines. Working population utilize the convenience outside the working hours thus increases vaccination rates. Patient seek vaccinations at times most convenient to them. Expanding the pharmacist ability to administer adults and children for all vaccines in all states will have the greatest impact on vaccination rates.
Community pharmacist-administered influenza immunization improves patient access to vaccines⁸ Papastergiou J et al. Can Pharm J (Ott). 2014; 147(6):359-65	Objective: To describe the demographics of patients receiving influenza vaccines in the community setting and to understand patient perceptions of pharmacy vaccinations.	Survey collected at 4 community pharmacy locations in Toronto in 8-week period.	1502 surveys were collected. 86% of patient were very comfortable or comfortable 14% with being vaccinated by pharmacist. 92% of patients were very satisfied or satisfied 8% with pharmacies’ service and injection technique. 28% of patients indicated that they would not have been vaccinated that year if the pharmacy service were not provided. 46% of the patients had risk factors such as heart disease, respiratory disease, cancer, diabetes or was receiving immunosuppressant.	Pharmacist have the potential to provide a positive effect on public health by improving vaccination rates among high risk patients and first time vaccine recipients. Expanding pharmacist vaccination services to cover other vaccines would improve patient access and would receive positive reception.
The effect of pharmacist intervention of Herpes Zoster Vaccination in community practice⁹ Wang et al. J Am Pharm Assoc (2003). 2013;53(1):46-53.	Prospective interventional with pre-post design. Investigate whether intervention by community pharmacist promoting herpes zoster would result in an increased rate. Outcomes: Primary: Compare vaccination rates for herpes zoster during the period control and intervention period and patients. Secondary: evaluate relative efficacy of the pharmacy intervention two areas: educating patients about vaccine and influence patients to receive vaccine.	Study of three pharmacies that serve suburban, semi-rural, rural demographics. Two protocols: collaborative practice and Rx all vaccines Control period, patients who voluntary presented to pharmacy requesting herpes zoster vaccination. 4 weeks. Intervention period, release of newspaper press containing information on herpes zoster, every script dispense contained herpes zoster flyer, all patients profiles with CDC ACIP- recommend indications were identified and a one-time personal letter was sent containing the same information from the press release and flyer. 4 weeks.	Vaccination rates increased from 0.37% (or 59/16,121) during the control period to 1.20% (or 193/16,062) during the intervention period (P <0.0001). The number of survey respondents was 158 while 193 individuals in pharmacy databases received the vaccine during the intervention period, giving a response rate over 80%. There was no statistical difference when pharmacy-based sources and family/friends were compared (P=0.1025). Patients were more likely to be influenced to receive the herpes zoster vaccination as a result of one of the pharmacist - driven interventions rather than a physician (P=0.0260) or other source (P <0.0001). The pharmacy-driven interventions, the personalized letter was more effective than all of the other interventions in influencing patients to receive the herpes zoster vaccine. 205 patients who filled out a survey during the study, 204 (99.5%) reported being either very comfortable or somewhat comfortable with the pharmacist administering the vaccine. Pharmacy sources were generally statistically more effective than were all other sources in educating people about the vaccine and influencing patients to receive the herpes zoster vaccination. The only exception was that there was no difference in efficacy of pharmacy sources and family members or friends in influencing patients to receive the vaccine.	Pharmacists can attain better vaccine outcomes by communication with patients using mediums as personal letters. Pharmacists are a well-trusted source for vaccination information.
It’s easier in pharmacy”: why some patients prefer to pay for flu jabs rather than use the National Health Service.¹⁰ Anderson C et al. BMC Health Serv Res. 2014;14:35.	This paper discusses retrospective data collected through a sample of Boots UK community pharmacies during 2012–13 to help support the case for national commissioning of flu vaccinations through pharmacy.	Data were collected during the 2012–13 flu season as part of a community pharmacy private flu vaccination service to help identify whether patients were eligible to have their vaccination free of charge on the NHS. Additional data were collected from a sample of patients accessing the private service within 13 pharmacies to help identify the reasons patients paid when they were eligible for free vaccination.	Data were captured from 89,011 privately paying patients across 479 pharmacies in England, of whom 6% were eligible to get the vaccination free. 921 patients completed a survey in the 13 pharmacies selected. Of these, 199 (22%) were eligible to get their flu vaccination for free. 131 (66%) were female. Average age was 54 years. Of the 199 patients who were eligible for free treatment, 100 (50%) had been contacted by their GP surgery to go for their vaccination, but had chosen not to go. Reasons given include accessibility, convenience and preference for pharmacy environment.	Patients would rather pay for convenience than wait for long time for free service.
Who uses pharmacy for flu vaccinations? Population profiling through a UK pharmacy chain¹¹ Anderson C et al. Int J Clin Pharm. 2016;38(2):218-22	To understand the profile of people accessing flu vaccination services within a large pharmacy chain. Retrospective data collected through a sample of in England during the 2014/15 Flu season.	Pharmacists requested people who had been vaccinated in 2014/15 to complete a questionnaire. Data was captured electronically on vaccine delivery levels across 1201 pharmacies. Deprivation profiles were calculated using the Carstairs index. Carstairs index (used to calculate deprivation quintiles for least and most deprived); based on four census indicators: low social class, lack of car ownership, overcrowding, and male unemployment.	1741 patients from a total of 55 pharmacies completed the survey. Convenience and accessibility remain the key reasons for attending pharmacy. Pharmacy services are accessed by people from all postcode areas, including some from the most deprived localities.	These services are highly accessed by patients from all socio demographic areas. Patients would rather pay for convenience than wait for long time for free service. Health professionals and working class people tend to use the pharmacy vaccine service.
Individual- and Neighborhood-Level Characteristics Associated with Support of In-Pharmacy Vaccination among ESAP-Registered Pharmacies: Pharmacists’ Role in Reducing Racial/Ethnic Disparities in Influenza Vaccinations in New York City¹² Crawford ND et al. J Urb–an Health. 2011;88(1):176-85.	New York State (NYS) passed legislation authorizing pharmacists to administer vaccines in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies.	Used pharmacy staff baseline data to assess support of in- pharmacy vaccination, which was measured using a Likert scale (very supportive, somewhat supportive, not supportive, don’t know, and refused) in response to, “How much do you support vaccination services being provided in your pharmacy?” Persons who reported being very supportive or somewhat supportive were classified as supportive, and those who reported not supportive were classified as not supportive. Persons who reported don’t know and refused were excluded from this analysis (n=4). It is important to note that support of in-pharmacy vaccination reflects individual attitudes and beliefs of this service rather than actual participation in current vaccination services in their pharmacy. Participants were probed about their level of support even if this service was not feasible in the pharmacy. Therefore, we refer to the reported beliefs and attitudes of in-pharmacy vaccination as in-pharmacy vaccination support.	The sample consists of 437 pharmacists, non- pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff that expressed support of in- pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39–2.04). There was a total of 437 pharmacy staff: 189 pharmacists, 19 non-pharmacist owners/managers, and 229 pharmacy technicians/clerks. Of these pharmacy staff, 38.7% were male, most were Hispanic (36.1%), followed by Asian/Pacific Islander (19.3%), African American (18.2%), White (13.1%), South Asian/Indian/Pakistani (8.3%), and other race/ethnicity (5.1%). Pharmacy staff worked an average of 9.4 years in pharmacies. Most (86.3%) pharmacy staff supported vaccination being provided inside the pharmacy.	Evidence-supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities, which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality. The majority of pharmacy personnel are very supportive of in pharmacy vaccination despite sociodemographics disparities. Pharmacies that also offer other public health service are more likely to support in-pharmacy vaccinations. Pharmacies are in the key position to vaccinate too-hard-to-reach population groups.
The role of pharmacists in the delivery of influenza vaccinations¹³ Steyer TE et al. Vaccine. 2004;22(8):1001-6.	The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines. To assess the impact of legislation allowing pharmacists to administer vaccine.	For this analysis, the 1995 and 1999 Behavioral Risk Factor Surveillance System (BRFSS) was used. The BRFSS is an annual telephone survey conducted by the Centers for Disease Control and Prevention that assesses health risks in the US. In this survey, individuals are asked, “During the past 12 months, have you had a flu shot?” Sixteen states were taken from the BRFSS to compare influenza vaccination rates for individuals both 18–64 and 65 years and older. Eight of these states (Arkansas, Kansas, Nebraska, North Dakota, Oklahoma, Tennessee, Texas and Virginia) passed legislation in 1997 allowing pharmacists to administer vaccines while eight (Louisiana, Missouri, Iowa, Wyoming, Utah, West Virginia, Florida, and Maryland) had no legislation prior to 2000. Data for the years 1995 and 1999 were then analyzed. Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association.	Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines.	Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older. Expanding the pharmacies ability to administer more vaccines increases vaccination rates in new populations. Expanding patient access and refining legal parameters in pharmacy practice has a correlated effect in the groups who are vaccinated.
Pharmacists as providers: Targeting pneumococcal vaccinations to high risk populations¹⁴ Taitel M et al. Vaccine. 2011;29(45):8073-6.	The objective of this study was to evaluate the impact of pharmacists educating at-risk patients on the importance of receiving a pneumococcal vaccination.	Using de-identified claims from a large, national pharmacy chain, all patients who had received an influenza vaccination between August 1, 2010 and November 14, 2010 and who were eligible for PPSV23 were identified for the analysis. Based on the Advisory Committee on Immunization Practices recommendations, at-risk patients were identified as over 65 years of age or as aged 2–64 with a comorbid conditions. A benchmark medical and pharmacy claims database of commercial and Medicare health plan members was used to derive a PPSV23 vaccination rate typical of traditional care delivery to compare to pharmacy-based vaccination. Period incidence of PPSV23 was calculated and compared.	Among the 1.3 million at-risk patients, 65,598 (4.88%) received a pneumococcal vaccine. This vaccination rate was significantly (p < .001) higher than the PPSV23 benchmark rate of 2.90% (34,917/1,204,104). In the study group, PPSV23 rates varied by age group but not by gender. Patients aged 60–70 years had the highest vaccination rate (6.60%, 26,430/400,454) of any age group.	Pharmacies have the ability to target at risk vaccination groups. Pharmacy electronic records can filter patient profiles based on risk factors characteristic. Pharmacies can expand this function to make more health or vaccine interventions and produce better outcomes for patients. These results support the expanding role of community pharmacists in the provision of wellness and prevention services. Pharmacies can help achieve the U.S. Department of Health and Human Services’ Healthy People goals for vaccine coverage. This study supports the expanding role of community pharmacists in the provision of wellness and prevention services. .
Improved Influenza Vaccination Rates in a Rural Population as a Result of a Pharmacist-Managed Immunization Campaign¹⁵ Van amburgh JA et al. Pharmacotherapy. 2001;21(9):1115-22.	To increase the rate of influenza vaccinations in high-risk patients by means of a pharmacist-managed immunization campaign. Unblinded, single intervention. Rural primary care clinic.	The pharmacy team developed an education packet that was sent to all patients who needed the influenza vaccine. The packet contained a letter and a two-sided information insert designed in collaboration with a teaching/learning specialist. The pharmacy team developed two surveys. One survey, for patients who received the influenza vaccine (entitled “We helped you, now you can help us”), was given by a nurse or pharmacist to patients during the vaccination clinic, at physician appointments, or by mail. A follow-up letter and survey were mailed in early December to unvaccinated patients who had indications for vaccine. The primary focus was to encourage them to get vaccinated if they had not yet done so.	Before intervention (1998), vaccination rates were low: 182 (28%) patients with and 102 (6%) patients without indications for the vaccine. After the pharmacy-directed intervention in 1999, 354 (54%) patients with and 148 (9%) patients without indications were successfully vaccinated. The influenza vaccination rate increased from 28% at baseline (before program initiation) to 54% after program initiation. Unvaccinated patients were younger and resided in more urban areas than vaccinated patients; vaccinated patients had a higher frequency of cardiovascular disease or diabetes mellitus. Vaccinated patients consistently identified the education packet and their health care providers as primary motivators for vaccination. Total of 283 patients completed the “We helped you, now you can help us” survey. Of these, 199 respondents were patients with positive indications who were vaccinated against influenza and had received the education packet (56.4% response rate). Patients consistently identified the mailing and their health care provider as the top factors that had convinced and reminded them to get vaccinated. The most common suggestions for improving the vaccination program were to provide more days and times available to be vaccinated and to increase the number of providers to administer vaccinations.	This study demonstrated that this pharmacy- directed program, which included a mailing and improved access to the influenza vaccine, significantly increased vaccinations by 95% for a group of high-risk patients in a rural community practice. The education packet received by mail was the most common reason patients were both convinced and reminded to get vaccinated.
Impact of pharmacist integration in a pediatric primary care clinic on vaccination errors: A retrospective review¹⁶ Haas-gehres A. J Am Pharm Assoc (2003). 2014;54(4):415-8.	To measure the impact of ambulatory clinical pharmacist integration in a pediatric. Primary care clinic on vaccination error rates and to evaluate missed opportunities.	A retrospective, quasi-experimental review of electronic medical records of visit encounters during a 3-month period compared vaccine error rates and missed opportunities between two pediatric residency primary care clinics. The intervention clinic has a full-time ambulatory clinical pharmacist integrated into the health care team. Pharmacy services were not provided at the comparison clinic. A vaccine error was defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended spacing from a previous dose, doses administered unnecessarily, live virus vaccination administered too close to a previous live vaccine, and doses invalid for combinations of these reasons.	900 encounters were randomly selected and reviewed. The error rate was found to be 0.28% in the intervention clinic and 2.7% in the comparison clinic. The difference in error rates was found to be significant (P = 0.0021). The number of encounters with greater than or equal to one missed opportunity was significantly higher in the comparison clinic compared with the intervention clinic (29.3% vs. 10.2%; P <0.0001).	Pharmacist have the ability to identify CDC scheduled recommendation in pediatric population. Pharmacist can support ambulatory clinics to increase vaccination rates and decreases the rates of missed opportunities.

Name of Study and Description

Type of Study / Objectives

Methods

Results

Implications

Vaccinations administered during off-clinic hours. Increasing patient access and convenience.⁷

Goad Ja et al. Ann Fam Med. 2013;11(5):429-36

Retrospective review.

Objective: Analyze the types of vaccine administered and patient pharmacies population vaccinated during off clinic hours in a nationally community pharmacy.

One-year vaccination review chain pharmacy.

Categorized by traditional hours (9am-6m) vs. off clinic hours (evening, holidays, weekends).

Compared demographic and types of vaccines.

Pharmacist administered 6,250,402 vaccinations.

30.5% provided during off clinic hours.

Patients had higher odds of off-clinic vaccination if they were younger than 65, male, reside in urban area, and did not have chronic conditions.

17.5% of all vaccines administered during lunch hours (11 am -1 pm).

Patients are more likely to use off clinic hours if they were vaccinated in states that authorize pharmacist to all CDC-recommended vaccines vs. states that authorize pharmacist to administer influenza, pneumonia and zoster (OR = 1.0044; 95% CI, 1.040-1.049).

The typical off clinic hour user, male, young, heather patient, reside highlighter more likely to be vaccinated during off-clinical hours.

Community pharmacies are expanding the access and convenience of vaccines.

Working population utilize the convenience outside the working hours thus increases vaccination rates.

Patient seek vaccinations at times most convenient to them.

Expanding the pharmacist ability to administer adults and children for all vaccines in all states will have the greatest impact on vaccination rates.

Community pharmacist-administered influenza immunization improves patient access to vaccines⁸

Papastergiou J et al. Can Pharm J (Ott). 2014; 147(6):359-65

Objective:

To describe the demographics of patients receiving influenza vaccines in the community setting and to understand patient perceptions of pharmacy vaccinations.

Survey collected at 4 community pharmacy locations in Toronto in 8-week period.

1502 surveys were collected.

86% of patient were very comfortable or comfortable 14% with being vaccinated by pharmacist.

92% of patients were very satisfied or satisfied 8% with pharmacies’ service and injection technique.

28% of patients indicated that they would not have been vaccinated that year if the pharmacy service were not provided.

46% of the patients had risk factors such as heart disease, respiratory disease, cancer, diabetes or was receiving immunosuppressant.

Pharmacist have the potential to provide a positive effect on public health by improving vaccination rates among high risk patients and first time vaccine recipients.

Expanding pharmacist vaccination services to cover other vaccines would improve patient access and would receive positive reception.

The effect of pharmacist intervention of Herpes Zoster Vaccination in community practice⁹

Wang et al. J Am Pharm Assoc (2003). 2013;53(1):46-53.

Prospective interventional with pre-post design.

Investigate whether intervention by community pharmacist promoting herpes zoster would result in an increased rate.

Outcomes:

Primary: Compare vaccination rates for herpes zoster during the period control and intervention period and patients.

Secondary: evaluate relative efficacy of the pharmacy intervention two areas: educating patients about vaccine and influence patients to receive vaccine.

Study of three pharmacies that serve suburban, semi-rural, rural demographics.

Two protocols: collaborative practice and Rx all vaccines

Control period, patients who voluntary presented to pharmacy requesting herpes zoster vaccination. 4 weeks.

Intervention period, release of newspaper press containing information on herpes zoster, every script dispense contained herpes zoster flyer, all patients profiles with CDC ACIP- recommend indications were identified and a one-time personal letter was sent containing the same information from the press release and flyer. 4 weeks.

Vaccination rates increased from 0.37% (or 59/16,121) during the control period to 1.20% (or 193/16,062) during the intervention period (P <0.0001).

The number of survey respondents was 158 while 193 individuals in pharmacy databases received the vaccine during the intervention period, giving a response rate over 80%.

There was no statistical difference when pharmacy-based sources and family/friends were compared (P=0.1025).

Patients were more likely to be influenced to receive the herpes zoster vaccination as a result of one of the pharmacist - driven interventions rather than a physician (P=0.0260) or other source (P <0.0001).

The pharmacy-driven interventions, the personalized letter was more effective than all of the other interventions in influencing patients to receive the herpes zoster vaccine.

205 patients who filled out a survey during the study, 204 (99.5%) reported being either very comfortable or somewhat comfortable with the pharmacist administering the vaccine.

Pharmacy sources were generally statistically more effective than were all other sources in educating people about the vaccine and influencing patients to receive the herpes zoster vaccination. The only exception was that there was no difference in efficacy of pharmacy sources and family members or friends in influencing patients to receive the vaccine.

Pharmacists can attain better vaccine outcomes by communication with patients using mediums as personal letters.

Pharmacists are a well-trusted source for vaccination information.

It’s easier in pharmacy”: why some patients prefer to pay for flu jabs rather than use the National Health Service.¹⁰

Anderson C et al. BMC Health Serv Res. 2014;14:35.

This paper discusses retrospective data collected through a sample of Boots UK community pharmacies during 2012–13 to help support the case for national commissioning of flu vaccinations through pharmacy.

Data were collected during the 2012–13 flu season as part of a community pharmacy private flu vaccination service to help identify whether patients were eligible to have their vaccination free of charge on the NHS. Additional data were collected from a sample of patients accessing the private service within 13 pharmacies to help identify the reasons patients paid when they were eligible for free vaccination.

Data were captured from 89,011 privately paying patients across 479 pharmacies in England, of whom 6% were eligible to get the vaccination free. 921 patients completed a survey in the 13 pharmacies selected. Of these, 199 (22%) were eligible to get their flu vaccination for free. 131 (66%) were female. Average age was 54 years. Of the 199 patients who were eligible for free treatment, 100 (50%) had been contacted by their GP surgery to go for their vaccination, but had chosen not to go. Reasons given include accessibility, convenience and preference for pharmacy environment.

Patients would rather pay for convenience than wait for long time for free service.

Who uses pharmacy for flu vaccinations? Population profiling through a UK pharmacy chain¹¹

Anderson C et al. Int J Clin Pharm. 2016;38(2):218-22

To understand the profile of people accessing flu vaccination services within a large pharmacy chain.

Retrospective data collected through a sample of in England during the 2014/15 Flu season.

Pharmacists requested people who had been vaccinated in 2014/15 to complete a questionnaire. Data was captured electronically on vaccine delivery levels across 1201 pharmacies. Deprivation profiles were calculated using the Carstairs index.

Carstairs index (used to calculate deprivation quintiles for least and most deprived); based on four census indicators: low social class, lack of car ownership, overcrowding, and male unemployment.

1741 patients from a total of 55 pharmacies completed the survey. Convenience and accessibility remain the key reasons for attending pharmacy.

Pharmacy services are accessed by people from all postcode areas, including some from the most deprived localities.

These services are highly accessed by patients from all socio demographic areas.

Patients would rather pay for convenience than wait for long time for free service.

Health professionals and working class people tend to use the pharmacy vaccine service.

Individual- and Neighborhood-Level Characteristics Associated with Support of In-Pharmacy Vaccination among ESAP-Registered Pharmacies: Pharmacists’ Role in Reducing Racial/Ethnic Disparities in Influenza Vaccinations

in New York City¹²

Crawford ND et al. J Urb–an Health. 2011;88(1):176-85.

New York State (NYS) passed legislation authorizing pharmacists to administer vaccines in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies.

Used pharmacy staff baseline data to assess support of in- pharmacy vaccination, which was measured using a Likert scale (very supportive, somewhat supportive, not supportive, don’t know, and refused) in response to, “How much do you support vaccination services being provided in your pharmacy?” Persons who reported being very supportive or somewhat supportive were classified as supportive, and those who reported not supportive were classified as not supportive. Persons who reported don’t know and refused were excluded from this analysis (n=4). It is important to note that support of in-pharmacy vaccination reflects individual attitudes and beliefs of this service rather than actual participation in current vaccination services in their pharmacy. Participants were probed about their level of support even if this service was not feasible in the pharmacy. Therefore, we refer to the reported beliefs and attitudes of in-pharmacy vaccination as in-pharmacy vaccination support.

The sample consists of 437 pharmacists, non- pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff that expressed support of in- pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39–2.04).

There was a total of 437 pharmacy staff: 189 pharmacists, 19 non-pharmacist owners/managers, and 229 pharmacy technicians/clerks. Of these pharmacy staff, 38.7% were male, most were Hispanic (36.1%), followed by Asian/Pacific Islander (19.3%), African American (18.2%), White (13.1%), South Asian/Indian/Pakistani (8.3%), and other race/ethnicity (5.1%). Pharmacy staff worked an average of 9.4 years in pharmacies. Most (86.3%) pharmacy staff supported vaccination being provided inside the pharmacy.

Evidence-supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities, which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality.

The majority of pharmacy personnel are very supportive of in pharmacy vaccination despite sociodemographics disparities.

Pharmacies that also offer other public health service are more likely to support in-pharmacy vaccinations.

Pharmacies are in the key position to vaccinate too-hard-to-reach population groups.

The role of pharmacists in the delivery of influenza vaccinations¹³

Steyer TE et al. Vaccine. 2004;22(8):1001-6.

The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines.

To assess the impact of legislation allowing pharmacists to administer vaccine.

For this analysis, the 1995 and 1999 Behavioral Risk Factor Surveillance System (BRFSS) was used. The BRFSS is an annual telephone survey conducted by the Centers for Disease Control and Prevention that assesses health risks in the US. In this survey, individuals are asked, “During the past 12 months, have you had a flu shot?”

Sixteen states were taken from the BRFSS to compare influenza vaccination rates for individuals both 18–64 and 65 years and older. Eight of these states (Arkansas, Kansas, Nebraska, North Dakota, Oklahoma, Tennessee, Texas and Virginia) passed legislation in 1997 allowing pharmacists to administer vaccines while eight (Louisiana, Missouri, Iowa, Wyoming, Utah, West Virginia, Florida, and Maryland) had no legislation prior to 2000. Data for the years 1995 and 1999 were then analyzed.

Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association.

Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines.

Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older.

Expanding the pharmacies ability to administer more vaccines increases vaccination rates in new populations.

Expanding patient access and refining legal parameters in pharmacy practice has a correlated effect in the groups who are vaccinated.

Pharmacists as providers: Targeting pneumococcal vaccinations to high risk populations¹⁴

Taitel M et al. Vaccine. 2011;29(45):8073-6.

The objective of this study was to evaluate the impact of pharmacists educating at-risk patients on the importance of receiving a pneumococcal vaccination.

Using de-identified claims from a large, national pharmacy chain, all patients who had received an influenza vaccination between August 1, 2010 and November 14, 2010 and who were eligible for PPSV23 were identified for the analysis. Based on the Advisory Committee on Immunization Practices recommendations, at-risk patients were identified as over 65 years of age or as aged 2–64 with a comorbid conditions. A benchmark medical and pharmacy claims database of commercial and Medicare health plan members was used to derive a PPSV23 vaccination rate typical of traditional care delivery to compare to pharmacy-based vaccination. Period incidence of PPSV23 was calculated and compared.

Among the 1.3 million at-risk patients, 65,598 (4.88%) received a pneumococcal vaccine. This vaccination rate was significantly (p < .001) higher than the PPSV23 benchmark rate of 2.90% (34,917/1,204,104). In the study group, PPSV23 rates varied by age group but not by gender. Patients aged 60–70 years had the highest vaccination rate (6.60%, 26,430/400,454) of any age group.

Pharmacies have the ability to target at risk vaccination groups.

Pharmacy electronic records can filter patient profiles based on risk factors characteristic. Pharmacies can expand this function to make more health or vaccine interventions and produce better outcomes for patients.

These results support the expanding role of community pharmacists in the provision of wellness and prevention services.

Pharmacies can help achieve the U.S. Department of Health and Human Services’ Healthy People goals for vaccine coverage. This study supports the expanding role of community pharmacists in the provision of wellness and prevention services.

Improved Influenza Vaccination Rates in a Rural Population as a Result of a Pharmacist-Managed Immunization Campaign¹⁵

Van amburgh JA et al. Pharmacotherapy. 2001;21(9):1115-22.

To increase the rate of influenza vaccinations in high-risk patients by means of a pharmacist-managed immunization campaign.

Unblinded, single intervention.

Rural primary care clinic.

The pharmacy team developed an education packet that was sent to all patients who needed the influenza vaccine. The packet contained a letter and a two-sided information insert designed in collaboration with a teaching/learning specialist.

The pharmacy team developed two surveys. One survey, for patients who received the influenza vaccine (entitled “We helped you, now you can help us”), was given by a nurse or pharmacist to patients during the vaccination clinic, at physician appointments, or by mail.

A follow-up letter and survey were mailed in early December to unvaccinated patients who had indications for vaccine. The primary focus was to encourage them to get vaccinated if they had not yet done so.

Before intervention (1998), vaccination rates were low: 182 (28%) patients with and 102 (6%) patients without indications for the vaccine. After the pharmacy-directed intervention in 1999, 354 (54%) patients with and 148 (9%) patients without indications were successfully vaccinated.

The influenza vaccination rate increased from 28% at baseline (before program initiation) to 54% after program initiation. Unvaccinated patients were younger and resided in more urban areas than vaccinated patients; vaccinated patients had a higher frequency of cardiovascular disease or diabetes mellitus. Vaccinated patients consistently identified the education packet and their health care providers as primary motivators for vaccination.

Total of 283 patients completed the “We helped you, now you can help us” survey. Of these, 199 respondents were patients with positive indications who were vaccinated against influenza and had received the education packet (56.4% response rate). Patients consistently identified the mailing and their health care provider as the top factors that had convinced and reminded them to get vaccinated.

The most common suggestions for improving the vaccination program were to provide more days and times available to be vaccinated and to increase the number of providers to administer vaccinations.

This study demonstrated that this pharmacy- directed program, which included a mailing and improved access to the influenza vaccine, significantly increased vaccinations by 95% for a group of high-risk patients in a rural community practice.

The education packet received by mail was the most common reason patients were both convinced and reminded to get vaccinated.

Impact of pharmacist integration in a pediatric primary care clinic on vaccination errors: A retrospective review¹⁶

Haas-gehres A. J Am Pharm Assoc (2003). 2014;54(4):415-8.

To measure the impact of ambulatory clinical pharmacist integration in a pediatric.

Primary care clinic on vaccination error rates and to evaluate missed opportunities.

A retrospective, quasi-experimental review of electronic medical records of visit encounters during a 3-month period compared vaccine error rates and missed opportunities between two pediatric residency primary care clinics. The intervention clinic has a full-time ambulatory clinical pharmacist integrated into the health care team.

Pharmacy services were not provided at the comparison clinic. A vaccine error was defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended spacing from a previous dose, doses administered unnecessarily, live virus vaccination administered too close to a previous live vaccine, and doses invalid for combinations of these reasons.

900 encounters were randomly selected and reviewed. The error rate was found to be 0.28% in the intervention clinic and 2.7% in the comparison clinic. The difference in error rates was found to be significant (P = 0.0021). The number of encounters with greater than or equal to one missed opportunity was significantly higher in the comparison clinic compared with the intervention clinic (29.3% vs. 10.2%; P <0.0001).

Pharmacist have the ability to identify CDC scheduled recommendation in pediatric population.

Pharmacist can support ambulatory clinics to increase vaccination rates and decreases the rates of missed opportunities.