With Proper Tools, Pharmacists Increase Adult Vaccination Rates

Friday, October 6, 2017

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Despite recommendations from the Advisory Committee on Immunization Practices (ACIP), adult vaccination rates in the United States remain low. Pharmacists have long been recognized as important members of the health care team to help boost these numbers—but just how much impact can pharmacists have? A new pilot study from the APhA Foundation may provide some answers.

With access to the right tools, eight community pharmacies in Washington State that were part of Project IMPACT: Immunizations increased the number of vaccines administered by 41.4% over a 6-month period. A variety of community pharmacy practice types in different areas of the state were selected for the pilot, in which the most essential aspect was the bidirectional access given to pharmacists to the state’s Immunization Information System (IIS), with clinical decision support at the point of care. The protocol for the pilot involved the pharmacist opening up the bidirectional IIS to identify the patient’s unmet vaccination needs when a patient presented to the pharmacy for an influenza vaccination. Within the system, the standard algorithm based on ACIP guidelines was used to generate a forecast for the vaccines for which the patient might be due.

For every patient who requested an influenza vaccination at the pharmacy, an additional 1.45 vaccines were forecast as due at the point of care, according to results of the pilot.

“We found it was important for the pharmacist to have an interaction with the patient,” said Benjamin Bluml, RPh, senior vice president for research and innovation at the Foundation. When the pharmacists conducted an assessment with the patient, they found 36 cases in which the vaccines forecast were contraindicated. In 196 cases, the patient self-reported that the vaccines had already been administered, but data were not present in the registry.

In total, 33.5% of identified unmet vaccination needs were resolved during the study period. “The results show you that when a pharmacist has actionable data, when they have information that is available, relevant, and current, they can take action at the point of patient care,” said Lisa Tonrey, BSPharm, MHA, PhC, FAPhA, who served as APhA President from 2003 to 2004.

Bidirectional capability

When pharmacists in the pilot identified patients with unmet immunization needs, nearly all (95%) were administered by the pharmacist at the point of care. The remaining patients received information about their immunization needs along with a recommendation for vaccination follow-up.

One of the main barriers that still exists with IIS technology is a pharmacist’s access to bidirectional capability, in which they can both see and contribute to the patient’s immunization records in the IIS. Currently, 32 states have bidirectional IIS registries.

However, Bluml said that’s just the beginning; the next step is to ensure that providers contribute to their state’s IIS. Three states—North Carolina, Oregon, and Iowa—have set a precedent by requiring bidirectional reporting for pharmacists. Washington State, where the pilot project took place, has no mandate for pharmacists to report immunizations to the state’s IIS, but the Washington State Department of Health along with pharmacy stakeholders have established it as a best practice.

According to Tonrey, challenges vary from state to state when it comes to pharmacists reporting to the IIS. In some states, pharmacists are limited by the immunizations they can give. Electronic systems also run the gamut, as do state IIS reporting requirements and exactly how the law is written.

“Unless the law requires everyone to report, the information [in the IIS] is not necessarily going to be complete,” said Tonrey. Incomplete vaccination information is especially the case for adult patients. Most pediatricians or family practice physicians who participate in the Vaccines for Children Program funded through CDC must report to their state’s IIS.

Expansion

According to Bluml, the Foundation is preparing to take steps to fund the next step of the project, which will be a scaled demonstration.

“We have a couple different forward-thinking payers who are interested in making sure pharmacists get paid fairly for the assessment, immunization, and administration,” said Bluml. “The point-of-care assessment would be a new service payment that we think pharmacists should be eligible for.”

Ideally, the objective is to scale a financially viable, market-based model.

Loren Bonner, senior editor

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