Optimizing the immunization activities of community chain pharmacists: Insights from a national survey

ObjectivesTo assess (1) the practices, attitudes, and perceptions of immunizing chain community pharmacists regarding implementation of immunization services per the National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice and (2) how community pharmacists view the effectiveness of corporate initiatives toward improving immunization volumes.DesignFollowing extensive formative research and pilot-testing, a cross-sectional survey was administered electronically to chain community pharmacists over a 4-week period.Setting and participantsRespondents were chain community pharmacists engaged in year-round immunization in the United States, randomly sampled from a list of 9717 maintained by the American Pharmacists Association.Outcome measuresPharmacists’ reports of immunization volumes, patterns of time use, perceptions of time spent on the immunization process, immunization attitudes, and confidence in completing NVAC standard components. Pharmacists also evaluated the utility of corporate goals, feedback, and incentives received.ResultsThe survey yielded 590 responses, with 489 meeting the eligibility criteria (5% response rate) and distributed from across the country. In total, 84% of respondents reported giving 26 or more vaccinations/week during the influenza season, whereas only 6% reported as many outside of the influenza season. Pharmacists spent, on average, 29% of their day addressing the immunization process during the influenza season and 12% outside of the influenza season. Only 29% of respondents were confident that their patients’ complete immunization needs were assessed at each patient encounter and only 46% were confident that their patients received strong recommendations regarding their specific immunization needs. Most pharmacists viewed corporate goals and the messages and strategies to achieve them as limited in scope and largely inadequate.ConclusionIn the context of their current role expectations, most community pharmacists who responded were not confident that key NVAC Standards were being implemented to improve patient immunization rates and did not view corporate initiatives as effective toward that effort.     

Patient perceptions of student pharmacist–run mobile influenza vaccination clinics

Objective

To assess patients’ perceptions of student pharmacist–run mobile influenza immunization clinics, including satisfaction, comfort, comparison to other experiences, and the views of pharmacists as immunizers.

Effects of a student pharmacist consultation on patient knowledge and attitudes about vaccines

ObjectiveTo measure the impact of student pharmacists’ consultation on participant knowledge and attitudes about influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines.DesignPre- and post-consultation surveys.SettingFree health care service and immunization clinics in Vallejo and Martinez, CA.ParticipantsChildren and adults 13 years of age or older.InterventionA convenience sample of participants completed a preintervention survey (PrIs) on basic vaccine knowledge and attitudes. Student pharmacists then delivered the intervention, which consisted of a 5-minute consultation on vaccines. A postintervention (PoIs) survey was administered immediately after the intervention.Main outcome measuresCumulative scores for eight knowledge-based questions and four attitude-based questions.Results198 participants completed both PrIs and PoIs. Compared with the PrI scores, the PoI scores showed significant improvement in basic vaccine knowledge and attitudes toward receiving vaccinations. Participants also were more likely to view pharmacists as a source of information about vaccines after the intervention. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations.ConclusionA short, 5-minute consultation by a student pharmacist may increase vaccination rates and help serve as a vehicle to change the public's view of vaccines as well as pharmacists and their role in primary and preventive care.     

Local and global volunteer opportunities for pharmacists to contribute to public health

There are many local and global volunteer opportunities for pharmacists to contribute to public health initiatives that help promote health, prevent disease and improve access to care. This article provides perspective and guidance for pharmacists and student pharmacists who desire to take part in volunteer initiatives related to local and global public health needs. The case examples provided are limited to activities that occurred strictly in a volunteer capacity. Pharmacists serving in a volunteer capacity have an opportunity to broaden their depth of practice and patient care responsibilities. Their skills sets and knowledge can be applied in a variety of public health settings to help meet the health care needs of the communities and patients they serve. Emergency response and caring for the underserved are recurring themes within the volunteer opportunities afforded to pharmacists. Examples include, but are not limited to, the US Medical Reserve Corps, health departments, health centres and clinics, medical service trips and disaster relief. Regardless of setting, the volunteer pharmacist will need to consider scope of practice limitations and certain legal protections. An array of volunteer opportunities exists for pharmacists and student pharmacists in the public health arena. Participating in these events allows pharmacists to expand their practice experiences while contributing to public health needs and outreach.     

Clinical impact of a community pharmacy-based health and wellness introductory pharmacy practice experience

ObjectiveTo assess the clinical impact of an intensive community pharmacy-based Health and Wellness Introductory Pharmacy Practice Experience (IPPE) completed by second-year (P2) student pharmacists.DesignThe Health and Wellness IPPE was a 1-week rotation developed to provide P2 student pharmacists with opportunities to provide clinical services to patients within the community pharmacy setting. Student pharmacists administered immunizations, performed blood pressure screenings and blood glucose measurements, and provided education to patients under the guidance of licensed pharmacist preceptors.Setting and participantsSecond-year student pharmacists completing a required Health and Wellness IPPE rotation in the community pharmacy setting.Outcomes measuredStudent pharmacist interventions were assessed to determine the course’s clinical impact, and preceptors were surveyed regarding the feasibility of student pharmacists performing clinical services at their training sites.ResultsA total of 147 student pharmacists completed the IPPE at 89 community pharmacy training sites and administered 9392 injections, 90% of which were influenza vaccinations. Student pharmacists performed 3458 patient health assessments, including measuring patients’ blood pressure and blood glucose and reviewing patient education materials. Most preceptors indicated that core activities were feasible during the experience.ConclusionThis study found that implementing a concentrated IPPE focused on immunizations and health screenings allowed student pharmacists to enhance their clinical skills and fulfill a large public health need, improving patient outcomes. Future studies should explore utilizing student pharmacists in community pharmacy settings to expand clinical services offered beyond these 2 services, such as diabetes risk tests, influenza point-of-care testing, and smoking cessation counseling.     

Enhancing an Introductory Pharmacy Practice Experience at free medical clinics

Objectives The aim of the study was to assess and improve first‐year student pharmacists' satisfaction and learning experience in a Student‐Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Methods Two consecutive classes of first‐year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter‐professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self‐assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self‐assessment survey instrument were compared between years 1 and 2. Key findings Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non‐pharmacy‐related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Conclusions Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.     

Shot of a lifetime: How pharmacists stay ahead of the season

ObjectivesThe profession of pharmacy has long advocated for the advancement of practice through increased clinical responsibility. Provision of immunization related services has been one service pharmacists have been able to provide to add to their existing responsibilities. A universal influenza vaccination has been under investigation and is nearing success. While other clinical services should be considered, now more than ever, development of the universal vaccine should provide a pause for the profession and consideration of not only the impact on student learning opportunities but also pharmacy revenue.SummaryThe development of the universal influenza vaccination poses a potential challenge to existing service-related revenue models for community pharmacies. There are many other opportunities pharmacists can capitalize on including, but not limited to, travel and other vaccinations, point-of-care testing, and transitions-of-care. In addition, through initiatives such as “Flip the Pharmacy” and Community Pharmacy Enhanced Service Network, pharmacists are in a great position to be innovative with clinical services while continuing to provide learners with training opportunities.ConclusionMany opportunities exist for pharmacists to expand services that lean into their clinical training and add other vaccination opportunities. These opportunities can augment revenue streams and still provide learners with training.     

Spanish-speaking patients’ satisfaction with clinical pharmacists’ communication skills and demonstration of cultural sensitivity

ObjectiveTo assess Spanish-speaking patients’ satisfaction with their clinical pharmacists’ communication skills and demonstration of cultural sensitivity, while controlling for patients’ sociodemographic, clinical, and communication factors, as well as pharmacist factors, and to identify clinical pharmacists’ cultural factors that are important to Spanish-speaking patients.DesignCross-sectional study.SettingCentral Texas during August 2011 to May 2012.ParticipantsSpanish-speaking patients of federally qualified health centers (FQHCs).Main outcome measure(s)A Spanish-translated survey assessed Spanish-speaking patients’ satisfaction with their clinical pharmacists’ communication skills and demonstration of cultural sensitivity.ResultsSpanish-speaking patients (N = 101) reported overall satisfaction with their clinical pharmacists’ communication skills and cultural sensitivity. Patients also indicated that pharmacists’ cultural rapport (e.g., ability to speak Spanish, respectfulness) was generally important to Spanish speakers. Multiple linear regression analyses showed that cultural rapport was significantly related to satisfaction with pharmacists’ communication skills and demonstration of cultural sensitivity.ConclusionOverall, patients were satisfied with pharmacists’ communication skills and cultural sensitivity. Patient satisfaction initiatives that include cultural rapport should be developed for pharmacists who provide care to Spanish-speaking patients with limited English proficiency.     

Pharmacy provision of influenza vaccinations in medically underserved communities

ObjectivesTo demonstrate the extent to which a community pharmacy can provide influenza immunizations in communities designated as medically underserved.MethodsThis retrospective study examined the number of influenza immunizations administered and populations served in areas with limited access to health care by Walgreens pharmacies during the 2009–10 influenza season.ResultsMore than 43% of the U.S. population resides in medically underserved areas (MUAs), and our results show that Walgreens pharmacies served nearly one-half of this population. Nationwide, more than one-third of influenza immunizations were administered by pharmacies located in MUAs. In states with the highest proportion of their population in MUAs, the percentage of influenza vaccines provided in MUAs was much greater (up to 77.1%).ConclusionCommunity pharmacies are convenient and accessible venues at which patients can obtain seasonal influenza vaccines and other immunizations. They are well-positioned throughout the country, including in areas that are otherwise medically underserved. These factors help community pharmacists eliminate one of the most important barriers to vaccination: accessibility.     

Evaluating the feasibility of pharmacist-facilitated tobacco cessation interventions in independent community pharmacies in rural Appalachia

BackgroundSmoking rates in the United States are the highest in underserved rural regions. Thus, more points of contact are needed to link smokers to evidence-based cessation programs.ObjectivesThe purpose of this study was to conduct an evaluation to determine the feasibility, acceptability, and interest among rural pharmacists in implementing a pharmacist-facilitated smoking cessation program in independent community pharmacies in rural Appalachian communities in Virginia, North Carolina, Tennessee, and West Virginia.MethodsThis study utilized a complementary sequential mixed-methods approach to explore independent community pharmacists and technicians’ experiences and beliefs about implementing a tobacco cessation program in their pharmacy.ResultsThere were 49 pharmacists or technicians who completed the survey and 7 pharmacists who participated in the interviews. Four main findings emerged from the data: 1) pharmacies can help fill the gap in tobacco cessation services in rural communities, 2) under current practice, tobacco cessation resources when offered by independent community pharmacies are not always formalized, 3) there are known barriers, such as reimbursing for services, that need to be addressed to provide tobacco cessation in an independent pharmacy setting, and 4) the Ask-Advise-Connect model is a feasible tobacco cessation approach in a pharmacy.ConclusionAlthough pharmacists may be ideally situated to build capacity for smoking cessation in rural areas, smoking cessation interventions need to use existing approaches that compensate pharmacists for their time spent counseling patients. Furthermore, simple documentation and billing systems are needed to maximize utilization of tobacco cessation products and services provided in the pharmacy.     

Vaccination delivery by chain pharmacies in California: Results of a 2007 survey

ObjectiveTo better understand the practice standards and scope of pharmacist-administered vaccination services at chain pharmacies in California.DesignCross sectional.SettingCalifornia in 2006–2007.ParticipantsEight state-level immunization coordinator corporate liaisons to chain pharmacies’ immunization programs.InterventionKey informant phone survey with follow-up written survey.Main outcome measuresPolicies, procedures, and vaccine usage.ResultsAll eight chains provided immunization services to adults; four chains also vaccinated adolescents. More than 1,000 California pharmacists employed at chain pharmacies have been trained to vaccinate; more than 500 locations participate with evening, weekend, and walk-in hours. Influenza and pneumococcal vaccines were the most common vaccines administered. Other vaccines were used less frequently. Respondents expressed interest in partnering with public health to improve record sharing, build awareness, receive vaccine news updates, and explore other activities.ConclusionChain pharmacies in California have started to vaccinate adults and adolescents—two commonly undervaccinated age groups. To date, patients seeking vaccination at pharmacies are most likely to receive influenza and pneumococcal vaccines. Community locations and extended hours offer patients convenience, although out-of-pocket fees may be a barrier to some patients. Opportunities exist to build and strengthen partnerships among public health, the medical community, and pharmacists in order to vaccinate and protect patients not vaccinated in traditional settings.     

Perceptions and barriers to the annual influenza vaccine compared with the coronavirus disease 2019 vaccine in an urban underserved population

BackgroundFor a vaccine to be successful, communities must perceive it as important, safe, effective, and necessary. However, there are many barriers and hesitancies to vaccination. Underserved patient populations may face additional challenges related to access and cost. Because community pharmacists improve vaccine access and increase vaccination rates, it is beneficial for pharmacists to understand perceptions and barriers to vaccinations in their community to increase vaccine confidence.ObjectivesThis study aims to assess and compare barriers and perceptions of the annual influenza to the coronavirus disease 2019 (COVID-19) vaccine for underserved patients of a charitable pharmacy.MethodsPatients who qualified to receive medications from an outpatient charitable pharmacy took an electronic survey when receiving medications. The survey incorporated questions developed by the World Health Organization’s Strategic Advisory Group of Experts on Vaccine Hesitancy on a 5-point Likert scale. Questions about the influenza and COVID-19 vaccines mirrored one another. Demographic data such as age, race, sex, and education level were also collected.ResultsOf the 189 patients surveyed at the charitable pharmacy, 71.7% were 55 years old and older and 58.9% were female. Of note, 78% and 77% of participants agreed or strongly agreed that the influenza and COVID-19 vaccines, respectively, were important for the health of others in their community. Adverse effects and the cost of the COVID-19 vaccine were noted to be statistically significantly more of a concern with the COVID-19 vaccine than that of the influenza vaccine (P < 0.001).ConclusionEnsuring equitable vaccine access, promoting the COVID-19 vaccine as free, and eliciting and addressing individual persons’ concerns related to vaccine safety and adverse effects are all important ways pharmacists and other health care providers and community stakeholders can help promote vaccine confidence within the populations they serve.     

Student pharmacist perceptions of community advanced pharmacy practice experiences and the impact on professional development

ObjectivesThis study was conducted to investigate the clinical experience that student pharmacists are exposed to during their core community Advanced Pharmacy Practice Experience (APPE) and how this affects their professional development.DesignCross-sectional survey.Setting and participantsA national survey of student pharmacists in their APPE year was conducted using the American Pharmacists Association broadcast e-mail system. The electronic survey consisted of 22 total items with 7 items pertaining to professional development, which focused on advanced professional learning intended to improve knowledge, competence, and skill. Students were included in this study if they were in their APPE year at the time of the study.Outcome measuresThe outcomes of interest in this study were to identify student pharmacist exposure to clinical services on their core community APPE and the impact these clinical exposures had on their professional development.ResultsResponses were collected from 429 students across the United States with a response rate of 11%. Of those results, 325 participants responded as having completed their core community APPE or currently completing with more than 50% completed. Student self-reported sufficient exposure in performing educational, patient care, and wellness services improved the professional development composite score. Comparatively, student pharmacists who self-reported “None” to the exposures had a lower professional development composite score.ConclusionStudent pharmacists who self-reported sufficient exposure to clinical services on their core community APPE had statistically higher professional development composite scores than those who did not report sufficient exposure. Experiential educators in community pharmacy practice nationwide may benefit from the results of this study as a tool to supplement their mentorship and enhance student pharmacist professional development.     

Influenza vaccination by pharmacists in a health sciences center: A 3-year experience

ObjectiveTo assess the design and implementation of influenza vaccination clinics across campus, assess participant satisfaction with the pharmacist-led clinics, and educate and increase visibility of the role of pharmacists as vaccinators.SettingUniversity of Oklahoma Health Sciences Center (OUHSC), a comprehensive health sciences center.Practice innovationThe College of Pharmacy on the OUHSC campus developed and implemented a vaccination program to increase influenza vaccination of OUHSC employees.Main outcome measuresNumber of employees receiving influenza vaccination, employee satisfaction with the pharmacist-led clinics, and employee awareness of the pharmacist's role in vaccination.ResultsReported OUHSC employee influenza vaccination rates increased from approximately 35% before implementation of the pharmacy-based program to 54% in 2012 after implementation. The increase was attributed to maintaining no out-of-pocket costs for employees, offering various clinic locations, and using media resources to educate employees about influenza infection and vaccination. Employees reported high satisfaction with the influenza vaccination clinics and with receiving vaccinations from pharmacists and student pharmacists. In the first 2 years of the program, the percentage of surveyed employees “very familiar” with the pharmacist's role in vaccinations increased from 23% to 66%.ConclusionA college of pharmacy on a large health sciences center developed and successfully implemented an influenza vaccination program, providing an accessible and convenient route for influenza prevention to employees, as well as enhanced the visibility of pharmacists as vaccination providers.