Impact of pharmacist-led educational intervention on pneumococcal vaccination rates in cancer patients: a randomized controlled study

Impact of pharmacist intervention on enhancing vaccination coverage: A systematic review and meta-analysis

BACKGROUND

Although vaccines are widely available, vaccination rates remain suboptimal. Pharmacists, as accessible healthcare providers, can potentially improve vaccination rates through education, advocacy, and direct immunization.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effects of pharmacist interventions on vaccination rates.

METHODS

A systematic search of randomized controlled trials (RCTs) and cluster RCTs assessing pharmacist involvement in vaccination was conducted using PubMed, Embase, and Web of Science up to November 2024. The primary outcome was vaccination rates, and a total of 22 studies were included. The Risk of bias was assessed using the Cochrane Risk of Bias Tool 2, and a meta-analysis was performed using a random-effects model in Review Manager 5.4. This review is registered in PROSPERO (CRD42024611321).

RESULTS

Seventeen RCTs were included in the meta-analysis. A pooled risk ratio (RR) of 1.58 [95 % confidence interval (CI) 1.40, 1.79], P < 0.00001 indicated a significant positive effect of pharmacist interventions on vaccination rates for all vaccine types. Significant heterogeneity was observed among the studies (P < 0.00001, I2 = 93 %). Pharmacists as immunizers had a greater impact (RR 1.76 [95 % CI 1.07, 2.88], P < 0.03) compared to their role as advocates (RR 1.59 [95 % CI 1.41, 1.80], P < 0.00001).

CONCLUSION

Pharmacist involvement significantly increases vaccination rates, with their role as immunizers having a particularly pronounced effect. Expanding the roles of pharmacists in vaccination services, primarily in developing countries, could improve global vaccination coverage and help address vaccine hesitancy.

Implementation of a Targeted Technologic Screening Tool to Increase Pneumococcal Vaccine Uptake in Health-System Retail Pharmacies: A Quality Improvement Initiative

Background/Purpose: Pneumococcal vaccination rates among eligible adults are lower than desired. Recently, pneumococcal vaccination guidelines for adults were updated to include new pneumococcal conjugate vaccines (PCV20), taking into consideration age, underlying risk factors, and previous vaccine status. To respond to PCV under-vaccination and help clarify the new guidelines, this project sought to develop a targeted pneumococcal vaccine screening tool and pop-up alert within retail pharmacies across a large health system with the goal of increasing rates of PCV20 vaccination. Methods: A Plan-Do-Study-Act (PDSA) cycle was employed to activate alerts within 24 retail pharmacies for patients indicated to be eligible for PCV20 vaccination. Adult patients who were PCV20 vaccine-naïve, met eligibility requirements, and were due for medication refill were identified through the electronic health record and uploaded to pharmacy software. Pharmacists screened patients for eligibility and inquired about willingness to receive PCV20 vaccine during the upcoming pharmacy visit. Vaccine rates and sociodemographic characteristics were compared before and after the PDSA cycle began, and reasons for patient decline were assessed. Results: Between December 2023 and April 2024, 1821 patients were screened for PCV20 vaccines, with 1369 (75%) patients eligible. Ultimately, 130 patients (9%) received PCV20 through the alert process, yet an additional 285 PCV20 vaccines were administered to additional patients, perhaps due to the intervention's success in promoting the tools such that pharmacists were more comfortable in screening patients for PCV20 vaccinations overall. Overall, the study represented a 140% increase in PCV20 vaccination rates compared to the same period of the previous year. The most common reason for declining vaccination was no interest in vaccines (n=231, 51%). Conclusions: This PDSA cycle demonstrated a vast increase in PCV20 vaccination rates in retail pharmacies across a large health system, indicating the potential utility of integrated technologic screening tools and alerts to increase administration of other routine immunizations.

Adult vaccination in three Eastern Mediterranean countries: current status, challenges and the way forward

INTRODUCTION

Changing population demographics places a premium on optimizing older adult health. Vaccine-preventable diseases represent a substantial clinical and economic burden in older adults (≥65 years).

AREAS COVERED

This narrative review summarizes the adult immunization landscape in three countries; Saudi Arabia, the United Arab Emirates and Türkiye, informed by literature searches; PubMed (23-27 September 2023) supplemented by citation tracking via Google Scholar). Existing vaccination recommendations and published data were reviewed to evaluate vaccine uptake, chiefly focusing on core adult vaccines (seasonal influenza, pneumococcal, and herpes zoster). Barriers to vaccine access and uptake were reviewed, and initiatives to improve recommended vaccine uptake in older (≥65 years) or otherwise high-risk adults are described.

EXPERT OPINION

Uptake of recommended adult vaccines is low in all three countries. Receipt of annual seasonal influenza vaccine is typically below 50% in both older and at-risk younger adults; pneumococcal vaccination rates are even lower in eligible adults (<15% and often far lower), as is herpes zoster vaccine uptake (typically <5%). Low coverage is driven chiefly by low awareness of vaccine benefits, inconsistent recommendations, and vaccine hesitancy, together with often complex adult vaccine access pathways. Initiatives and remedies aimed at augmenting adult vaccination rates are warranted.

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis

Background

Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake.

Objective

To evaluate the influence of pharmacist interventions on public vaccination rate.

Methods

SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed.

Results

Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)].

Conclusion

While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.