A pharmacist-driven academic detailing program to increase adult pneumococcal vaccination

Development and Implementation of Workshops to Optimize the Delivery of Vaccination Services in Community Pharmacies: Thinking beyond COVID-19

Vaccines are widely recognized as the most economically efficient strategy to combat infectious diseases. Community pharmacists, being highly accessible healthcare professionals, have the potential to significantly contribute to the promotion and facilitation of vaccination uptake. In Canada, the jurisdiction of healthcare falls under provincial legislation, leading to variations in the extent of pharmacist practice throughout the country. While some pharmacists in Canada already functioned as immunizers, Québec pharmacists gained the authority to prescribe and administer vaccines in March 2020 amidst the COVID-19 pandemic. Our workshop aimed to equip pharmacists in Québec with the necessary guidance to optimize vaccinations, emphasizing the importance of maintaining and expanding immunization services beyond influenza and COVID-19 vaccines in the future. During the workshop, pharmacists had the opportunity to exchange valuable insights and best practices regarding workflow optimization, identifying areas for improvement in competency, effectively reaching vulnerable population groups, and integrating allied team members into their practice. Participants were also asked to develop a plan of action to help implement practice change beyond the workshop. Interactive workshops centered around discussions like these serve as catalysts for advancing the pharmacy profession, uniting professionals with a collective aim of enhancing patient care.

Barriers and facilitators influencing the management of academic detailing programs: A descriptive analysis of four programs

BACKGROUND

Educating prescribers is a key strategy to reduce inappropriate prescribing in selection, dose, type, timing, and duration. Academic detailing (AD) is a form of continuing medical education to educate prescribers. AD programs have been established in Canada, Australia, the United States, and other countries. Each program operates uniquely to reflect its local context and resources. It remains unclear how AD programs in universal health care systems differ from each other in their program components and experiences.

OBJECTIVES

To compare AD programs focusing on components of resources, activities, and services and to identify factors influencing program efficiency during the processes of program management, topic development, and service delivery among the selected Canadian and international AD programs.

METHODS

We adopted a process evaluation methodology with semistructured interviews and documents. We selected 4 well-established AD programs through an iterative discussion with the BC Ministry of Health: three provincial AD programs in the Canadian provinces of British Columbia, Ontario, and Saskatchewan, and an Australian program based in the State of South Australia. We invited one leader from each program to attend a 1-hour teleconferencing interview.

RESULTS

The 4 programs shared similarities of public government funding while differed in their operation models (centralized vs. decentralized), employment of detailers (part-time vs. full-time; hired by AD programs vs. hired by partnered multidisciplinary primary care teams) and staff who developed topics (detailers vs. nondetailers). The most common barriers were funding and reaching new participants, followed by team connection, detailer training resources, summarizing skills, and AD session scheduling. The most common facilitators were participant retention, participant recruitment through partnership, and easy access sessions.

CONCLUSION

AD programs can potentially guide a prescriber's choice of drug. A program's operation can be impacted by its access to resources and participants, activities, and service design.

Student pharmacists delivering academic detailing on adult pneumococcal vaccination to community pharmacists

BACKGROUND

Academic detailing is an educational outreach approach to disseminate evidence-based information to health care professionals and improve clinical decision making. Pharmacists and physicians are recognized as the most qualified individuals to perform academic detailing; however, trained student pharmacists may also serve as suitable academic detailers.

OBJECTIVES

To describe our academic detailing intervention that used trained student pharmacists to disseminate an updated pneumococcal vaccination clinical pathway (i.e., decision-support tool) and education to community pharmacists in Rhode Island and Massachusetts.

METHODS

We updated an academic detailing initiative that included a pneumococcal vaccination clinical pathway and education for community pharmacists in 2021. Two University of Rhode Island (URI) College of Pharmacy pharmacist faculty members trained 6 student pharmacists to perform academic detailing. Student pharmacists visited URI-affiliated community pharmacies throughout Rhode Island and Massachusetts. After each session, each participant received a 6-question anonymous paper survey to assess the effectiveness of the updated pathway and academic detailing session. The survey used a 5-point Likert-type scale. We assessed the percentage agreement with each question.

RESULTS

Academic detailing was delivered to 76 community pharmacists from May to August 2021. Most respondents agreed (89.2%, 58/65) that their knowledge of which patient populations met eligibility for the pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine improved. Respondents were confident they could apply the knowledge gained (93.8%, 61/65) and intended to apply the pathway (93.8%, 61/65) to clinical practice. Most respondents expected vaccination practices to change because of the academic detailing and education materials received (83.6%, 51/61). Almost all respondents (95.4%, 62/65) found the educational materials easy to understand.

CONCLUSION

Trained student pharmacists can deliver academic detailing regarding adult pneumococcal vaccination to community pharmacists. Enlisting the help of student pharmacists may be a sustainable approach to academic detailing and provides students with valuable opportunities to practice delivering educational outreach to community pharmacists.

Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries

BACKGROUND

There is low uptake of the pneumococcal vaccination in eligible older adults, even in high-income countries that offer routine and universal vaccination programs.

OBJECTIVE

To systematically characterize interventions aimed at improving pneumococcal vaccine uptake in older adults.

DESIGN

We conducted a scoping review following PRISMA-SCr guidelines of five interdisciplinary databases: Medline-Ovid, Embase, CINAHL, PsychInfo, and Cochrane Library. Databases were searched from January 2015 until April 2020. The interventions were summarized into three pillars according to the European Union Conceptional Framework for Action: information campaigns, prioritization of vaccination schemes, and primary care interventions.

RESULTS

Our scoping review included 39 studies that summarized interventions related to pneumococcal vaccine uptake for older adults, encompassing 2,481,887 study participants (945 healthcare providers and 2,480,942 older adults) across seven countries. Examples of interventions that were associated with increased pneumococcal vaccination rate included periodic health examinations, reminders and decision-making tools built into electronic medical records, inpatient vaccination protocols, preventative health checklists, and multimodal educational interventions. When comparing the three pillars, prioiritization of vaccination schemes had the highest evidence for improved rates of vaccination (n = 14 studies), followed by primary care interventions (n = 8 studies), then information campaigns (n = 5 studies).

CONCLUSION

Several promising interventions were associated with improved outcomes related to vaccine uptake, although controlled study designs are needed to determine which interventions are most effective.

Implementation of an academic detailing intervention to increase naloxone distribution and foster engagement in harm reduction from the community clinician

BACKGROUND

Respond to Prevent (R2P) is a randomized clinical trial which sought to accelerate distribution of naloxone and other harm reduction materials from community pharmacies. R2P combined an online continuing education course with in-store materials, specifically designed for use in community pharmacies, and then supported implementation through the one-on-one educational technique of academic detailing.

OBJECTIVE

The objective of this paper is to describe and synthesize our experiences providing academic detailing as part of the R2P randomized trial.

METHODS

Closed-ended items from standardized post detailing questionnaires were analyzed with descriptive statistics. Open-ended items were content analyzed for key themes using immersion-crystallization qualitative methods.

RESULTS

A total of 176 pharmacies participated in R2P with 175 receiving their initial academic detailing visit between August 2019 and May 2021. Initial visits were in-person and lasted a median of 35 minutes (interquartile range, 20-45 minutes). The R2P naloxone guide was the most common topic covered (n = 162, 92.6%). Following a fidelity check to assess adequacy of the R2P program implementation, 80 pharmacies (45.7%) required secondary academic detailing. Secondary detailing was more targeted and most frequently focused on the sale of nonprescription syringes (n = 28; 35.2%) or disposal container distribution (n = 30; 37.5%). Analysis of the open-ended items identified factors that the detailers perceived to affect the quality of academic detailing sessions, including the pharmacy environment, participant knowledge of and attitudes toward the subject matter, and ability of the detailer to remain flexible yet consistent.

CONCLUSION

R2P provided a standardized process to foster naloxone distribution and engagement in harm reduction with demonstrated implementation in 175 community pharmacies across 4 states. Academic detailing was perceived to be well-received and effective at providing education and promoting distribution of naloxone and nonprescription syringes in community pharmacies. Additional research is needed to confirm these perceptions through evaluation post-intervention behavioral and attitude changes.

A survey of Alberta pharmacists' actions and opinions in regard to administering vaccines and medications by injection

BACKGROUND

Pharmacists in Alberta have been authorized to administer vaccines and other medications by injection for more than 10 years; however, little is known about the provision of this service and their opinions regarding this service. Understanding pharmacists' experiences regarding injection services would inform development of strategies to improve provision of injection services.

OBJECTIVES

To describe the actions related to administering an injection, including identification of commonly administered medications, and to identify perceived barriers and facilitators pharmacists face when providing injection services.

METHODS

An online survey was developed and loaded into REDCap, and e-mail invitations were sent to 5714 pharmacists registered with the Alberta College of Pharmacy in October 2020. Responses were analyzed using descriptive statistics. Pharmacists who administered at least one injection in the previous year were considered active providers, and their opinions regarding injection services were compared with nonactive providers.

RESULTS

A total of 397 pharmacists responded to our survey, mean age was 42 years, 66% were female, 82% were community pharmacists, and 90% were active providers. The most common injection, administered by 98% of active providers, was influenza vaccine, followed by vitamin B12 (95%), herpes zoster vaccine (88%), hepatitis vaccines (86%), and pneumococcal vaccines (82%). Nonactive providers were more likely than active providers to report that comfort with administering injections (P < 0.001) and managing adverse reactions (P = 0.013) were moderate or major barriers to providing injections. More than 60% of pharmacists indicated that access and automated reporting to the provincial immunization registry would be essential to increasing the frequency of providing injection services.

CONCLUSION

We identified that Alberta pharmacists administer a wide variety of vaccines and other medications by injection. Respondents identified several barriers and facilitators to providing these services. Addressing these barriers may help improve provision of injection services by pharmacists.

Previsit Planning Improves Pneumococcal Vaccination Rates in Childhood-Onset SLE

BACKGROUND

Childhood-onset systemic lupus erythematosus (c-SLE) is a complex autoimmune disease that requires systemic immunosuppressive therapy. Infections are the second leading cause of death in these patients, with invasive pneumococcal infections being a major preventable cause of morbidity and mortality. Pneumococcal vaccination is recommended in this population; however, vaccination rates remain low.

METHODS

The plan-do-study-act method of quality improvement was applied. We calculated baseline vaccination rates for pneumococcal conjugate and pneumococcal polysaccharide vaccines in patients with c-SLE in the rheumatology clinic from January 2015 to August 2016. We developed an age-based algorithm to simplify the vaccination guidelines. The clinical pharmacist and nurses performed weekly previsit planning to update vaccine records, make targeted recommendations, and ensure vaccine availability. The primary outcome measure was the percentage patients with of c-SLE seen per month who had received age-appropriate pneumococcal vaccination.

RESULTS

The percentage of children receiving at least 1 pneumococcal vaccine increased from 24.9% to 92.7% by 12 months. By 18 months, the compliance rate with both pneumococcal vaccines increased from 2.5% to 87.3%, with sustained results. No serious adverse events or disease flares were reported.

CONCLUSIONS

By identifying the major barriers to pneumococcal vaccination in our population with c-SLE, we significantly improved vaccination rates while decreasing time burden on providers. We attribute our success to a team-based quality improvement approach and plan to implement alerts in the electronic health record to streamline the process.

Improving Nursing Staff Attitudes toward Vaccinations through Academic Detailing: The HProImmune Questionnaire as a Tool for Medical Management

Vaccinations remain the most effective way of preventing infection, disease, and mortality. Public health institutions consequently recommend vaccines to target groups, including healthcare workers, who are considered to be more at risk of exposure and transmission. The aim of this cross-sectional study is to assess, through the administration of a questionnaire, the nursing staff’s knowledge and attitude towards recommended vaccinations, and to explore the effects of a training course (carried out according to the academic detailing methodology) aimed at increasing operators’ knowledge and outreach on recommended vaccinations among healthcare workers. A total of 85 HCWs (30 nursing coordinators and 55 nurses) completed the questionnaire. Results demonstrate a higher rate of agreement towards vaccinations in nursing staff answers (75%), if compared with results of other studies (62–63%). Statistically significant differences between nursing coordinators and nurses can be found. Regarding vaccination attitudes, nursing coordinators agreed in 86% of the answers on healthcare workers’ vaccination vs 70% of nurses (p < 0.001). Considering immunization for influenza, 57% of nursing coordinators vs 18% of nurses reported for vaccination (p < 0.001). Educational programs, carried out according to academic detailing methods, could impact on vaccination attitudes and raise awareness about recommended vaccinations among healthcare workers. The questionnaire is a useful tool for investigating nursing staff knowledge and attitudes towards vaccinations, and to implement strategies to promoting vaccinations among healthcare workers.

Experiences Among African American Community Members With Pharmacy-Based Immunization Services in Detroit, Michigan

Background: Although vaccination rates improved modestly in the United States during the 2014-2015 season, racial and ethnic disparities in the use of vaccines persist. Pharmacy-based immunization programs expand access to immunization services; however, African Americans in one metropolitan community did not have the same level of access to this service as non-Hispanic whites. Objective: To examine the experiences of African Americans with pharmacy-based services and identify how pharmacies and pharmacy organizations can better service patients in urban communities with similar dynamics. Methods: This qualitative study utilized focus group discussions among African American residents in Detroit, Michigan, where there are reported disparities in access to pharmacists that immunize to learn more about their experiences with pharmacy-based immunization services. Results: Three major themes emerged: the pharmacy location is often more convenient and accessible than doctors’ offices, there is clear communication with the pharmacist, and perceived lower immunization fees at pharmacies. Participants found pharmacies easier to access in their community for immunization services. Consistent interaction with familiar pharmacists and pharmacy staff members facilitated strong relationships and dialogue between pharmacists and patients. Patients perceived costs for vaccines to be less at the pharmacy than at their physicians’ offices. Conclusions: Participants reported positive experiences with pharmacy-based immunization services and expansion of these services may influence more African Americans to receive recommended vaccines in this community.