Costs of adult vaccination in medical settings and pharmacies: an observational study

Pharmacy-Based Influenza Vaccination: A Study of Patient Acceptance in Romania

Background

This study explores patient acceptance of influenza vaccination administered by pharmacists in Romania during the 2023 season, considering it a novel strategy to address gaps in knowledge. Pharmacy-based vaccination deviates from traditional methods, providing high-risk patients with full reimbursement and others with 50% reimbursement, allowing a choice between family doctors and pharmacies for vaccine administration.

Material and Method

The survey includes 15 questions covering socio-demographic data, health information, vaccination preferences, and perceptions of pharmacy-based vaccinations.

Results

Respondents showed a positive inclination toward pharmacy-based vaccination, with 68% expressing favorable sentiments, but an awareness gap exists, as only 36% were aware of pharmacy-based vaccination availability.

Conclusion

Challenges include a lack of patient awareness and understanding of benefits, emphasizing the need for structured pharmacist-patient dialogues. Legal changes, a defined funding mechanism, and collaboration are crucial for successful implementation. The study provides valuable insights into patient perceptions, contributing to discussions on optimizing influenza vaccination coverage in Romania and beyond and recognizing pharmacies' potential in achieving broader vaccination goals.

Pharmacists' readiness and willingness to vaccinate the public in United Arab Emirates community pharmacies: A cross-sectional study

Background

Pharmacist-administered vaccination is currently implemented in many countries worldwide. It has contributed to increased vaccine access and vaccine uptake. This observational cross-sectional study assessed community pharmacists' willingness, and readiness to administer vaccines to the public in the United Arab Emirates (UAE) and relate it to national and international policies on vaccination.

Methods

This research was an online survey of 24-questions that was made available to community pharmacists via social media and WhatsApp. The survey was open for six weeks (from April to June 2022). Descriptive and inferential analysis was performed.

Results

The questionnaire was completed by 374 of 575 (65%) respondents. More than half (64.2%) of the respondents agreed or strongly agreed that pharmacists should be able to vaccinate and 68.4% responded that they were willing to administer vaccines if local regulations allowed them to vaccinate. Most (81.8%) expressed willingness to complete training required to be able to administer vaccines in their pharmacies. Logistic regression showed that pharmacists defined as having high readiness were significantly more willing to undergo all essential training to start a vaccination service in their pharmacies than were pharmacists with poor readiness (OR 2.647; 95% CI: 1.518-4.615; p=0.001). High readiness was also significantly associated with agreement on safety of pharmacy-based vaccination (p=0.027).

Conclusions

The majority of community pharmacists surveyed showed readiness to commence pharmacy-based vaccination services. Those with high readiness characteristics are amenable to receiving essential training and consider that vaccination in the community pharmacy setting would be safe.

Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review

CONTEXT

Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities.

OBJECTIVE

The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies.

METHODS

We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion.

RESULTS

A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them.

CONCLUSION

Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.

Pharmacists’ readiness and willingness to vaccinate the public in United Arab Emirates community pharmacies: A cross-sectional study

Background: Pharmacist-administered vaccination is currently implemented in many countries worldwide. It has contributed to increased vaccine access and vaccine uptake. This observational cross-sectional study assessed community pharmacists’ willingness, and readiness to administer vaccines to the public in the United Arab Emirates (UAE) and relate it to national and international policies on vaccination.  Methods: This research was an online survey of 24-questions that was made available to community pharmacists via social media and WhatsApp. The survey was open for six weeks (from April to June 2022). Descriptive and inferential analysis was performed.   Results: The questionnaire was completed by 374 of 575 (65%) respondents. More than half (64.2%) of the respondents agreed or strongly agreed that pharmacists should be able to vaccinate and 68.4% responded that they were willing to administer vaccines if local regulations allowed them to vaccinate. Most (81.8%) expressed willingness to complete training required to be able to administer vaccines in their pharmacies. Logistic regression showed that pharmacists defined as having high readiness were significantly more willing to undergo all essential training to start a vaccination service in their pharmacies than were pharmacists with poor readiness (OR 2.647; 95% CI: 1.518–4.615; p=0.001). High readiness was also significantly associated with agreement on safety of pharmacy-based vaccination (p=0.027).  Conclusions: The majority of community pharmacists surveyed showed readiness to commence pharmacy-based vaccination services. Those with high readiness characteristics are amenable to receiving essential training and consider that vaccination in the community pharmacy setting would be safe.

Pharmacy-based immunization: a systematic review

Background

The coronavirus disease 2019 pandemic has prompted the exploration of new response strategies for such health contingencies in the near future. Over the last 15 years, several pharmacy-based immunization (PBI) strategies have emerged seeking to exploit the potential of pharmacies as immunization, medication sale, and rapid test centers. However, the participation of pharmacies during the last pandemic was very uneven from one country to another, suggesting a lack of consensus on the definition of their roles and gaps between the literature and practice.

Purpose

This study aimed to consolidate the current state of the literature on PBI, document its progress over time, and identify the gaps not yet addressed. Moreover, this study seeks to (i) provide new researchers with an overview of the studies on PBI and (ii) to inform both public health and private organization managers on the range of possible immunization models and strategies.

Methodology

A systematic review of scientific qualitative and quantitative studies on the most important scientific databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyzes guidelines were followed. Finally, this study discusses the trends, challenges, and limitations on the existing literature on PBI.

Findings

Must studies concluded that PBI is a beneficial strategy for the population, particularly in terms of accessibility and territorial equity. However, the effectiveness of PBI is affected by the economic, political, and/or social context of the region. The collaboration between the public (government and health departments) and private (various pharmacy chains) sectors contributes to PBI's success.

Originality

Unlike previous literature reviews on PBI that compiled qualitative and statistical studies, this study reviewed studies proposing mathematical optimization methods to approach PBI.

Pharmacist's Perspectives on Administering a COVID-19 Vaccine in Community Pharmacies in Four Balkan Countries

Community pharmacists expanded their roles and engaged in vaccination services in many countries around the world, but not in Balkan countries. This research aimed to assess the perceptions of pharmacists on involvement in the coronavirus disease (COVID-19) vaccine administration in four Balkan countries (Albania, Bulgaria, Romania, and Serbia). A cross-sectional survey was conducted using an online questionnaire that was distributed to community pharmacists across these countries between February and March 2021. A total of 636 community pharmacists were included in the analysis of the survey. The willingness to administer vaccines for COVID-19 (or other vaccines well established in the practice, like a flu vaccine) in community pharmacies is significantly different among the countries: the pharmacists from Albania were more willing to administer vaccines. The factors associated with the eagerness to vaccinate are almost the same among the countries: the lack of training in the faculty classes and the lack of a special place where to administer vaccines. Additional significant factors were found in Bulgaria (pharmacists from independent pharmacies wanted more than the pharmacists working in chain pharmacies to administer vaccines) and in Serbia (male pharmacists agreed more with administering vaccines than female pharmacists). Further national reforms are needed for adopting the expanding role of community pharmacists.

Who receives influenza vaccinations at the Pharmacy? An analysis of the Texas Behavioral Risk Factor Surveillance System

INTRODUCTION

Vaccination helps to prevent influenza infection and reduce associated costs but the influenza vaccination rate in Texas for adults between the ages of 18 to 64 years old is the lowest in the US. Pharmacies and alternative locations have been shown to help increase vaccination rates but many adults still go unvaccinated.

OBJECTIVE

This research aims to determine the factors associated with obtaining influenza vaccination at the pharmacy compared to non-pharmacy locations in Texas.

METHOD

This study used pooled Texas Behavior Risk Factor Surveillance System datasets (2014 to 2018) for this assessment. The main outcome variable was categorized into pharmacy and non-pharmacy vaccination locations and analyzed using a logistic regression analysis. Further statistical analysis was done using a multinomial logistic regression after re-categorizing the outcome variable into pharmacy, doctor office, and other locations.

RESULT

Blacks were 63% (AOR 0.37, C.I. 0.26, 0.50) and Hispanics were 38% (AOR 0.62, C.I. 0.48, 0.80) less likely to receive influenza vaccinations at the pharmacy respectively when compared to Whites. Furthermore, those who did not live in a Metropolitan Statistical Area (MSA) were 33% (AOR 0.67, C.I 0.53, 0.84) less likely to receive influenza vaccinations at the pharmacy compared to those who lived in an MSA. While there was no observed difference in the likelihood of receiving influenza vaccination, the unemployed population were 40% (AOR 1.40, C.I 1.15, 1.71) more likely to be vaccinated in the pharmacy compared to the employed population.

CONCLUSION

There is potential for increased utilization of pharmacies as a source of influenza vaccination in Texas. Racial differences exist both for receiving influenza vaccinations and being vaccinated in the pharmacy. Influenza vaccination advocacy and education efforts may be necessary to improve pharmacy-based vaccination in Texas, especially for minorities and rural-dwelling Texans.

Primary healthcare policy and vision for community pharmacy and pharmacists in the United States

The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.

A Review of the Pharmacist as Vaccinator

Objective:

The aim of this study is to review literature about how the pharmacist’s role as vaccination providers has been financially and clinically measured.

Methods:

A broad literature search was conducted up to May 2016 to identify economic or clinical data on pharmacy vaccinations. MEDLINE® and PUBMED databases were searched for publications useful or potentially useful for this review. The NIH and CDC websites were also searched for relevant materials. Search terms included vaccination, pharmacist, economic, pharmacoeconomics, cost, benefits cost-effectiveness, physicians, immunizations, vaccinations, pharmacy vaccines, cost, physician vaccines, financial, benefit, ambulatory pharmacist vaccination, clinical pharmacist, economics, pharmacist vaccine impact.

Results:

The search yielded a total of 68 articles of which 12 met the criteria to be included in this review. After examining articles for relevance to pharmacy vaccinations, two tables were created to highlight the clinical and economic advantages of the pharmacist as a vaccinator.

Conclusion:

Pharmacists who administer vaccines are an underutilized provider. This literature review reveals a pattern among studies measuring the pharmacist’s impact on vaccination rates, patient preferences, and cost savings. Pharmacists have a history of demonstrated dependability, accuracy, and cost effectiveness. State laws, collaborative agreements, and health plans have continued to prevent patients from using the pharmacy to receive the CDC recommended vaccines. These barriers ultimately delay the Healthy People 2020 goals.

Cost-effectiveness of increased influenza vaccination uptake against readmissions of major adverse cardiac events in the US

Background

Although influenza vaccination has been shown to reduce the incidence of major adverse cardiac events (MACE) among those with existing cardiovascular disease (CVD), in the 2015–16 season, coverage for persons with heart disease was only 48% in the US.

Methods

We built a Monte Carlo (probabilistic) spreadsheet-based decision tree in 2018 to estimate the cost-effectiveness of increased influenza vaccination to prevent MACE readmissions. We based our model on current US influenza vaccination coverage of the estimated 493,750 US acute coronary syndrome (ACS) patients from the healthcare payer perspective. We excluded outpatient costs and time lost from work and included only hospitalization and vaccination costs. We also estimated the incremental cost/MACE case averted and incremental cost/QALY gained (ICER) if 75% hospitalized ACS patients were vaccinated by discharge and estimated the impact of increasing vaccination coverage incrementally by 5% up to 95% in a sensitivity analysis, among hospitalized adults aged ≥ 65 years and 18–64 years, and varying vaccine effectiveness from 30–40%.

Result

At 75% vaccination coverage by discharge, vaccination was cost-saving from the healthcare payer perspective in adults ≥ 65 years and the ICER was $12,680/QALY (95% CI: 6,273–20,264) in adults 18–64 years and $2,400 (95% CI: -1,992–7,398) in all adults 18 + years. These resulted in ~ 500 (95% CI: 439–625) additional averted MACEs/year for all adult patients aged ≥18 years and added ~700 (95% CI: 578–825) QALYs. In the sensitivity analysis, vaccination becomes cost-saving in adults 18+years after about 80% vaccination rate. To achieve 75% vaccination rate in all adults aged ≥ 18 years will require an additional cost of $3 million. The effectiveness of the vaccine, cost of vaccination, and vaccination coverage rate had the most impact on the results.

Conclusion

Increasing vaccination rate among hospitalized ACS patients has a favorable cost-effectiveness profile and becomes cost-saving when at least 80% are vaccinated.

The impact of pharmacy-based immunization services on the likelihood of immunization in the United States

OBJECTIVES

A major policy to increase immunization rates against infectious diseases in the United States has included pharmacy-based immunization services. We aimed to determine the impact of pharmacy-based immunization services on the likelihood of adult influenza and pneumococcal immunization.

DESIGN

National individual-level immunization data were merged with pharmacy-level data on the availability of immunization services for 8466 pharmacies from a national pharmacy chain. County-level variation in availability of vaccines from 2006 to 2010 was used to characterize exposure to immunization services. We used a longitudinal logistic regression model to estimate the impact of pharmacy-based immunization services on the outcomes of interest.

SETTING AND PARTICIPANTS

We conducted the main analysis in the U.S. adult population. We conducted subgroup analyses of high-risk populations, including people 65 years of age or older.

OUTCOME MEASURES

Odds of being immunized for influenza or pneumococcal disease after exposure to the service compared with before the service while controlling for existing trends in immunization rate growth and other confounders.

RESULTS

Each additional year of exposure to pharmacy-based immunization services was associated with a 1.023 (CI 1.012-1.034) greater odds of reporting an influenza immunization and a 1.016 (CI 1.006-1.027) greater odds of reporting a pneumococcal immunization. Five years after national implementation, we estimate that 6.2 million additional influenza immunizations and 3.5 million additional pneumococcal immunizations are attributable to pharmacy-delivered immunization services each year. Subgroup analyses further indicate that the policy increased the odds of immunization for both diseases over time among adults 65 years of age or older (influenza odds ratio [OR] 1.025, CI 1.013-1.038; and pneumococcal OR 1.026, CI 1.010-1.042).

CONCLUSION

Pharmacy-based immunization services increased the likelihood of immunization for influenza and pneumococcal diseases, resulting in millions of additional immunizations in the United States.

Community pharmacies as sites of adult vaccination: A systematic review

Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative approaches to immunization delivery may help address under-vaccination among adults. This systematic review assesses the feasibility, acceptability, and effectiveness of community pharmacies as sites for adult vaccination. We searched 5 electronic databases (PubMed, EMBASE, Scopus, Cochrane, LILACS) for studies published prior to June 2016 and identified 47 relevant articles. We found that pharmacy-based immunization services (PBIS) have been facilitated by state regulatory changes and training programs that allow pharmacists to directly provide vaccinations. These services are widely accepted by both patients and pharmacy staff, and are capable of improving access and increasing vaccination rates. However, political and organizational barriers limit the feasibility and effectiveness of vaccine delivery in pharmacies. These studies provide evidence to inform policy and organizational efforts that promote the efficacy and sustainability of PBIS.