Medicare Advantage-pharmacy partnership improves influenza and pneumococcal vaccination rates

A review of factors influencing vaccination policies and programs for older adults globally

Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.

An organizational assessment of 101 Community-Based Adult Services centers to identify and address gaps in influenza vaccination among Medicare-Medicaid beneficiaries

INTRODUCTION

Medicare-Medicaid beneficiaries are at high risk of experiencing severe disease from influenza. Yet, immunization assessment followed by influenza vaccination (when needed) are not regularly performed at Community-Based Adult Services (CBAS) centers in/near medically underserved areas. To better understand this challenge, an organizational assessment was conducted in early 2020 to identify and examine modifiable factors that may impede or facilitate immunization assessment and influenza vaccination at CBAS centers in Los Angeles County (LAC), California.

METHODS

All 158 CBAS centers in LAC were asked to complete a 17-question survey. The survey asked about immunization assessment, gaps in communication with primary care providers, knowledge and use of the California Immunization Registry (CAIR), and institutional policies for influenza vaccination. In addition, the survey asked each center about its vaccination policy for staff and clients, including whether or not increasing vaccinations was an interest/priority for the center. Best subsets algorithms (regression models) were performed to identify factors that may influence CBAS centers' practices on immunization assessment and vaccination.

RESULTS

Of the 158 centers, 101 (66 %) completed the survey. A majority did not conduct immunization assessments for influenza (n = 59; 58 %); nearly-two-thirds (n = 70; 71 %) reported it would be feasible to do so if the practice is integrated as part of the individualized/nursing plan of care. Best subsets algorithms showed the strongest factors influencing whether CBAS centers assess for influenza vaccination were: center size, staff training on CAIR, presence of barriers to vaccination, and the belief that it is the center's responsibility to conduct immunization assessments and vaccinations.

CONCLUSIONS

Findings suggest that practice gaps in immunization assessment and influenza vaccination are common at LAC's CBAS centers. Closing these gaps may help LAC (and California) improve influenza vaccine uptake and other vaccinations (e.g., pneumococcal, COVID-19) among the most vulnerable of the state's aging populations, Medicare-Medicaid beneficiaries.

The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis

Background

The underutilization of immunization services remains a big public health concern. Pharmacists can address this concern by playing an active role in immunization administration.

Objective

We performed a systematic review and meta-analysis to assess the impact of pharmacist-involved interventions on immunization rates and other outcomes indirectly related to vaccine uptake.

Methods

A systematic literature search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception to February 2022 to identify randomized controlled trials (RCTs) and observational studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Meta-analyses were performed using a random-effects model.

Results

A total of 14 RCTs and 79 observational studies were included. Several types of immunizations were provided, including influenza, pneumococcal, herpes zoster, Tdap, and others in a variety of settings (community pharmacy, hospital, clinic, others). Pooled analyses from RCTs indicated that a pharmacist as immunizer (risk ratio 1.14 [95% CI 1.12–1.15]), advocator (1.31 [1.17–1.48]), or both (1.14 [1.12–1.15]) significantly increased immunization rates compared with usual care or non–pharmacist-involved interventions. The quality of evidence was assessed as moderate or low for those meta-analyses. Evidence from observational studies was consistent with the results found in the analysis of the RCTs.

Conclusion

Pharmacist involvement as immunizer, advocator, or both roles has favorable effects on immunization uptake, especially with influenza vaccines in the United States and some high-income countries. As the practice of pharmacists in immunization has been expanded globally, further research on investigating the impact of pharmacist involvement in immunization in other countries, especially developing ones, is warranted.