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Ryan GW, Kahl AR, Callaghan D, Kintigh B, Askelson NM. Locations of COVID-19 vaccination provision: Urban-rural differences. J Rural Health 2023. [PMID: 37957524 DOI: 10.1111/jrh.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Our goal was to compare locations of COVID-19 vaccine provision in urban and rural communities over the course of the pandemic. METHODS We used the Iowa Immunization Registry Information System (IRIS) to identify the organizations providing COVID-19 vaccines (eg, pharmacies, public health departments, and medical providers). Proportions of first-dose vaccines by organization type and patient census-based statistical area were generated. We calculated Chi-square tests to assess differences among metropolitan, micropolitan, and noncore communities. FINDINGS IRIS data revealed that 64% (n = 2,043,251) of Iowans received their first COVID-19 vaccine between December 14, 2020, and December 31, 2022. For metropolitan-dwelling individuals, most first doses were administered at pharmacies (53%), with similar trends observed for micropolitan (49%) and noncore (42%) individuals. The second most common location for metropolitan individuals was medical practices (17%); public health clinics and departments were the second most common provider for micropolitan (26%) and noncore (33%) individuals. These trends shifted over time. In December 2020, hospitals were the most common vaccine provider for everyone, but by December 2022, medical providers were the most common source for metropolitan individuals, and pharmacies were most common for micropolitan and noncore individuals. CONCLUSIONS Trends in the type of vaccine provider differentiated metropolitan residents from micropolitan and noncore residents. For the latter groups, local public health departments played a more significant role. Across all groups, pharmacists emerged as a critical vaccine provider. Our findings can be used to plan for seasonal vaccine campaigns as well as potential future mass vaccination campaigns.
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Affiliation(s)
- Grace W Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Don Callaghan
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Bethany Kintigh
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
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Chadi A, Thirion DJG, David PM. Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review. BMC Public Health 2023; 23:1855. [PMID: 37741997 PMCID: PMC10518112 DOI: 10.1186/s12889-023-16601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
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.
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Affiliation(s)
- Alexandre Chadi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
| | - Daniel J G Thirion
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
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Christian I, Cafer A, Brenner D, Rosenthal M. Defining rural spaces within pharmacy practice research: Current practice and implications. J Am Pharm Assoc (2003) 2023; 63:1490-1494. [PMID: 37088365 DOI: 10.1016/j.japh.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
The literature suggests that community pharmacies are a critical buffer to poor health for rural spaces, which are disproportionately impacted by a lack of facilities, providers, and resources. Yet, the actual impact is hard to measure because location is not often considered in assessments of community pharmacy practice. We explored the definitions applied to rural spaces in community pharmacy practice-based research studies that explicitly discuss rural pharmacy practice in 2 U.S. based pharmacy practice research publications. Across both journals, we identified 10 articles that used 8 different definitions of "rural" including both a variety of federal designations and idiosyncratic definitions developed just for that research. A consensus definition in rural community pharmacy practice research could make comparison across studies possible, help to build the evidence base for rurally focused interventions, and ultimately improve patient outcomes in this setting.
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Sullivan E, Zahnd WE, Zhu JM, Kenzie E, Patzel M, Davis M. Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act. J Gen Intern Med 2022; 37:2941-2947. [PMID: 34981345 PMCID: PMC9485404 DOI: 10.1007/s11606-021-07229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. OBJECTIVE Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. DESIGN We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. PARTICIPANTS American Community Survey data representing Oregon adults. MAIN MEASURES Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). KEY RESULTS Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. CONCLUSIONS Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.
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Affiliation(s)
- Eliana Sullivan
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA.
| | - Whitney E Zahnd
- Arnold School of Public Health, Rural & Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Erin Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Mary Patzel
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Melinda Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Yu H, Klompas M, Kofner A, Horvitz-Lennon M, Zhang F, McKernan S. COVID-19 Vaccination: Concerning Trends in Primary Care Health Professional Shortage Areas. Am J Prev Med 2022; 63:e31-e33. [PMID: 35277314 PMCID: PMC8825564 DOI: 10.1016/j.amepre.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan McKernan
- Department of Preventive and Community Dentistry, The University of Iowa, Iowa City, Iowa
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Mohamed R, Kelly KM, Nili M, Kelley GA. A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake. J Am Pharm Assoc (2003) 2022; 62:1142-1153. [DOI: 10.1016/j.japh.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
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Fernandes BD, Foppa AA, Almeida PHRF, Lakhani A, Lima TDM. Application and utility of geographic information systems in pharmacy specific health research: A scoping review. Res Social Adm Pharm 2021; 18:3263-3271. [PMID: 34836813 DOI: 10.1016/j.sapharm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. OBJECTIVES The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. METHODS During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. RESULTS After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables. CONCLUSIONS GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.
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Affiliation(s)
- Brígida Dias Fernandes
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo (UFES), Avenida Marechal Campos, 1468, Bonfim, Vitória, Espirito Santo, 29047105, Brazil.
| | - Aline Aparecida Foppa
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Ali Lakhani
- School of Psychology and Public Health, La Trobe University, 360 Collins St, Melbourne, Victoria, Australia, 3000; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia, 4131.
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro (UFRRJ), Brazil.
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