Pharmacy-based immunizations: Getting the word out
On June 20, 2013, during the CDC Advisory Committee on Immunization Practices meeting, APhA Chief Strategy Officer Mitchel Rothholz, BSPharm, MBA, provided an overview of the profession’s immunization activities and the role of community pharmacies/pharmacists in vaccine delivery in the United States. Playing off the themes discussed by Rothholz, pharmacists can engage patients, physicians, lawmakers, public health officials, and other stakeholders in discussions on the valuable role of pharmacists in vaccine delivery. The complete version of Rothholz’s presentation is available at www.pharmacist.com/node/273635.
“Through immunization activities, the pharmacy profession has demonstrated the value pharmacists bring to the health care team and efforts to improve public health,” said Rothholz. “During the past 20 years, pharmacists’ immunization activities have gained recognition by various immunization stakeholders, including patients and decision makers. As a profession, we are ‘walking the walk.’”
In 1996, the APhA House of Delegates adopted policy that called on pharmacists to get involved in our nation’s immunization priorities. In addition to administering vaccines themselves, where authorized, pharmacists can educate and facilitate patients receiving vaccinations. Pharmacists can assess patient vaccination status, educate patients on immunizations, and motivate patients to get vaccinated.
Key points and other noteworthy facts from Rothholz’s presentation included the following:
- More than 200,000 pharmacists are trained to administer vaccines.
- All 50 states, the District of Columbia, and Puerto Rico authorize pharmacists to administer vaccines at some level.
- Pharmacists are trained on vaccines throughout the human lifespan and can help ensure that patients complete vaccine series.
- More than 96% of pharmacies are computerized and use computers in practice management.
- Pharmacies can target immunization messages to patients using patient data and medication markers.
- Pharmacists are accessible and valued partners on the patient’s health care team.
Supporting the immunization neighborhood
The ultimate goal, said Rothholz, is to create an “immunization neighborhood” in which pharmacists are one of several key players.
“The immunization neighborhood would involve the collaboration, coordination, and communication of immunization stakeholders who are dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases,” said Rothholz.
Key elements of the immunization neighborhood include the following:
- Increasing immunization access points
- Providing enhanced and more consistent patient education and communication
- Documenting outcomes in patient medical records and tracking quality measures. This would require collaboration among primary care physicians and other prescribers, public health officials, and pharmacists, as well as the leveraging of technology (e.g., two-way access to electronic medical/health records).
- Improved collaboration. State laws and regulations make obtaining protocol agreements challenging, and these barriers need to be addressed. Also, consensus needs to be achieved regarding immunization components and definitions. Finally, immunizations need to be integrated with other patient care activities, such as diabetes management.
- Clarification on payment models. Pharmacists need to be recognized as in-network providers, and standard and simplified processes need to be implemented.
On the horizon
According to Rothholz, as new models for health care delivery evolve and a greater number of quality metrics are adopted, pharmacists are positioned to assume greater public health roles on the health care team—built upon pharmacists’ experiences in immunization activities. Pharmacists have an opportunity to help fill access gaps in their communities, whether by, for example, ensuring patients complete their human papillomavirus vaccine series, protecting newborns through increasing Tdap (tetanus–diphtheria–acellular pertussis) immunization rates, addressing adolescent immunization rates, or providing travel health services. These services are provided as part of pharmacists’ role within the immunization neighborhood. New technologies, new systems, and new opportunities will guide the evolution of practice in this area.