Pharmacy-based immunizations growing, improving

Special Immunization Section

Using an ever-increasing network of patient-referral relationships and taking steps to improve documentation practices, pharmacists are increasing the volume and diversity of immunization services they offer in the pharmacies of America, according to a 2013 survey conducted by APhA.

The national survey assessed pharmacy-based immunizations on behalf of the U.S. Department of Health & Human Services National Vaccine Program Office. Links to the Internet-based survey were e-mailed to 32,603 pharmacists in all pharmacy practice settings from August 24 to September 14, 2013, and 2,351 pharmacists responded.

Expanding access

Overall, 77% of pharmacy practice sites were offering vaccinations on a walk-in basis without an appointment. Compared with 2012 survey results, the use of appointment-based or time-restricted access decreased, with only 36% of practice sites in 2013 offering vaccinations by appointment, compared with 41% in 2012. In addition, immunization services offered via in-store clinics remained low, with 18% of respondents selecting this option, down from 26% in 2012.  

Influenza remained the most commonly administered vaccine (88%). However, the majority of practice sites also reported the current administration of pneumococcal (77%), herpes zoster (75%), and tetanus (57%) vaccines. Fewer than one-half of the practice sites were reported as currently administering vaccines for hepatitis B (47%), hepatitis A (43%), meningococci (43%), human papillomavirus (37%), international travel (25%), and pediatric patients (10%). The percentage of currently administered vaccines was higher for most categories compared with results of the 2012 survey (e.g., herpes zoster vaccine administration was 57% in 2012).  

To successfully expand immunization services beyond influenza, pharmacists ranked their highest priorities (on a 10-point scale) as obtaining the support of public health (7.02), pharmacy management (6.35), and medicine (6.32). Other priorities included training pharmacists on how to counsel patients or offer additional vaccinations (6.25), and aligning or including incentives in performance evaluations of immunizing pharmacists (6.19).

Referrals happening 

The National Vaccine Advisory Committee’s (NVAC) updated Standards for Adult Immunization Practice support the establishment of patient referral relationships to minimize any potential patient barriers to vaccination (see related article on page 66). The 2013 results show that referrals are happening across various groups. Pharmacists reported an increase in patient referrals from physicians (88% vs. 84% in 2012) as a result of various factors, including vaccine availability, cost, reimbursement, and time. In addition, 29% of responding pharmacists reported referring patients to physician offices to address immunization issues. 

Among all practice sites, 22% of respondents were referring patients to other immunizing pharmacists when access was not available at their primary pharmacy practice site. The majority of respondents (56%) reported that other pharmacists had referred patients to them, and 16% of practice sites noted referring patients to their own in-store clinic practitioner. 

Nearly one-quarter of respondents (24%) had referred patients to the public health department. Respondents practicing in independent pharmacies (32%) were most likely to make such referrals. One in 10 practice sites (9%) reported that their immunizing pharmacists have protocols or standing orders with the public health department. 

Documentation key

Another important component of the updated NVAC standards is appropriate documentation that takes advantage of electronic medical records and state immunization registries. The survey noted that 91% of respondents’ practice sites maintain documentation of a patient receiving a vaccination in the pharmacy, 69% provide patients with a copy of their consent form, and 53% enter the vaccination into the patient’s medical record. In addition, more than 6 in 10 respondents (64%) were providing documentation of the patient’s vaccinations directly to the patient’s physician.

Overall, 35% of respondents were entering a patient’s vaccinations into an immunization registry, and 28% noted submitting all immunizations to state or local immunization registries. Only a small percentage of respondents reported submitting adult (7%), childhood (6%), adolescent (5%), and influenza (5%) immunizations to state or local registries; 11% said they were not permitted to access state and local immunization registries.

Onward and upward

The results of APhA’s 2013 immunization survey show the increased administration of numerous vaccines by pharmacists, a growing network of patient referral relationships, and steps being taken toward improved documentation practices. Additional improvements can be made in the coming years by focusing on initiatives that improve immunization access and use of immunization registries.