Appropriately trained pharmacists should eventually provide the full range of vaccinations across Australia, says a leading pharmacy vaccination expert.
WA community pharmacist and the Pharmacy Guild of Australia Vaccination Committee member Paul Rees, who is at the forefront of the move to pharmacist delivered vaccinations, says that at his Innaloo pharmacy, customers have been delighted to find they could receive the flu vaccination in-store.
“We have had expressions of delight from consumers about how convenient and easy it is for them to get vaccinated in the pharmacy,” he says.
“Frankly people were surprised that a pharmacy could provide this service.”
Governments must allow pharmacists to administer the full range of vaccinations, he says.
“We are administering only flu vaccinations in WA at the moment but we have sent a submission to the Health Minister pointing out the 97% satisfaction rate from customers and also pointing out that our course is designed to train pharmacists to administer vaccines, not just flu vaccines,” he says.
“The risks from other vaccines can be addressed in the same way as any issues arising from flu vaccinations – albeit we didn’t have any issues anyway.
“In the interests of better public health outcomes through improved accessibility, it makes good sense for pharmacists to be able to administer the same 17 vaccines that are administered by the nurses who undertake equivalent training.
“Whooping cough is a priority and late last year (Dec 2015) the Government enacted to allow whooping cough vaccines to be delivered at pre-natal clinics and also by midwives.
“This is fine as it picks up the mothers and children but it is all the other relatives and friends of the newborn child who can also bring infection to that child, so we are urging everyone who comes into the pharmacy and who has contact with a newborn to be vaccinated even though we are unable to administer the vaccine at present.
“How sensible it would be to be able to vaccinate them on the spot.”
Pharmacy vaccination is picking up customers who were not being vaccinated against flu at all, he says, rather than poaching from other providers like GPs.
Rees says the pharmacy approached a lot of customers, based on their health condition (such as chronic respiratory or cardiovascular patients) to recommend that they think about getting a flu shot.
“They were pleasantly surprised and in many cases agreed to have their vaccination in-store,” he says.
“They didn’t realise they were at risk and so having the service in the pharmacy, and having pharmacists able to identify at-risk patients, certainly has helped to increase the coverage of the local population who are immunised.”
Rees said that in many cases, consumers decided to have their vaccination in the pharmacy despite the fact they were eligible under the National Immunisation Program and could have returned to their doctor and received the vaccination for free.
“Doctors might see this as us stealing their patients as being on the National Immunisation Program is something that drives them back to their GP but the reality is they weren’t going anyway,” he says.
“They were just going to skip the vaccination because it was a problem getting to the doctor.
“They couldn’t be bothered making another appointment and then sitting in the waiting room at the doctor’s for something they can get right here, right now.
“The ‘right here, right now’ works. It’s what people want and we have been able to easily integrate the walk-in activity within current pharmacy workflow practices whereby we already cater for a vast array of patient needs that require varied levels of complexity and pharmacist time to service.”
“The local GPs have accepted that the pharmacy is vaccinating and that this is how it is now.”
Mr Rees said the pharmacy was picking up a lot of people who had never been vaccinated before or hadn’t been vaccinated for several years.
WA feedback showed there were 24,000 safe vaccinations with 57% of recipients advising they had not been vaccinated before or in the previous year, thereby increasing the level of community protection.
“The biggest reason for people not being vaccinated is that people didn’t think they were at risk or were putting others at risk and just couldn’t be bothered making a separate trip to the doctor to have it done,” says Rees.
“We had more than 20 pharmacists on staff trained so we had two to three pharmacists in the pharmacy at any one time who could deliver the vaccine.
“Western Australia has an unusual, and I think unnecessary, requirement that you must have at least two pharmacists on duty when administering vaccinations. This is an absolute nonsense.”
The Guild calls the tens of thousands of Australians being immunised against the flu by pharmacists a “quiet revolution” in the way vaccination is provided.
No major adverse events have been reported from consumers receiving their vaccinations from a pharmacist in a pharmacy, the Guild reports.
The growing push for full range pharmacy vaccinations comes at a time when the National Health Performance Authority, in its Healthy Communities: Potentially preventable hospitalisations in 2013–14 report – released in mid-December – found that more than 30,000 people nationwide were hospitalised in 2013-14 for conditions that could have been prevented if they were vaccinated.
The report found the majority of admissions were for diseases including whooping cough, chickenpox and severe childhood diarrhoea.
It also found 12,000 people over the age of two months were hospitalised for vaccine-preventable pneumonia and influenza, and a further 18,000 would have avoided hospital if they were vaccinated against whooping cough, chickenpox and severe childhood diarrhoea.
Data from the QPIP Phase 1 trial showed that 15% of those who received their shots through their pharmacy during the trial had never previously been vaccinated against influenza.
In addition, the evaluation of the QPIP Phase 1 showed 10,889 vaccinations were delivered in the pilot and no serious adverse events were encountered.
The data also showed patients were happy to receive their vaccination from pharmacists, with 95% of patients happy to return in the future. Overall the patient satisfaction with the service was 96%.
Following the report, the QPIP was extended to Phase II which also includes pharmacists being able to vaccinate against measles and whooping cough and expanded from 80 pharmacies to 200. The trial was due to conclude in October, however Queensland Health has extended it until the end of March 2016.
The success of Phase 1 of the pilot also gave impetus to moves in other States and Territories to legislate, or begin the process to legislate, to enable pharmacists to deliver vaccinations.
At present, all jurisdictions except the ACT and Tasmania have enacted, or have indicated they will enact, legislation to enable pharmacist delivered vaccinations.
The Guild reports that the state of play in each State and Territory is as follows:
Pharmacists are able to directly administer the influenza vaccine to adults over the age of 16 as long as they have completed approved pharmacist training courses and professional requirements which are specified in the SA Vaccine Administration Code.
The Territory’s Department of Health has finalised legislative instruments to allow NT pharmacists to provide vaccinations, with a pilot program in place for the 2015-16. Participating pharmacists can administer influenza, MMR (measles, mumps and rubella) and DTP (diphtheria, tetanus and whooping cough) vaccines.
Pharmacists in NSW who meet approved immunisation training requirements can supply and administer an influenza vaccine to adults 18 years and over at a retail pharmacy. The pharmacist must have completed a training course conducted by an Australian Pharmacy Council accredited provider and the pharmacist must record each vaccination.
Phase II of the Queensland Pharmacist Immunisation Pilot which is underway and the pilot has been extended to include administering whooping cough and measles vaccines. Queensland Health is considering legislative changes to allow pharmacists outside of the Queensland Pharmacist Immunisation Pilot to commence vaccinating.
Enacting legislation enabling pharmacists to deliver flu vaccinations in 2016 and whooping cough vaccines from 2017 under the state-based immunisation scheme as well as part of the National Immunisation Program.
The Department of Health and Human Services in Tasmania is reviewing pharmacist immunisation training programs with a view to introducing legislative changes.
The ACT Government has completed public consultation to seek feedback on the proposed introduction of an ACT pharmacist vaccination program.
Approved pharmacists in WA have been vaccinating against influenza to adults 18 years and older since early 2015. The WA Pharmacist Vaccination Code outlines criteria that pharmacists and pharmacies must comply with.