Maximising vaccination in the pharmacy space

The author with Professor Lisa Nissen at PSA16 conference, Saturday 30 July 2016.

Pharmacists are not “cannibalising” doctor’s provision of vaccine service, say QPIP trial leader Professor Lisa Nissen

Prof Nissen presented evidence at the PSA conference on Saturday 30 July regarding the vaccination trials that ran in Queensland in 2014.

Influenza is just one vaccination that has been approved for pharmacy, she was quick to highlight – so far, pharmacists have administered 22,835 influenza vaccinations as well as 1834 pertussis and 33 measles injections.

Data show that while about half of patients get vaccinated every year, about 15% have never been vaccinated.

“During the QPIP trial, 5% of people who came to get a pharmacist vaccination had never gotten a vaccination before, ever. For these people who won’t attend their GP for a vaccination, there could be an absolute benefit,” she says.

There was a high uptake of pharmacist vaccinations last year and this was because they received the vaccines before GPs, a convenient occurrence for the high percentage of older people who attend for early vaccination.

“Pharmacists got the vaccines about a month before general practice, and 67% over 65 years of age received their vaccinations before 1 May of 2015,” says Prof Nissen.

“Through facilitating pharmacist vaccination, we’ve opened up a doorway to access preventative healthcare in the community that we didn’t have before,” said Prof Nissen.

Pharmacy vaccinations’ detractors

Many doctors and doctor groups have called their members to “take a stand” against pharmacist vaccination.

For example Dr Edwin Kruys, chair of RACGP Queensland and member of the AMA Queensland Council of General Practice, recently said there is little evidence that delivering vaccinations and other health services via pharmacists will improve efficiency, safety or quality of care for patients.

“People need to ask how commercial interests have been allowed to be placed before health benefits to the Queensland population,” he wrote, before slamming the QPIP trial data as “superficial, selective and shows elements of observer bias.”

He said claims of managing people who had not been vaccinated “are neither verified, nor explained”.

Prof Nissen vehemently disagrees and points to the QPIP trial results as evidence.

“Satisfaction rate was basically 100%. Most participants said they didn’t know pharmacists could do this so it’s about letting them know that we can,” she says.

“Even though GPs say it’s important for them to vaccinate so they have that contact with the patient, most of the time it’s the practice nurse giving the injection,” she adds.

Overseas data shows the same positive results, she says, with the proportion of adults vaccinated in US pharmacies at about 25%.

“This is our future.”

Maximising the space

Evidence from the past year shows having clinic rooms and more screened-off areas, as well as both a walk-in service in addition to bookings, led to a greater number of vaccinations provided.

Post-vaccination follow up is also important about a week later, to check for any adverse events. In the QPIP trials, there were small adverse reactions and mild events as expected.

Pharmacists can look past the administration route of “just injections,” she says.

“Where are the gaps? What are the areas that need an increase in vaccination rates? It’s not about replacing existing services but working with them.

“For example, we probably don’t need to do vaccinations for babies. But there’s potential to provide for children who miss some of their school-based vaccinations. Or perhaps do HPV vaccination follow up.”

“The future for us is about administration and managing adverse events. There are new hypo sprays that fire at a high rate, liquids across the skin, and patches. It’s about us being in the administration space and the competencies.

“We have shown that we are competent in administrating vaccines. But our future can also include injecting biologicals, vitamin B, Depo-Provera.

“It may take some upskilling and training, but think about how we can do these most appropriately. It’s about looking at the opportunity and the door that’s been opened for us, and walking through it,” says Prof Nissen.

A pharmacy in semi-rural NSW

Margaret-Anne Smith, a pharmacist at Medowie Pharmacy in NSW, says she has just completed her training in administering vaccines and is looking forward to practising her new skills.

“We built a brand-new consult room but just missed the beginning of winter, so we’ll be starting out next year nice and early,” Smith told AJP.

As a pharmacy, her team was wary of being the first ones to start vaccinating considering the backlash some GPs have had to the transition.

However, now that a few other pharmacies have begun offering it in the area, Smith says their pharmacy is more confident in offering the service themselves.

“We wanted to start the right way. Now that we’ve got our consult room ready, I believe we can do so,” she says.

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  1. Mouhamad Zoghbi

    In reply to Dr Edwin Kruys comment. I believe that pharmacy may enhance patient efficiency by reducing patient waiting times in comparison to GP’s. On the other hand, when it comes to safety and quality of care for patients, both pharmacists and GP surgeries must ensure that patient safety is the ultimate priority. This means ensuring that the patient is monitored and remains in the pharmacy/surgery to observe for allergies or anaphylactic shock which are more likely to occur up to 30 minutes post vaccine. This is something that I do not feel is practiced appropriately.

    • Karalyn Huxhagen

      as a pharmacist in the QPIP trial and following the trial I can say with hand on my heart that we make our patients wait in the phcy for the recommended waiting time. I have seen some GP practices where patients are isolated and watched by staff to wait in the surgery and others where the patient is lost in the general waiting area and they escape out the door.

      The biggest take home message I took from my time in the immunisation project was the amount of people we vaccinated who would never have gone to a GP. we vaccinated at times when the surgery was closed and gained so many adults (esp males) who would never have made an appointment with a GP. Most could not tell us their regular GP. They pick a GP based on where they are and if the surgery is open.

      I also get miffed about the disparaging remarks about pharmacists when the same GPs do not put down the various ‘clinics’ that perform workplace vaccinations. many workplaces use companies to inoculate their staff to keep staff wellness at its optimum level. Why are we any different to these wellness clinics?

      Is not the whole idea to increase the rate of immunisation in Australia?

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