No salt needed for vaccination study: researcher


vaccination - vaccine bottle and needle

The lead author of the recent WA vaccination study, Dr Laetitia Hattingh, has hit back at a GP’s claims that profit drives pharmacist vaccination and the study should be taken with a “pinch of salt”.

Dr Hattingh labelled turf war politics over pharmacist vaccination as “unhelpful,” particularly when the study showed pharmacist vaccination is safe and profit is far from the main driver.

GP Dr Edwin Kruys has again taken aim at community pharmacy, writing in his Doctor’s Bag blog that the success of new health services in community pharmacies should be measured by “the way they integrate and communicate with the rest of primary care including general practice”.

“Recently we’ve heard about the ‘success’ of pharmacy trials in several states,” he writes, citing the recent WA trial, which reported earlier this month that more than 15,000 vaccinations were administered in pharmacy with no adverse effects.

“However, the question arises: by what measure are the trials a success?” he asks.

“Many of my patients tell me they’ve been vaccinated at a pharmacy but have forgotten where, when and with what exactly – and communication from the pharmacy is usually missing.”

He disputes claims that pharmacy vaccination only targets “people who don’t have a GP, or people who fall outside the national immunisation program” as well as walk-in convenience.

But Dr Hattingh says that the claim that pharmacists in the trial were not communicating with GPs is not correct.

“He claims that there’s lack of continuative care because the doctors don’t know where or if the patients have been vaccinated, but in WA it’s actually part of the pharmacist vaccination code that they should notify the patient’s prescriber,” Dr Hattingh pointed out to AJP today.

“Under the code, they are required to do it: the pharmacist is to provide notification to any GP or primary health practitioner nominated by the patient, of their name, address, date of vaccination and any reaction.

“So all the WA pharmacists I’ve spoken to have said, ‘I had to do that anyway’.”

She says she would like to see this legislation extended country-wide.

Dr Kruys again attacked the original Queensland immunisation trials, labelling them “superficial, selective and showed elements of observer bias”.

He also complained that there has been “no mention of whether commercial practices have been monitored, such as using vaccinations as a means to onsell other products.

“As we know, the pharmacy business model relies heavily on upselling products to patients,” he writes. “There is a well-known conflict of interest in pharmacists delivering health services including vaccinations.

“It is clear to me that the claimed success of pharmacy vaccinations has to be taken with a pinch of salt.

“If community pharmacy is able to better integrate their services with the rest of primary care, including general practice, the resulting model has the potential to become truly successful.

“If, on the other hand, the main drivers continue to be profit and sales – leading to more fragmentation and duplication – the model will fail and others may take over medication dispensing soon.”

Dr Hattingh told the AJP that part of the WA research included asking pharmacists in the first phase of the study, before they began vaccinating, why they were keen to do so.

“Profit is the least likely consideration for the pharmacist in deciding to offer the service,” she says.

“The highest rating was given to wanting to enhance the role of pharmacists, and the second was to increase consumer vaccination rates. Out of six options, the lowest one by far was for financial gain.”

Pharmacist vaccination not only helps save the taxpayer money, but also gives consumers choice, she says.

“Our research did show that some patients still qualified under the National Immunisation Program, but still chose to have their vaccination done in pharmacy,” says Dr Hattingh.

“And if they want to go to a pharmacy and pay the $25 that’s their choice – the fact is that the Government saves a lot of money from people getting vaccinated in pharmacy.

“Those people also don’t pay the consultation fee – if they get the vaccine from their doctor, the doctor still gets money from the Government, and the patient sometimes also has to pay an additional private fee to that doctor anyway.

“This is about choice, convenience and accessibility,” she says.

Dr Hattingh says GP-pharmacist spats about services such as vaccination are ultimately unhelpful.

“One of the things our studies showed was that some of the pharmacists we interviewed said providing vaccination services actually helps their relationship with their GP.

“At the end of the day, the turf war is not helping patients.

“This study has been published in a well-respected journal, it’s been through extensive peer review, and so to come back and say, ‘just take it lightly’… I don’t understand the basis for that statement.”

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