People immunised at pharmacies reported fewer adverse events compared with general practice or other clinics, an Australian study has found
A study that tracked adverse events following flu shots has found positive results for those who were vaccinated in pharmacies.
It also confirmed that active vaccine safety surveillance can be effectively rolled out across the national network of community pharmacies.
Research led by Dr Sandra Salter, a pharmacist and senior lecturer at the University of Western Australia, looked at more than 100,000 individuals receiving their flu vaccination from 22 pharmacies and 90 non-pharmacy sites (general practice or other clinic) between March and October 2020 in WA.
A few days after immunisation, all participants were invited to report adverse events through SMS on their smartphones.
More than 76% responded to the SMS, the majority of these within 24 hours.
Around 5,000 of respondents were vaccinated in a pharmacy, and 72,000 at a non-pharmacy site.
Participants reported similar types of reactions across sites, and these were the usual reactions expected after influenza vaccination – fever, pain, swelling, tiredness, headache.
Those who were vaccinated in a pharmacy reported fewer adverse events (4.8%, n=247) compared with those vaccinated at non-pharmacy sites (6%, n=4356).
This difference still existed after adjusting for age, sex and vaccine brand (OR=0.87, 95% CI: 0.76-0.99, p=0.039).
Among participants aged 65 years and over, those immunised at pharmacies reported similar proportions of any adverse events when compared with participants immunised at non-pharmacy sites after adjusting for age, sex and vaccine brand (OR=0.94; 95% CI: 0.65 to 1.35; p=0.725).
“As participants immunised in pharmacies were significantly younger than those in non-pharmacy sites, it is possible that more complex or sicker participants visited non-pharmacy immunisers,” said Dr Salter and co-authors in BMJ Open.
“However, there was no difference in overall adverse events observed in our subanalysis of the over 65 years age group, whom we might expect to have more comorbidities or be sicker.
“Notably, a surge in demand for early influenza vaccination in 2020 means we did not capture all participants immunised in participating pharmacies, as our integrated system was activated a month after pharmacy vaccinations began. This could have included sicker patients of any age, as they may seek immunisation as early as possible in the season.
“The reason for the observed difference and whether it is a true effect remains unclear. Even if the difference is true, it may simply represent different cohorts being immunised in different sites.
This in itself is of benefit as it indicates pharmacies may capture a different set of people who may otherwise not seek immunisation.
Participants reporting any adverse event were sent a second SMS asking if they visited a doctor, medical centre, after-hours service or hospital ED as a result of their vaccination reaction.
After adjusting for age, sex and vaccine brand, participants immunised at pharmacies reported fewer adverse events for which medical attendance was sought, compared with participants immunised at non-pharmacy sites (OR=0.35; 95% CI: 0.13 to 0.97; p=0.042).
No participants 65 years and over who were immunised at pharmacies reported seeking medical care following an adverse event, compared with 0.3% (n=72) of the same age group immunised at non-pharmacy sites.
The results reveal that pharmacists are safe immunisers who may capture patients not seen in general practice or other clinics, said the authors.
“Our response rates were similar between groups and patient engagement was very high – with 96% of respondents replying within 24 hours,” Dr Salter told AJP.
The use of SmartVax to monitor patient reactions, which is widely used in general practice, ensured equivalence of pharmacy data with GP data, she said.
“This tells us we can trust the data, that pharmacists are safe immunisers, that the public engage with surveillance from pharmacy, and that the public can have confidence in pharmacists’ ability to deliver vaccinations safely.”
Her team has been awarded further funding from WA Health to monitor the safety of COVID-19 vaccines given in WA pharmacies.
Ultimately the research team aims to investigate the safety of any vaccine given by pharmacists and contribute to national active vaccine safety surveillance programs using their tested model, which integrated MedAdvisor’s PlusOne vaccination recording software with the SmartVax active vaccine surveillance tool.
“The system technically can be extended across Australia – at the moment through MedAdvisor pharmacies, and in future potentially to any pharmacy – however we need to finalise a sustainable funding model to do so, as SMS costs are the biggest consumable in the active system,” she said.
“I am hoping that in another month or so I will have a more permanent solution for pharmacy vaccination safety surveillance … and in the meantime will leverage the good work we are doing in our research projects to demonstrate the importance to policymakers.
We are on the cusp of a new period in immunisation, said Dr Salter.
“The crucial next step is to leverage our pharmacists as safe immunisers with access to automated active vaccine safety surveillance, to enable broad scale vaccination programs to be successful,” she told AJP.
“Pharmacists can and should be able to administer National Immunisation Program and travel vaccines, and remuneration models should be properly developed to ensure consistency in funding vaccine provision across all health professionals.
“Our completely novel system offers an end-to-end solution for pharmacists – from bookings, to consent, recording the vaccination, reporting to AIR, active safety surveillance, and then reminders for next vaccinations – all as an automated system.
“Patients, pharmacists and governments can be confident that pharmacists can safely and actively support all immunisation programs in Australia.”
See the full study in BMJ Open.