“Convenience and accessibility”

An evaluation of the first pharmacist-administered vaccinations in WA has shown positive results for patient and practitioner

A team from Curtin University’s School of Pharmacy has evaluated the first run of influenza vaccinations administered by pharmacists in WA between March and October of 2015.

They approached the study using mixed methods including: surveys; analysing pharmacy computer records; and conducting interviews with immuniser pharmacists.

Between March and October 2015, 15,621 influenza vaccinations were administered by pharmacists at 76 WA pharmacies. The researchers found that:

  • there were no major adverse events;
  • less than 1% of patients experienced minor events which were managed appropriately;
  • between 12-17% of patients eligible to receive free vaccinations chose to have it at a pharmacy;
  • a high percentage of vaccinations were delivered in rural and regional areas; and,
  • pharmacists reported significant professional satisfaction in providing the service.

Why are these results important?

The results reinforce the notion that accessibility to services, including vaccinations, is key in primary care, says Dr Lisa Nissen, Head of the Queensland University of Technology’s School of Clinical Sciences.

For example, the study showed that provision of pharmacist vaccination services facilitated access for rural and remote people that may have otherwise not received a vaccination.

“The people who received those services placed a high value in them, and the break-down presented of locations demonstrated that areas outside the metro centres are likely to benefit from the accessibility to pharmacist-provided vaccination,” Dr Nissen told AJP, adding that the QPIP trials that she led in 2014 had similar findings.

Brisbane consultant clinical pharmacist Debbie Rigby agrees.

“The results highlight the important role community pharmacists can play in extending the reach of influenza vaccination in the population,” she says.

“One of our key advantages [as pharmacists] is accessibility and convenience, and this is important to consumers. This implementation evaluation showed how important this is in rural and remote areas,” says Rigby.

There is still a long way to go in advocating for pharmacists as immunisers, not just in Australia but worldwide.

For example, while pharmacists have been providing vaccination services in the United States for over a decade, a recent study shows that only about 31% of the country’s jurisdictions have established formal relationship integrating pharmacists’ services, in order to utilise them in pandemic influenza vaccination efforts.

This is despite 90% of jurisdictions stating their intention to do so.

It shows that while some countries have implemented pharmacist-administered vaccinations, this does not mean that pharmacists are being fully utilised or recognised for these services.

Adverse events

Most doctors have come out against pharmacist vaccination, claiming that pharmacies are not equipped with the correct knowledge or environment to provide safe vaccinations.

“Only GPs have the training, experience and background knowledge of your medical needs to provide vaccination in the safest possible environment,” said AMA President Dr Michael Gannon in April this year, while he was still the AMA’s WA branch president.

The results of the WA study tell a different story.

Out of the nearly 16,000 vaccinations administered by pharmacists between March and October 2015, there were no major adverse events, and less than 1% of patients experienced minor events.

Adverse events reported by the pharmacists included mild local injection site reactions, light headedness, fainting and slight fever several days post-vaccination.

The authors found that in all of these cases, pharmacists appeared to be well-informed of the possible adverse effects during vaccination, and protocols were in place and followed when managing these situations – including appropriate follow-up.

“The most significant issue to me was that it showed that pharmacist vaccination services are safe,” says lead author Dr Laetitia Hattingh.

“There is definitely a need for more discussions as vaccination is an important public health issue and pharmacy is, for some consumers, a more convenient option.”

“Whilst some opposition continues from GPs and medical organisations, it is clear the role is supported by consumers,” says Rigby.

 “I think the key to improving acceptance by the medical professional is communication with the consumers’ GP on the service and uploading the My Health Record.”

Rigby believes vaccination training will be integrated into pharmacy degrees as a core skill for pharmacists. This is already underway with some universities offering accreditation in the weeks after graduation.

Others have built vaccination training into their courses, allowing their students to begin learning how to administer injections early.

Expanding pharmacist vaccinations from influenza to include other diseases such as measles and whooping cough is the next step, says Dr Nissen.

This has already been recognised in Queensland, and she hopes for areas in need to include a “raft of other vaccinations in the future”.

“The key is that any vaccination provisions or expansions are in the context of the broader care team and care plan for patients.

“As such, targeting areas where increased accessibility and timelines may improve vaccination rates will be a key consideration,” she says.

Professional satisfaction

Dr Nissen is not surprised that the vaccinating pharmacists reported feeling high levels of professional satisfaction in providing the service.

“[It] brings forward an enhanced role for pharmacists in primary and preventative care, giving a rewarding contribution to the provision of essential services in the community.

“This is a role long held by pharmacists through minor ailment services and OTC medication provision, however vaccination provides us with a more hands-on contribution.”

Rigby agrees and adds that the service works for both patient and pharmacist.

“Pharmacists see immunisation as extending their scope of practice and improving integration into the primary health system,” she says.

“Most importantly, it is meeting consumer’s needs.”

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