Barriers to pharmacist vaccination

pharmacy jabs: vaccine on blue

A new US study has examined factors that encourage or discourage adolescent and adult vaccination in pharmacy

The study involved 40 licensed pharmacists in states with different pharmacy vaccination laws.

They had all administered, or were currently administering, vaccinations including HPV; tetanus, diphtheria and pertussis; or meningitis vaccines to adolescents aged nine to 17 years.

They then participated in a semi-structured survey on in-pharmacy vaccine provision, and three-quarters said vaccination rates could be increased.

“Opportunities exist for improvements in vaccine access within pharmacies to improve uptake in both adolescent and adult populations to prevent vaccine-preventable diseases in the general population,” write the authors.

“National efforts should expand insurance coverage for vaccine administration reimbursement and improve data information systems to optimize provision within pharmacies.”

While a range of US stakeholders have endorsed alternative sites including pharmacy for the provision of vaccines, barriers to expanding these services include time constraints; concerns over legal liability; reimbursement issues; and problems with tracking/recall of vaccinations with multiple doses.

For adults, pharmacists reported that reimbursement and insurance issues were the biggest challenge (78%) followed by the availability of administration area/vaccine shortage/cost of vaccine storage (43%) and the public’s education on the issue (40%).

As for adolescents, the biggest challenges were “patient’s fear, lack of cooperation, and opposition” (53%); education of patient/parent/public (30%); reimbursement/insurance issues (28%); and time constraints of the pharmacists (28%).

One of the barriers highlighted was consumer promotion: “Most pharmacists reported not having promotion efforts for several vaccines, including TD (86%), hepatitis A (86%), hepatitis B (84%), HPV (84%), MCV4 (62%), and travel vaccines (84%). However, on-site corporate promotion was used for influenza (84%), herpes zoster (81%), pneumococcal (62%), and TDAP (62%) vaccines.”

Insurance coverage was also an issue, with 57% of surveyed pharmacists considering insurance reimbursement inadequate to cover vaccine administration costs for all vaccines and insurance plans.

And pharmacists also felt that their time was also not adequately covered by insurers, while many patients worried that out-of-pocket costs prevented them from accessing vaccination in pharmacy.

“The potential benefits of in-pharmacy vaccine administration include expanded hours of operation (eg, evenings and weekends), flexibility of scheduling (no appointment needed with walk-ins welcome), easy access to multiple locations, rapidity, and potential for high patient traffic,” the authors wrote.

“Despite these benefits, we found that three-quarters of surveyed pharmacists reported that they could vaccinate more people at their respective pharmacy location. This indicates a potential underuse of pharmacies as an alternative vaccination site in the United States.

“Several factors contribute to the underuse of on-site pharmacy provision, including challenges identified in our present survey, lack of public awareness of vaccines available at pharmacies, and lack of trust in pharmacists to administer vaccines.

“Although previous studies have shown that parents consider pharmacists as acceptable immunisation providers for their children, adults frequently hesitate to use pharmacies as an immunisation site and often do not perceive pharmacists as regular providers of immunisations.

“Pharmacists included in our study emphasised the importance of public education through vaccination promotion and advertisements to overcome the educational barriers to vaccine uptake.”

The authors also suggested that encouraging doctors to improve the perception of pharmacists as vaccine providers could help.

“A quarter of the pharmacists in our study believed that communication and support from doctors was a requirement of a successful vaccination program, especially among adolescents.

“In a study conducted in 2003 of family practice physicians in North Carolina, three-quarters of physicians were not aware that pharmacists could administer vaccinations in the state.

“Although half of the physicians considered that it was appropriate for pharmacists to administer the influenza vaccine, other vaccines received less support.

“A more recent national study found that physicians believed that it is helpful for pharmacists to share a role in vaccine administration efforts but found it problematic because both physicians and patients do not routinely receive documentation of in-pharmacy vaccination.

“Thus, collaborative efforts to establish electronic data management systems between pharmacists and primary care physicians will be necessary to document vaccinations provided for the successful implementation of vaccination programs among target populations, especially among those with limited access to primary health care services.”

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