Pharmacists are already making a big difference in how Australians get their flu vaccines, in a “game changer” for the profession that is transforming patient relationships and making pharmacists stand a little taller
Health stakeholders in Australia and around the world are highlighting the importance of vaccination this week: it’s World Immunization Week (24-30 April) and the World Health Organization is campaigning for health authorities around the globe to “close the immunisation gap” and meet global vaccination targets by 2020.
The ability of pharmacists around the country to provide flu vaccination is greatly increasing access – see here for the PSA’s roundup of where the different states and territories currently stand – with the ACT the most recent jurisdiction to give pharmacists the go-ahead to vaccinate their patients. Victoria is expected to fall into place in the near future.
The service is already off to a running start in Canberra: for example, the Wanniassa Capital Chemist told the AJP that customers are taking up the offer eagerly, encouraged by its accessibility.
Pharmacist vaccination had been lobbied for over some time, but it was the Queensland Pharmacist Immunisation Pilot that actually got the ball rolling.
The QPIP implementation team was led by then PSA Queensland President Professor Lisa Nissen, who said that the Guild and PSA had been lobbying for some time for pharmacist vaccination, and that it was “really just a matter of timing that it all came to a head”.
Queensland Chief Health Officer Dr Jeannette Young was very proactive about the contribution pharmacy could make in the public health space, says Prof Nissen, and offered the opportunity to look at a pilot working with the two professional organisations.
“And hindsight is beautiful,” she says. “They really wanted a strong evaluation framework, and that’s served us well when it comes to the contention provided by our medical friends around ‘Where’s the evidence’ or ‘Who did you vaccinate’ or ‘Did anybody die in the street’.
“We knew when we constructed it that we would need to provide the evidence to counter all the things they were concerned about.
“And that was the most powerful thing. Even after one flu season, we were able to go to other jurisdictions who wanted pharmacist vaccination and say that we vaccinated 11,000 people and nobody died, and if you appropriately train pharmacists you can do this too.
“It was compelling.”
Tim Logan, who led the Pharmacy Guild Queensland Branch’s involvement in the pilot, told the AJP that QPIP formed the foundation of rolling out vaccination programs around the country and went a long way towards counteracting arguments from other health professionals about pharmacy’s role in allied health care.
“Every other state saw that the trial was happening and saw the irrefutable benefits of the service, and basically skipped the trial and went straight to legislation,” says Logan.
“It really bore out that people valued the convenience, that they thought pharmacy was a trustworthy source of the service and that they recognised that pharmacists already had many of the skills required to provide vaccination – all they needed to brush up on was how to stick a needle in someone’s arm.
“They already knew the material handling challenges of dealing with biological products, they already knew how to deal with anaphylaxis – we’re the ones who tell people how to use an EpiPen – and in terms of anatomy, physiology and chemistry, pharmacists have training in all those areas, so it was all about a bit of needle technique, and there you go.
“The PSA did a lot of work in delivering training in a short space of time, the Guild got the message out to members and there were some pretty enlightened people at Queensland Health who saw the need for a trial, and saw it as a way of answering the misinformation that we saw from certain other quarters who perceived that their turf was being invaded.
“At one stage they were saying pharmacists would be doing this out with the toilet paper and jelly beans. That wasn’t the case because the standards required it to be in a private room. I’ve had a few people in those organisations admit to me now that they knew there was nothing wrong with it.”
Nissen told the AJP that from the beginning the service was getting to people who would have in previous flu seasons fallen through the cracks.
“It’s about improving the overall access to vaccination in the community, and working with other mechanisms for that, through general practice or workplace vaccination or other services, to make sure we reach as many people as possible,” Prof Nissen says.
“The data we saw in the over-65 population alone showed a number of people who were National Immunisation Program eligible who’d never had a vaccine before.
“Among NIP eligible people the majority would be seeing their GP and being vaccinated through them, because they’re seeing them for their general health needs, and vaccination through GPs is a great conduit for that.
“But some of these people were saying they would never have gotten a vaccine unless it was available through pharmacy.
“So the message is that there are at-risk people in the community, who because of accessibility aren’t getting free vaccination through their GP, and we need to provide as many access points as possible.”
The key market for pharmacy vaccination has been the mid-40s working population, she says.
“That’s my demographic. And I’ve got an 80-year-old mother and two children under the age of five who can’t be vaccinated, so if I get the flu and give it to them, that’s a pretty significant problem. Aside from my boss being pissed that I’m not at work for two weeks, it can have a pretty significant flow-on effect.
“From a Government point of view the bang for their buck is not spending money on free vaccines for me, but to encourage me to invest in my own health care, and to make vaccination as accessible as possible and cost-effective as possible.
“That’s what’s happening in pharmacy – we increase overall uptake in the community, and people are prepared to pay $20 for it without flinching.”
Both Nissen and Logan say there are more opportunities for pharmacists to provide other vaccines beyond those now under the purview of Phase II of the Queensland Pharmacist Immunisation Pilot, which was extended to include administering whooping cough and measles vaccines.
“Travel vaccinations, some of the hepatitis vaccines, the follow-up for Gardasil – the second and third vaccines for Gardasil have a decrease in their completion rate, and if you don’t complete your course you’re not covered,” says Prof Nissen.
“You’ve got people with B12 injections, Depo injections, and pharmacists can get involved in that. People who need big complex intramuscular injections once a month and aren’t comfortable doing that on their own – that would be a great service and they wouldn’t need to rock up to a doctor’s surgery.”
Logan says that pharmacy vaccination could also be a boon during times of crisis.
“If you ever do get an emergency situation, a pandemic or some other type of nasty virulent disease that requires prompt action via vaccination, you’ve got a whole lot of people here ready and able to be enlisted in dealing with that,” he says.
“And while it’s not on the agenda at the moment, and in the whole country we’re restricted to adults, I can see the day where they might bring that down to teenagers, and then pharmacists could be involved in the provision of other vaccines.”
“I think the key thing I’ve got out of this is that it’s been a real opportunity for pharmacists to feel that they’re making a major contribution as part of the health system,” says Prof Nissen.
“They puff up their cheeks a little bigger and say, ‘I really feel like I’m doing the things I trained to do’.
“They are valuing the opportunity they have to interact with the patient and the time they’re spending with them and the more intimate relationship they get to have on a clinical level. Patients are interacting with them and treating them differently, and you can’t put a price on that from a professional point of view.
“It’s a game changer for us. If I never do anything else in my professional career, I’ll be really glad I was part of this.”