Country case-studies: The role of pharmacists in vaccinations USA. Pharmacy s Unique Contribution. Medical Home. Pharmacist Immunization Factoids

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1 Country case-studies: The role of pharmacists in vaccinations USA September 8, 2011 Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA Executive Vice President and CEO APhA Roles of Pharmacists in Immunization Advocacy Pharmacist as advocate Educating and motivating patients Pharmacist as facilitator Hosting others who vaccinate Pharmacist as immunizer Giving vaccinations yourself 1996, APhA House of Delegates Pharmacist Immunization Factoids More than 150,000 pharmacists trained to administer vaccines influenza season CDC estimates almost 20% of adult vaccinations administered by pharmacists (our estimate is 25 million doses) All 50 states, DC,and PR authorize pharmacists to administer vaccines at some level Pharmacies can target immunization messages to patients using patient data and medication markers More than 96% of pharmacies are computerized and use computers in practice management Pharmacists are trained to administer vaccines across the lifespan and are helping patients complete vaccine series Pharmacy profession estimated spend on marketing / patient communication in season is $40 million Pharmacists are an accessible and valued partner on the patient s health care team Property of APhA Pharmacy s Unique Contribution Access, proximity, extended hours Identify high-risk patients (based upon medications) Public s trust Message dissemination vehicles Nationally adopted guidelines (APhA based on CDC, etc) Support convenience of multi-dose vaccines Knowledgeable vaccine resource - Extensive education / training Ability to handle storage issues IMMUNIZATION ADVOCACY Guideline 1 - Prevention Protect patients' health by being vaccine advocates. Guideline 2 - Partnership Pharmacists are in partnership with their community. Guideline 3 - Quality Pharmacists are competent to administer immunizations (CTP). Guideline 4 - Documentation Pharmacists should document immunizations fully and report clinically significant events appropriately. Guideline 5 - Empowerment Pharmacists should educate patients about immunizations and respect patients' rights. Adopted by APhA, 1996 Medical Home Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. Source: Joint Principles of the Patient Centered Medical Home 1

2 Practice Growth Two kinds of market share* American College of Physicians and American Society of Internal Medicine Position 4 ACP-ASIM supports the use of the pharmacist as immunization information source, host of immunization sites, and immunizer, as appropriate and allowed by state law. ACP- ASIM will work with pharmacy organizations to increase immunization awareness. *Not to scale Grabenstein J et al. J Am Pharm Assoc. 2001;41: Grabenstein J et al. Medical Care. 2001;39: Grabenstein J et al. J Clin Epidemiol. 2001;55: Ann Intern Med.2002;136: v1-7 Ways to Meet Patient Needs Complete multi-dose series HPV, Hepatitis A & B, others Document vaccine administration Technology in transition (Hard-copy electronic health record / registry) Coordination of Care (medical home model) Goal: getting patient immunized Access to Knowledgeable provider Pneumo, Zoster, Influenza, etc Walk the Walk: Policy of APhA: Health Care Personnel Vaccination /CM/ContentDisplay.cfm&CONTENTID=25910 (under New Business Item #1) 2011 adopted statement: APhA supports an annual influenza vaccination as a condition of employment, training, or volunteering, within an organization that provides pharmacy services or operates a pharmacy or pharmacy department (unless a valid medical or religious reason precludes vaccination). 10 Targeting Messages: Prescription Vial Auxiliary Labels % 70% Baseline Year 1 Year 2 Year 3 Combined Participant Percent* Flu, Foot and Eye *As reported in the Patient Self-Management Program reports each year for 99 patients with baseline,1 st, 2 nd and 3 rd year results Flu Shot Foot Exam J Am Pharm Assoc. 2005;45: Eye Exam Pt Self-Mgt Program (N=256) Averages thru Sept 25, 2004 Flu Vaccination Rates: NCQA (Commercial Accredited Plans): 48% PSMP Results: 77% Need for influenza & pneumococcal vaccines: % of Patients Heart Disease Digoxin, warfarin, nitrates Lung Disease Theophylline, zafirlukast, steroids, chronic inhaler use Diabetes Insulin, oral hypoglycemics All > 65 y/o Any or none Other vaccines? *Diabetes Ten City Challenge (N=573) Averages thru Dec 31, 2007 Flu Vaccination Rates: NCQA (Commercial Accredited Plans): 49% DTCC Results: 65% 100% 80% 60% 40% 20% 0% Flu Foot Eye Lipid Shots Exams Exams Profiles Beginning End 31-Dec-07 The Diabetes Ten City Challenge: Interim Clinical and Humanistic Outcomes of a Multisite Community Pharmacy Diabetes Care Program. J Am Pharm Assoc Mar-Apr;48: v1-11 2

3 Public Health officials recognize the role and value of pharmacists Framework guides health departments in working with pharmacists Pharmacist Authority to Administer Immunizations created in consultation with APhA,, CDC, NASPA, NACDS,NACCHO, ASTHO, NCPA, HHS, Department of Homeland Security, and Rx Response. Includes Washington, DC, and Puerto Rico Operational Framework for Partnering with Pharmacies for Administration of 2009 H1N1 is available for download from the Pharmacist Immunization Center at Patient-Age Limitations Based upon APhA Survey of State IZ Laws/ Rules conducted in collaboration with NASPA, November 2010 (updated April 2011) Types of Vaccines Authorized to Administer Based upon APhA Survey of State IZ Laws/ Rules conducted in collaboration with NASPA, November 2010 (updated Jan 2011) Any age >18yo Adults AL, AK*, AZ*,CA, KY*,MI, MS, NE, NV, NM, OK, TN, VA*, WA CT, DC, HI, IA, KS, MD, MA, NJ, NY, NC, ND, PA, PR, RI, SD, WV, WI FL, WY Based on Protocol CO, SC, UT, VT >3yo NH >7yo >9yo AR*,LA, TX DE, ME* >10yo MN* >11yo OR >12 yo ID, MO,MT >13yo GA >14yo IL, IN, OH* Any vaccine Influenza Only Influenza and Pneumo Other combos AL, AK, AZ*, AR*, CA, CO, DE, GA*, HI, ID,IL, IN*, IA, KS, KY, LA, MI, MN, MS, MT, NE, NV,NJ, NM, NC*, ND, OK, OR**, PA, RI, SC*, TN, TX, UT**, VT, VA*, WA, WI DC, FL, MA, NH, PR NY, WV OH, CT, ME, MD, MO, SD, WY * Scope varies * Via Rx for some; ** broad list of vaccines Collaborative Care: Components of an Immunization Protocol Identify individual who has delegated activity Identify pharmacist authorized to vaccinate Types of vaccines authorized for administration Procedures, criteria or plan to follow When to refer patient Procedure for emergency situations Record keeping and documentation procedures Protocols vs Rx Based upon APhA Survey of State IZ Laws/ Rules conducted in collaboration with NASPA, November 2010 (updated Jan 2011) Protocol Rx Protocol or Rx Protocol / SO / Rx Protocol / SO AK, CO, DC, FL, HI, ID, KS, KY, MN, MS, MT, NV, NH, NM, ND, OH, OK, OR*, UT, WA, WV, WI AL, LA, RI AZ*,CA, DE, GA,IL, IN, IA, ME, MD, MA, MO, NE, NJ, NC, NY, PA, PR, SC, SD, TX, VT, VA, WY AR, MI, TN CT * Via Rx / pt specific protocol for some 3

4 Sources for Protocols 2006 n= n= n=209 Continuing Challenges Payers Compensation levels Recognition as providers Administrative processes Plan design Documentation Authority Information Needed: What are / can pharmacists in your country do in regard to immunizations? Pharmacists Rx to immunization initiatives TO COMPLETE SURVEY, fill out onsite or GO TO: Practice Examples ion=pharmacist_immunization_center1&conten TID=25537&TEMPLATE=/CM/ContentDisplay.cfm Screen prescriptions for targeted messaging Overcame some payment barriers Provided info to physicians MOU with public health Use of pharmacy residents / interns / students Ask patient about immunizations at each visit Collaboration with immunization coalitions Don t talk about it Be About It This says it all Goal: getting patients vaccinated An 82 yo female with CHF has been hospitalized for 6 months earlier in the year and had seen her physician multiple times over the last several months. She was never offered an influenza vaccination during any of her visits nor was she directed to get one. The pharmacist identified that she was a high-risk patient and educated her about the pros and cons of getting a seasonal flu shot. The patient elected to get vaccinated and was very grateful that our pharmacist cared enough and took the time to ensure she would remain as healthy as possible during the flu season. 4

5 Why we do what we do Contacts Thomas E. Menighan, EVP & CEO or Mitchel C. Rothholz, RPh, MBA Chief Strategy Officer American Pharmacists Association 2215 Constitution Ave, NW Washington, DC (w) (FAX) (cell) Source: Evan Marcus Rothholz, Born November 8,