Pharmacists: Access to Immunization Services. American Pharmacists Association Chief of Staff
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1 Pharmacists: Access to Immunization Services Mitchel C. Rothholz, RPh,, MBA American Pharmacists Association Chief of Staff
2 American Pharmacists Association Washington, DC National professional society of pharmacists Represents the interests of pharmacists across practice settings Improving medication use Advancing patient care 63,000 members and growing Largest and oldest organization in pharmacy Immunization Roles for Pharmacists Advocate Facilitate Immunize
3 Pharmacy s Unique Contribution Access, proximity, extended hours Ability to narrow-cast messages to elderly and high risk patients Public s trust - Gallop Poll Public s enthusiastic acceptance
4 Pharmacists Role in Emergency Preparedness and Response Surveillance Information Patient education and counseling Distribution of pharmaceuticals and medical supplies Administration of vaccines Evaluation / Triage Community planning and preparation Developed by the JCPP Working Group on Emergency Preparedness & Response
5 APhA Focus for Adult Immunization Educate the public about adult vaccine-preventable diseases and the value of immunizations; Be accessible to the public for immunization information and administration of vaccine Increase pharmacist knowledge regarding adult immunizations, vaccine schedules and opportunities to improve public health Maximize opportunities for pharmacists to remind or encourage patients to be immunized But Immunization activities Across Lifespan
6 GUIDELINES FOR PHARMACY-BASED IMMUNIZATION ADVOCACY Guideline 1 - Prevention Pharmacists should protect their patients' health by being vaccine advocates. Guideline 2 - Partnership Pharmacists who administer immunizations do so in partnership with their community. Guideline 3 - Quality Pharmacists must achieve and maintain competence to administer immunizations. Guideline 4 - Documentation Pharmacists should document immunizations fully and report clinically cally significant events appropriately. Guideline 5 - Empowerment Pharmacists should educate patients about immunizations and respect ect patients' rights. Adopted by APhA, 1996
7 Education & Training APhA Immunization Program CDC Recognized Self-Study Study (0.8CEU) Seminar (1.2 CEUs) Primer on immunology Clinical disease review Practice management Regulatory roadmap CDC resources Recap of vaccines, antibodies, diseases, microbes Implementation Record keeping Public health collaboration Cases and practicum Also CPRP and OSHA Training
8 Statutory Barrier: Authority for Pharmacists to Administer Immunizations Regulations / Attorney General Opinion No position Limitations of Authority Requirements Protocols / Standing Orders/ Rx Antigens Age
9 49 states currently authorize pharmacists to administer immunizations Over 40,000 pharmacists trained Delivered over 2 million influenza vaccinations
10 Pharmacist Authority to Administer Immunizations Before States authorizing pharmacists
11 Pharmacist Immunization Administration Protocol / Standing Order vs Rx States authorizing Protocol only Protocol &/or Standing Order Protocol &/or Prescription Prescription only Standing order or Prescription Protocol, Standing Order &/or Prescription 49 states, July 2008
12 Protocol Health Department Medical Directors can play a major role 50.00% % % % 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Individual Rx Not Required Internal Med Family MD Corporate MD Health Dept 2006 n= n= n=174
13 Components of Protocol Identify individual who has delegated activity Identify pharmacist authorized to administer vaccine Types of vaccines pharmacist is authorized to administer Procedures, decision criteria or plan pharmacist should follow, including when to refer patient Procedure for emergency situations Record keeping and documentation procedures
14 Other Limits to Pharmacist s authority Age Restriction No restriction (17) > 18yo (22) > 16 yo (1) > 14 yo (4) Other (5) 10+ influenza, > 18 other >12 influenza, No restriction for others > 13yo > 19yo > 15yo influenza, > 18 for others Antigen Influenza only (3) Influenza / Pneumo (2) Adult (1) No restrictions (33) Other (10) Authority could state: vaccines recommended by ACIP for targeted patient population.
15 What Immunization Services Do Pharmacies Provide to Patients? Pediatric Check All That Apply Education Refer patients to physicians Result Facilitation of immunizations (host other providers) Administer Immunizations by pharmacists Refer patients to public health departments 44.2% 5.7% 18.0% 63.9% 32.7% Percentage Graph Adolescent Check All That Apply Education Refer patients to physicians Result Facilitation of immunizations (host other providers) Administer Immunizations by pharmacists Refer patients to public health departments 45.0% 6.5% 50.8% 40.9% 23.7% Percentage Graph 2006, Responses represent 4,700 sites
16 What Immunization Services Do Pharmacies Provide to Patients? Adult >65 Years Old Check All That Apply Result Percentage Graph Education Facilitation of immunizations (host other providers) Administer Immunizations by pharmacists Refer patients to physicians Refer patients to public health departments 55.7% 18.0% 86.0% 21.3% 17.2% 2006, Responses represent 4,700 sites
17 Targeting Messages: Prescription Vial Auxiliary Labels Need for influenza & pneumococcal vaccines: Heart Disease Digoxin, warfarin,, nitrates Lung Disease Theophylline, zafirlukast, steroids, chronic inhaler use Diabetes All > 65 y/o Other vaccines? Insulin, oral hypoglycemics Any or none 2008v1-17
18 Comparison of Vaccination Rates When Pharmacists Vaccinate the Elderly 70 Vaccination Rates % Change 3.5% Change States that allow Pharmacist Immunizations States that do not allow Pharmacist Immunization Persons 65 y/o Steyer TE et al. Vaccine. 2004;22:
19 Combined Participant Percent* Flu, Foot and Eye % 70% Baseline Year 1 Year 2 Year 3 *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 Eye Exam Align the Incentives, Empower the Patient, Control the Costs SM
20 Access: Structure of Practice Appointment Walk-in Anytime Walk-in Hourly Walk-in Limited Clinic 0% 20% 40% 60% 80% 2006 n= n=363
21 Documentation Access to registries limited to pharmacists Maintained in Rx Copy of Consent Rx Record Card Pt Record Card Protocol MD Patient's MD Public Health 0.00% 20.00% 40.00% 60.00% 80.00% 2006 n= n=229
22 Compensation Employer HMO Insurance Medicaid Medicare Patient 0.00% 20.00% 40.00% 60.00% 80.00% % 2006 n= n=354
23 Please complete the following statement: "To expand influenza immunization services in our practice we need..." Patient education regarding pharmacist education /training and service. Patient education that the shot will not cause the disease. A huge outbreak of the flu in our area. Additional local physician support. Ability to bill for our services to insurance companies other than Medicare Part B. Staff members to understand importance of getting vaccinations. State laws and regulations to be more pharmacist-friendly. APhA, 2008 survey, 330 responses representing 11,188 sites
24 Questions? Mitchel C. Rothholz, RPh, MBA Chief of Staff American Pharmacists Association th Street NW, Suite 400 Washington, DC /
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