Laying the foundation for a community pharmacist intervention  to improve pneumococcal vaccine uptake
Creators: Khan, Daniyal Z
Publisher: name: University of Alberta Library
Year: 2023

<p>Background: Pneumonia is an invasive infectious disease of the lower respiratory tract that reduces the lungs’ ability to transport oxygen in an individual and can be fatal. Among the various pathogens, Streptococcus pneumoniae is a common bacterial cause of community-acquired pneumonia. Effective pneumococcal vaccines are available for use in Canada but their uptake has remained suboptimal due to multiple barriers such as vaccine hesitancy. Community pharmacists are in a unique position to address these barriers due to their accessibility to the public. Pharmacists in Alberta have been able to administer vaccines and medications by injection since 2007 and can provide insight into addressing barriers related to pneumococcal vaccine uptake. <br>
Goal and Objectives: The overall goal of this thesis is to develop foundational knowledge that will help inform a community pharmacy-based intervention aimed at improving pneumococcal vaccine uptake. Within my two thesis projects, I sought to: 1) describe the actions related to administering an injection, including the types of medications commonly administered; and, identify perceived barriers and facilitators pharmacists face when providing injection services and 2) identify and describe community pharmacy-based intervention programs aimed at improving pneumococcal vaccine uptake.<br>
Methods: The first thesis project was a cross-sectional survey of Alberta pharmacists registered with the Alberta College of Pharmacy. We collected information regarding the types of vaccines and medications they administer within their practice. Additionally, pharmacists were asked about their perspectives on various barriers and facilitators they encounter when providing an injection service. The second thesis project was a systematic review of interventions and strategies employed to improve the pneumococcal vaccination rate in community pharmacies.<br>
Results: : In project 1, a total of 397 pharmacists (7.8%) out of 5102 pharmacists willing to be contacted for research purposes responded to the survey. Participants were grouped into “Active”, and “Non-Active” Providers based on responses to questions of injection authorization and administration in the first section of the survey. The most common medication injected was influenza vaccine, administered by 98% of Active Providers followed by vitamin B12 (95%), herpes zoster vaccine (88%), hepatitis vaccines (86%), and pneumococcal vaccines (82%). Non-Active Providers were more likely than Active Providers to report that comfort with administering injections (p&lt;0.001) and managing adverse reactions (p=0.013) were moderate or major barriers to providing injections. More than 60% of survey respondents indicated that access and automated reporting to the provincial immunization registry would be essential to increasing the frequency of providing injection services. <br>
In project 2, we identified 21 studies (10 experimental, 11 quasi-experimental) that implemented intervention strategies to improve pneumococcal vaccination uptake within community pharmacies. The intervention programs were implemented between 1998 and 2020. Strategies focused on training pharmacy staff on pneumococcal vaccine indications, screening strategies, coordination of vaccine delivery amongst pharmacy staff, utilizing automated systems to proactively identify eligible patients, and utilizing assertive and motivational communication techniques to address vaccine hesitancy. Direct to consumer advertising to raise awareness of vaccine eligibility and practice tools such as decision-making aids were also implemented in several studies. We identified practice tools such as follow-up coaching, software for record documentation, automated patient screening, and decision support tools that were implemented during the intervention. A majority of studies reported improvement in pneumococcal vaccination rates compared to baseline or comparison group, however, only 7 studies reported these differences were statistically significant.<br>
Conclusion: In project 1, we identified that Alberta pharmacists administer a wide variety of vaccines and other medications by injection. By stratifying the participant pool to Active and Non-Active Providers, we identified benefits, organizational factors, education policies and patient-related strategies that pharmacists frequently employ to better help their patients. In project 2, we observed that strategies focused on training pharmacy staff on pneumococcal vaccine indications, screening strategies, and coordination of vaccine delivery amongst pharmacy staff. Although, all interventions helped raise awareness of pneumococcal vaccines, none of the studies included in our review reported reasons for individuals refusing a pneumococcal vaccine. Information gathered in these two studies enables us to develop an intervention program that address barriers and help improve pneumococcal vaccine uptake.</p>