Int J Clin Pharm DOI 10.1007/s11096-015-0073-8
SHORT RESEARCH REPORT
Pharmacists as immunizers: a survey of community pharmacists’ willingness to administer adult immunizations Nicholas Edwards • Erin Gorman Corsten • Mathew Kiberd • Susan Bowles • Jennifer Isenor Kathryn Slayter • Shelly McNeil
•
Received: 7 September 2014 / Accepted: 27 January 2015 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015
Abstract Background Adult immunization rates worldwide fall below desired targets. Pharmacists are highly accessible healthcare providers with the potential to increase immunization rates among adults by administering vaccines in their practice setting. Objective To determine the attitudes of community-based Canadian pharmacists with respect to expanding their scope of practice to include administration of immunizations. Method An internetbased survey was emailed to community pharmacists across Canada. The survey was piloted through focus groups for qualitative feedback, tested for content validity, and test–retest reliability prior to dissemination. Results There were 495 responses to the survey. The majority (88 %) agreed that pharmacists as immunizers would increase public access, improve rates (84 %), and be acceptable to the public (72 %). However, only 68 % agreed that pharmacists should be permitted to immunize. The
majority of respondents (90 %) agreed that certification in vaccine administration should be required for pharmacists to administer vaccines. Pharmacists identified education, reimbursement, and negative interactions with other providers as barriers to pharmacists administering vaccines. Conclusion Canadian pharmacists are willing to expand their scope of practice to include immunization. However, implementation requires professional development and certification in vaccine administration. Keywords Canada Immunisation Pharmaceutical services Pharmacist Vaccination
Impacts on practice • •
Electronic supplementary material The online version of this article (doi:10.1007/s11096-015-0073-8) contains supplementary material, which is available to authorized users.
Pharmacists can improve immunization rates in patients. Many Canadian community pharmacists are willing to provide immunization services following further education and training.
N. Edwards S. Bowles J. Isenor College of Pharmacy, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS B3H 4R2, Canada
S. Bowles Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Halifax, NS B3H 3A6, Canada
E. Gorman Corsten S. Bowles K. Slayter Faculty of Medicine, Dalhousie University, 1459 Oxford St, Halifax, NS B3H 4R2, Canada
S. Bowles J. Isenor K. Slayter Canadian Center for Vaccinology, IWK Health Centre, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada
E. Gorman Corsten S. Bowles K. Slayter Department of Medicine, Queen Elizabeth II Health Sciences Centre, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
S. McNeil (&) Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, 5850/5980 University Ave., Halifax, NS B3K 6R8, Canada e-mail: [email protected]
M. Kiberd Department of Anesthesia, Pain Management, and Perioperative Medicine, Queen Elizabeth II Health Sciences Centre, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
123
Int J Clin Pharm
•
Major barriers to providing immunizations include knowledge of vaccine indications/contraindications, reimbursement of vaccination expenses, and legal liability.
Ethical approval The study received approval from the Capital Health Research Ethics Board, Halifax, Nova Scotia, Canada.
Introduction
Methods
Vaccine-preventable diseases and the underutilization of immunization programs remain a significant public health concern [1–3]. Many factors have been identified as contributors to low immunization rates, including general public apathy, concerns and misconceptions about the safety and efficacy of vaccines, cost, distance to clinics, inconvenient hours, and wait times [4]. Barriers to immunization must be addressed if immunization rates are to improve. Among the strategies suggested to address barriers and improve immunization rates is the training of non-traditional immunization providers to administer vaccines safely and effectively in their practice settings [5]. As underutilized healthcare professionals, community-based pharmacists are highly accessible, with an estimated 55 % of people over 18 years of age visiting a pharmacy in any given week, pharmacists have many opportunities to interact with patients [6, 7]. United States (US) public health officials recognized the potential for increasing immunization rates by utilizing non-traditional immunization providers, with the addition of community-based pharmacists as immunizers in 1996 [8]. Evaluation of pharmacist immunization programs demonstrated increased public awareness, improved access, and higher rates of adult immunization in states that allowed pharmacists to vaccinate in comparison to those which did not [2, 9–12]. Legislation has passed in six Canadian provinces to increase the scope of pharmacy practice to include the administration of immunizations [13]. Some studies have been published around this new role, however, Canadian pharmacists’ perceptions on the expanded scope have not been previously studied [14, 15]. It is important to understand Canadian pharmacists‘ interest in becoming immunization providers, as well as their attitudes and beliefs about immunization. Such information may inform policy development and statutory reform around expanding the scope of pharmacy practice.
An anonymous, quantitative web-based survey was distributed to all community-based pharmacists who were members of the Canadian Pharmacists Association (CPhA) or the Pharmacy Association of Nova Scotia (PANS) for whom email addresses were available. The survey instrument was developed specifically for this study and was drafted, piloted and modified with input from community-based pharmacists in Nova Scotia prior to distribution. Two focus groups were held involving both rural and urban pharmacists, allowing stakeholders an opportunity to provide input on the survey design before being finalized. Participants were asked to provide qualitative feedback on clarity, wording, and relevance. The final survey instrument was modified to address the focus group comments. Survey participants were provided the opportunity to enter a draw for a gift certificate. Entrants into the draw remained anonymous to the investigators. A return rate of 10 %, or n = 415 pharmacists, was required to provide an acceptable margin of error (or 95 % CI half width) of \5 %. Data was analyzed using descriptive statistics to identify the frequency of responses and general respondent characteristics. All analyses were completed using SAS statistical software, version 8.2 (Cary, NJ).
Aim of the study To complete a national survey of Canadian pharmacists on their perceptions of the addition of immunization administration to their scope of practice before legislative changes were made.
123
Results There were 495 responses to the survey analyzed, a response rate of 12 %. Responses were received from all ten provinces and one territory. The majority of respondents were staff pharmacists, but a substantial number (43 %) were pharmacy owners or managers. Of the 495 responses, 68 % felt that pharmacy practice should expand to include immunization; however, only 51 % reported willingness to incorporate provision of immunization into their personal practice, 24 % were unwilling and 25 % were unsure if they were willing to incorporate. Regardless of whether the pharmacist was willing or unwilling to vaccinate, low confidence was seen in the level of education on vaccinations. Only 29 % of pharmacists willing to vaccinate and 12 % of pharmacists unwilling to vaccinate, thought their undergraduate education was adequate in preparing them for immunization.
Int J Clin Pharm
Furthermore, 99 % of willing and 83 % of unwilling pharmacists felt there should be a formal certification program to allow the provision of vaccines, and 99 % of respondents felt more professional training should be required. Additionally, eight key barriers to providing immunization services were identified: availability of pharmacy space; availability of support staff; current knowledge about vaccines; current training about indications/contraindications; legal liability; reimbursement of expenses/supplies; support from physicians; and time for professional development.
Discussion The current study showed a majority of Canadian pharmacists felt their scope of practice should expand to include immunizations, with about half prepared to proceed. Despite the willingness to proceed, many pharmacists felt their undergraduate education was not adequate to begin incorporating immunization services and that formal certification should be required to do so. Proper immunization training has been acknowledged as a concern by pharmacist regulatory bodies as well, resulting in mandatory immunization training prior to service provision. The development of many immunization training programs throughout Canada emphasizes the profession’s efforts to ensure safe and effective administration of vaccines by pharmacists [16]. Such programs have been shown to be successful, as indicated by an accredited immunization training program in the Maritimes, in which 97 % of pharmacists felt prepared to administer immunizations following completion [17]. Other barriers identified related to reimbursement of expenses/supplies associated with vaccinations and lack of support from physicians. Pharmacy associations will need to negotiate reimbursement, as physician groups have, for administration of publicly funded vaccines to ensure sustainability of pharmacist administrated immunizations. Furthermore, though there has been resistance to pharmacists as immunizers from physicians in the past, a 2011 study by Hurley et al. showed 79 % of physicians were willing to refer patients to community immunizers, such as pharmacists [18]. Limitations of the study include the small sample size, which may not be representative of the Canadian pharmacist population. However, studies completed in other jurisdictions have found similar results with respect to barriers identified, such as lack of time, lack of space, reimbursement concerns, legal liability, and lack of formal education, which further support our results [19–21].
Conclusion Many Canadian pharmacists are willing to offer immunizations following further education and training. It is important for any jurisdictions considering the expansion of pharmacists’ scope of practice to include provision of immunizations to consider education as an integral part of the process. Future research is needed to examine pharmacists’ knowledge, attitudes, and beliefs about immunization, as well as the effect of pharmacist immunizers on Canadian immunization rates. Acknowledgments The authors would like to thank Donna MacKinnon-Cameron of the Canadian Center for Vaccinology for her statistical support, the Canadian Pharmacists Association for assistance with survey administration, and Tania Alia for her assistance with manuscript preparation and review. Funding Fund.
This work was supported by the Capital Health Research
Conflicts of interest The authors have no conflicts of interest to declare in relation to this work.
References 1. US Department of Health and Human Services. 2010 National Vaccine Plan. [Internet]. United States of America: Department of Health & Human Services; 2010 [cited 2014 Nov 16]. http:// www.hhs.gov/nvpo/vacc_plan. 2. Skelton JB. American pharmacists association, academy of managed care pharmacy. Pharmacist-provided immunization compensation and recognition: white paper summarizing APhA/AMCP stakeholder meeting. J Am Pharm Assoc. 2003;2011(51):704–12. 3. World Health Organization. What are some of the myths and facts about vaccination? [Internet]. World Health Organization; 2013 April [cited 2014 Nov 16]. http://www.who.int/features/qa/ 84/en/index.html. 4. Kamal KM, Madhavan SS, Amonkar MM. Determinants of adult influenza and pneumonia immunization rates. J Am Pharm Assoc. 2003;2003(43):403–11. 5. Shen AK, Bridges CB, Tan L. The first national adult immunization summit 2012: implementing change through action. Vaccine. 2013;31:279–84. 6. Grabenstein JD, Guess HA, Hartzema AG, Koch GG, Konrad TR. Attitudinal factors among adult prescription recipients associated with choice of where to be vaccinated. J Clin Epidemiol. 2002;55:279–84. 7. Steyer TE, Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine. 2004;22:1001–6. 8. Ashby-Hughes B, Nickerson N. Provider endorsement: the strongest cue in prompting high-risk adults to receive influenza and pneumococcal immunizations. Clin Excell Nurse Pract. 1999;3:97–104. 9. Higginbotham S, Stewart A, Pfalzgraf A. Impact of a pharmacist immunizer on adult immunization rates. J Am Pharm Assoc. 2003;2012(52):367–71. 10. Loughlin SM, Mortazavi A, Garey KW, Rice GK, Birtcher KK. Pharmacist-managed vaccination program increased influenza
123
Int J Clin Pharm
11.
12.
13.
14.
15.
vaccination rates in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27:729–33. Ernst ME, Chalstrom CV, Currie JD, Sorofman B. Implementation of a community pharmacy-based influenza vaccination program. J Am Pharm Assoc (Wash). 1997;NS37:570–80. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved influenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21:1115–22. Canadian Pharmacists Association. Pharmacists’ Expanded Scope of Practice. [Internet]. Ottawa (ON): Canadian Pharmacists Association; 2014 [updated 2014 Nov; cited 2014 Nov 16]. http:// www.pharmacists.ca/index.cfm/pharmacy-in-canada/scope-ofpractice-canada. Marra F, Kaczorowski J, Gastonguay L, Marra CA, Lynd LD, Kendall P. Pharmacy-based Immunization in Rural Communities Strategy (PhICS): a community cluster-randomized trial. Can Pharm J (Ott). 2014;147:33–44. Sauvageau C, Dube´ E, Bradet R, Mondor M, Lavoie F, Moisan J. Immunization services offered in Quebec (Canada) pharmacies. Hum Vaccin Immunother. 2013;9:1943–9.
123
16. Canadian Society of Hospital Pharmacists. Immunization Competencies Education Program (ICEP). [Internet]. Ottawa (ON): Canadian Society of Hospital Pharmacists; 2014 [cited 2014 Nov 16]. http://www.cshp.ca/programs/onlineeducation/icepCourse_e. asp. 17. Isenor J, Tobin C, Bowles S, Slayter K. Immunization training: preparing pharmacists for an expanded scope of practice. Can J Infect Dis Med Microbiol. 2010;21:228. 18. Hurley LP, Wortley P, Allison MA, O’Leary S, Daley MF, Babbel C, et al. Seasonal influenza vaccination in adults: practice and attitudes about collaborative delivery with community vaccinators. Vaccine. 2011;29:8649–55. 19. Pace AC, Flowers SK, Hastings JK. Arkansas community pharmacists’ opinions on providing immunizations. J Pharm Pract. 2010;23:496–501. 20. Kummer GL, Foushee LL. Description of the characteristics of pharmacist-based immunization services in North Carolina: results of a pharmacist survey. J Am Pharm Assoc. 2003;2008(48):744–51. 21. Bain KT, Cullison MA. Deficiencies in immunization education and training in pharmacy schools: a call to action. Am J Pharm Educ. 2009;73(6):110.
SHORT RESEARCH REPORT
Pharmacists as immunizers: a survey of community pharmacists’ willingness to administer adult immunizations Nicholas Edwards • Erin Gorman Corsten • Mathew Kiberd • Susan Bowles • Jennifer Isenor Kathryn Slayter • Shelly McNeil
•
Received: 7 September 2014 / Accepted: 27 January 2015 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015
Abstract Background Adult immunization rates worldwide fall below desired targets. Pharmacists are highly accessible healthcare providers with the potential to increase immunization rates among adults by administering vaccines in their practice setting. Objective To determine the attitudes of community-based Canadian pharmacists with respect to expanding their scope of practice to include administration of immunizations. Method An internetbased survey was emailed to community pharmacists across Canada. The survey was piloted through focus groups for qualitative feedback, tested for content validity, and test–retest reliability prior to dissemination. Results There were 495 responses to the survey. The majority (88 %) agreed that pharmacists as immunizers would increase public access, improve rates (84 %), and be acceptable to the public (72 %). However, only 68 % agreed that pharmacists should be permitted to immunize. The
majority of respondents (90 %) agreed that certification in vaccine administration should be required for pharmacists to administer vaccines. Pharmacists identified education, reimbursement, and negative interactions with other providers as barriers to pharmacists administering vaccines. Conclusion Canadian pharmacists are willing to expand their scope of practice to include immunization. However, implementation requires professional development and certification in vaccine administration. Keywords Canada Immunisation Pharmaceutical services Pharmacist Vaccination
Impacts on practice • •
Electronic supplementary material The online version of this article (doi:10.1007/s11096-015-0073-8) contains supplementary material, which is available to authorized users.
Pharmacists can improve immunization rates in patients. Many Canadian community pharmacists are willing to provide immunization services following further education and training.
N. Edwards S. Bowles J. Isenor College of Pharmacy, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS B3H 4R2, Canada
S. Bowles Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Halifax, NS B3H 3A6, Canada
E. Gorman Corsten S. Bowles K. Slayter Faculty of Medicine, Dalhousie University, 1459 Oxford St, Halifax, NS B3H 4R2, Canada
S. Bowles J. Isenor K. Slayter Canadian Center for Vaccinology, IWK Health Centre, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada
E. Gorman Corsten S. Bowles K. Slayter Department of Medicine, Queen Elizabeth II Health Sciences Centre, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
S. McNeil (&) Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, 5850/5980 University Ave., Halifax, NS B3K 6R8, Canada e-mail: [email protected]
M. Kiberd Department of Anesthesia, Pain Management, and Perioperative Medicine, Queen Elizabeth II Health Sciences Centre, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
123
Int J Clin Pharm
•
Major barriers to providing immunizations include knowledge of vaccine indications/contraindications, reimbursement of vaccination expenses, and legal liability.
Ethical approval The study received approval from the Capital Health Research Ethics Board, Halifax, Nova Scotia, Canada.
Introduction
Methods
Vaccine-preventable diseases and the underutilization of immunization programs remain a significant public health concern [1–3]. Many factors have been identified as contributors to low immunization rates, including general public apathy, concerns and misconceptions about the safety and efficacy of vaccines, cost, distance to clinics, inconvenient hours, and wait times [4]. Barriers to immunization must be addressed if immunization rates are to improve. Among the strategies suggested to address barriers and improve immunization rates is the training of non-traditional immunization providers to administer vaccines safely and effectively in their practice settings [5]. As underutilized healthcare professionals, community-based pharmacists are highly accessible, with an estimated 55 % of people over 18 years of age visiting a pharmacy in any given week, pharmacists have many opportunities to interact with patients [6, 7]. United States (US) public health officials recognized the potential for increasing immunization rates by utilizing non-traditional immunization providers, with the addition of community-based pharmacists as immunizers in 1996 [8]. Evaluation of pharmacist immunization programs demonstrated increased public awareness, improved access, and higher rates of adult immunization in states that allowed pharmacists to vaccinate in comparison to those which did not [2, 9–12]. Legislation has passed in six Canadian provinces to increase the scope of pharmacy practice to include the administration of immunizations [13]. Some studies have been published around this new role, however, Canadian pharmacists’ perceptions on the expanded scope have not been previously studied [14, 15]. It is important to understand Canadian pharmacists‘ interest in becoming immunization providers, as well as their attitudes and beliefs about immunization. Such information may inform policy development and statutory reform around expanding the scope of pharmacy practice.
An anonymous, quantitative web-based survey was distributed to all community-based pharmacists who were members of the Canadian Pharmacists Association (CPhA) or the Pharmacy Association of Nova Scotia (PANS) for whom email addresses were available. The survey instrument was developed specifically for this study and was drafted, piloted and modified with input from community-based pharmacists in Nova Scotia prior to distribution. Two focus groups were held involving both rural and urban pharmacists, allowing stakeholders an opportunity to provide input on the survey design before being finalized. Participants were asked to provide qualitative feedback on clarity, wording, and relevance. The final survey instrument was modified to address the focus group comments. Survey participants were provided the opportunity to enter a draw for a gift certificate. Entrants into the draw remained anonymous to the investigators. A return rate of 10 %, or n = 415 pharmacists, was required to provide an acceptable margin of error (or 95 % CI half width) of \5 %. Data was analyzed using descriptive statistics to identify the frequency of responses and general respondent characteristics. All analyses were completed using SAS statistical software, version 8.2 (Cary, NJ).
Aim of the study To complete a national survey of Canadian pharmacists on their perceptions of the addition of immunization administration to their scope of practice before legislative changes were made.
123
Results There were 495 responses to the survey analyzed, a response rate of 12 %. Responses were received from all ten provinces and one territory. The majority of respondents were staff pharmacists, but a substantial number (43 %) were pharmacy owners or managers. Of the 495 responses, 68 % felt that pharmacy practice should expand to include immunization; however, only 51 % reported willingness to incorporate provision of immunization into their personal practice, 24 % were unwilling and 25 % were unsure if they were willing to incorporate. Regardless of whether the pharmacist was willing or unwilling to vaccinate, low confidence was seen in the level of education on vaccinations. Only 29 % of pharmacists willing to vaccinate and 12 % of pharmacists unwilling to vaccinate, thought their undergraduate education was adequate in preparing them for immunization.
Int J Clin Pharm
Furthermore, 99 % of willing and 83 % of unwilling pharmacists felt there should be a formal certification program to allow the provision of vaccines, and 99 % of respondents felt more professional training should be required. Additionally, eight key barriers to providing immunization services were identified: availability of pharmacy space; availability of support staff; current knowledge about vaccines; current training about indications/contraindications; legal liability; reimbursement of expenses/supplies; support from physicians; and time for professional development.
Discussion The current study showed a majority of Canadian pharmacists felt their scope of practice should expand to include immunizations, with about half prepared to proceed. Despite the willingness to proceed, many pharmacists felt their undergraduate education was not adequate to begin incorporating immunization services and that formal certification should be required to do so. Proper immunization training has been acknowledged as a concern by pharmacist regulatory bodies as well, resulting in mandatory immunization training prior to service provision. The development of many immunization training programs throughout Canada emphasizes the profession’s efforts to ensure safe and effective administration of vaccines by pharmacists [16]. Such programs have been shown to be successful, as indicated by an accredited immunization training program in the Maritimes, in which 97 % of pharmacists felt prepared to administer immunizations following completion [17]. Other barriers identified related to reimbursement of expenses/supplies associated with vaccinations and lack of support from physicians. Pharmacy associations will need to negotiate reimbursement, as physician groups have, for administration of publicly funded vaccines to ensure sustainability of pharmacist administrated immunizations. Furthermore, though there has been resistance to pharmacists as immunizers from physicians in the past, a 2011 study by Hurley et al. showed 79 % of physicians were willing to refer patients to community immunizers, such as pharmacists [18]. Limitations of the study include the small sample size, which may not be representative of the Canadian pharmacist population. However, studies completed in other jurisdictions have found similar results with respect to barriers identified, such as lack of time, lack of space, reimbursement concerns, legal liability, and lack of formal education, which further support our results [19–21].
Conclusion Many Canadian pharmacists are willing to offer immunizations following further education and training. It is important for any jurisdictions considering the expansion of pharmacists’ scope of practice to include provision of immunizations to consider education as an integral part of the process. Future research is needed to examine pharmacists’ knowledge, attitudes, and beliefs about immunization, as well as the effect of pharmacist immunizers on Canadian immunization rates. Acknowledgments The authors would like to thank Donna MacKinnon-Cameron of the Canadian Center for Vaccinology for her statistical support, the Canadian Pharmacists Association for assistance with survey administration, and Tania Alia for her assistance with manuscript preparation and review. Funding Fund.
This work was supported by the Capital Health Research
Conflicts of interest The authors have no conflicts of interest to declare in relation to this work.
References 1. US Department of Health and Human Services. 2010 National Vaccine Plan. [Internet]. United States of America: Department of Health & Human Services; 2010 [cited 2014 Nov 16]. http:// www.hhs.gov/nvpo/vacc_plan. 2. Skelton JB. American pharmacists association, academy of managed care pharmacy. Pharmacist-provided immunization compensation and recognition: white paper summarizing APhA/AMCP stakeholder meeting. J Am Pharm Assoc. 2003;2011(51):704–12. 3. World Health Organization. What are some of the myths and facts about vaccination? [Internet]. World Health Organization; 2013 April [cited 2014 Nov 16]. http://www.who.int/features/qa/ 84/en/index.html. 4. Kamal KM, Madhavan SS, Amonkar MM. Determinants of adult influenza and pneumonia immunization rates. J Am Pharm Assoc. 2003;2003(43):403–11. 5. Shen AK, Bridges CB, Tan L. The first national adult immunization summit 2012: implementing change through action. Vaccine. 2013;31:279–84. 6. Grabenstein JD, Guess HA, Hartzema AG, Koch GG, Konrad TR. Attitudinal factors among adult prescription recipients associated with choice of where to be vaccinated. J Clin Epidemiol. 2002;55:279–84. 7. Steyer TE, Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine. 2004;22:1001–6. 8. Ashby-Hughes B, Nickerson N. Provider endorsement: the strongest cue in prompting high-risk adults to receive influenza and pneumococcal immunizations. Clin Excell Nurse Pract. 1999;3:97–104. 9. Higginbotham S, Stewart A, Pfalzgraf A. Impact of a pharmacist immunizer on adult immunization rates. J Am Pharm Assoc. 2003;2012(52):367–71. 10. Loughlin SM, Mortazavi A, Garey KW, Rice GK, Birtcher KK. Pharmacist-managed vaccination program increased influenza
123
Int J Clin Pharm
11.
12.
13.
14.
15.
vaccination rates in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27:729–33. Ernst ME, Chalstrom CV, Currie JD, Sorofman B. Implementation of a community pharmacy-based influenza vaccination program. J Am Pharm Assoc (Wash). 1997;NS37:570–80. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved influenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21:1115–22. Canadian Pharmacists Association. Pharmacists’ Expanded Scope of Practice. [Internet]. Ottawa (ON): Canadian Pharmacists Association; 2014 [updated 2014 Nov; cited 2014 Nov 16]. http:// www.pharmacists.ca/index.cfm/pharmacy-in-canada/scope-ofpractice-canada. Marra F, Kaczorowski J, Gastonguay L, Marra CA, Lynd LD, Kendall P. Pharmacy-based Immunization in Rural Communities Strategy (PhICS): a community cluster-randomized trial. Can Pharm J (Ott). 2014;147:33–44. Sauvageau C, Dube´ E, Bradet R, Mondor M, Lavoie F, Moisan J. Immunization services offered in Quebec (Canada) pharmacies. Hum Vaccin Immunother. 2013;9:1943–9.
123
16. Canadian Society of Hospital Pharmacists. Immunization Competencies Education Program (ICEP). [Internet]. Ottawa (ON): Canadian Society of Hospital Pharmacists; 2014 [cited 2014 Nov 16]. http://www.cshp.ca/programs/onlineeducation/icepCourse_e. asp. 17. Isenor J, Tobin C, Bowles S, Slayter K. Immunization training: preparing pharmacists for an expanded scope of practice. Can J Infect Dis Med Microbiol. 2010;21:228. 18. Hurley LP, Wortley P, Allison MA, O’Leary S, Daley MF, Babbel C, et al. Seasonal influenza vaccination in adults: practice and attitudes about collaborative delivery with community vaccinators. Vaccine. 2011;29:8649–55. 19. Pace AC, Flowers SK, Hastings JK. Arkansas community pharmacists’ opinions on providing immunizations. J Pharm Pract. 2010;23:496–501. 20. Kummer GL, Foushee LL. Description of the characteristics of pharmacist-based immunization services in North Carolina: results of a pharmacist survey. J Am Pharm Assoc. 2003;2008(48):744–51. 21. Bain KT, Cullison MA. Deficiencies in immunization education and training in pharmacy schools: a call to action. Am J Pharm Educ. 2009;73(6):110.
