Vaccinations a step in expanding pharmacist role
Along with major paradigm shifts in how people communicate, read and do business, the way they receive healthcare services is changing dramatically, and retail pharmacies are at the front line.
In no area is this more true than vaccinations. According to a report released in June by the Centers for Disease Control and Prevention, the largest percentage of adults (39.8%) received their flu vaccinations during the 2010-2011 influenza season at physicians’ offices, but a growing number of people are opting to receive them at retail pharmacies instead. In the 1998-1999 season, only 5% got their vaccinations at pharmacies. But by the 2010-2011 season, the rate had reached 18.4%.
This dramatic rise is due largely to the ability of pharmacists in all 50 states and the District of Columbia to administer vaccinations, with Maine as the last state to join the list in 2009. Retail pharmacy chains have responded by rolling out pharmacist-administered flu vaccinations on a grand scale, with Walgreens, Rite Aid and CVS now offering them at all of their stores, in addition to regional chains.
Another major catalyst was the H1N1 influenza pandemic. “Community pharmacy worked very closely with the federal government at that time and with the CDC,” National Association of Chain Drug Stores Foundation president Edith Rosato told Drug Store News, calling retail pharmacies’ collaboration with the government a “watershed event.” “There was so much pressure to ensure that patients would be able to get the vaccine, so the government reached out to community pharmacy and used us as a distribution point.”
A recent study published in the Journal of Public Health Management and Practice called pharmacists “an integral part of the nation’s ‘first line resource’ for health and wellness, and can extend the reach for public health initiatives.” NACDS president and CEO Steve Anderson responded to the report by saying it drove home the message that pharmacists play a critical role in the healthcare delivery system.
In many ways, it would seem natural that pharmacies have become a major destination for flu vaccinations. Patients can walk in, pay a small fee and receive the vaccination instead of having to make an appointment, as they would have to at a doctor’s office. In addition, pharmacy retailers are well positioned to offer vaccinations thanks to their role as shopping destinations. Rite Aid, for example, offers customers who receive vaccinations at its stores coupon books with more than $100 in savings, while members of the retailer’s Wellness+ loyalty card program receive 25 reward points. In September, Winn-Dixie offered Customer Reward Card members who received its vaccinations a discount on shot and flu-prevention groceries — fruit, orange juice, hand sanitizer, wipes and tissues — worth $12.71.
But pharmacists’ clinical roles look likely to increase even further. NACDS currently is lobbying state governments to allow vaccination of younger children, as well as lobbying for the ability to provide other vaccinations, including shingles, hepatitis A and B, measles-mumps- rubella and travel vaccines. Many states already allow pharmacists to administer shingles vaccines, while Seattle-based Bartell Drugs has taken advantage of regulations in Washington state that allow pharmacists working under physicians’ supervision to administer travel vaccinations.
Child vaccinations up despite fears
At the beginning of the year, a major global controversy was settled when it turned out that a study published in The Lancet in 1998 linking the measles-mumps-rubella vaccine to autism in children turned out to be a whopper of a fraud.
But despite the exposure of the study’s author — and outbreaks of preventable diseases among children in the United States and Europe, thanks to parents who opted to have their kids vaccinated — it appears that sowing fear of childhood vaccines still appears to have some currency.
Republican presidential candidate Michele Bachmann decided to try and spend a bit of that currency in a debate last month when she criticized Texas Gov. Rick Perry for mandating the human papillomavirus vaccine for girls in his state, later claiming that a woman had approached her and said the vaccine caused her daughter to develop mental retardation. In contrast with the millions who bought Wakefield’s fraudulent research, Bachmann drew ridicule from voices on the left and the right. Merck, which makes Gardasil (human papillomavirus quadrivalent [types 6, 11, 16 and 18] vaccine, recombinant), responded by saying that the vaccine’s safety and efficacy were supported by clinical trials. Meanwhile, American Academy of Pediatrics president O. Marion Burton said Bachmann’s statement was “false” and had “absolutely no scientific validity.”
Meanwhile, vaccinations of children against a wide range of diseases have risen dramatically in recent years. According to the Centers for Disease Control and Prevention’s “2010 National Immunization Survey,” of the 17,000 households that participated, immunizations of children born between 2007 and 2009 against measles, mumps, rubella, rotavirus, hepatitis A, pneumococcal disease and Haemophilus influenzae type B were at 90% or more. In addition, vaccinations against polio, chickenpox and hepatitis B remained at or above 90%.
Also, immunization rates did not differ between racial and ethnic groups for most vaccines, and thanks to recent increases in coverage among minority children, levels for most vaccines in other racial and ethnic groups were similar to or higher than those among white children, though large disparities between racial and ethnic groups have remained with other health services.
Some holes in vaccination rates have nevertheless persisted. According to research by the CDC, 115 people ages 18 years and younger died from influenza-related causes between September 2010 and August 2011. According to the research, information about influenza vaccination was available for 74 of those children ages 6 months and older; 17 (23%) received influenza vaccine in the appropriate number of doses at least 14 days before illness onset. The CDC recommends that everybody ages 6 months and older be vaccinated against the flu, a recommendation that has been in place since 2008.
Industry aims to prevent primary nonadherence
While medication nonadherence is a perennial problem that costs the healthcare system $290 billion per year, one of the least explored facets of it is primary nonadherence, when patients receive new prescriptions on paper or electronically and never drop them off or pick them up. But some researchers hope to change that.
The study, conducted by Kaiser Permanente Colorado and the University of Colorado, and published in the Journal of General Internal Medicine, found 11% of diabetes patients failed to pick up or fill their new prescriptions. But this study took place in an integrated healthcare system with extensive use of electronic health records; studies in nonintegrated health systems have found general rates of primary nonadherence to be as high as 22%, though the higher rate could be because of lack of data sharing between different organizations and pharmacy claims databases.
What makes an issue like primary nonadherence particularly significant in diabetes is the scope of the disease. According to the Centers for Disease Control and Prevention, 26 million Americans have Type 1 and Type 2 diabetes, and Type 2 diabetes — once called adult-onset diabetes — has grown rapidly among children.
Earlier this year, the National Association of Chain Drug Stores Foundation announced plans to fund two studies on primary nonadherence in response to the lack of available scholarship on it — a recent analysis by the NACDS Foundation and the Rand Corp. found that out of 4,600 peer-reviewed studies on nonadherence, only three addressed primary nonadherence. The studies, to be conducted by research teams from Harvard University and the University of Mississippi, will focus on various interventions for addressing primary nonadherence at the community pharmacy level in order to determine which are the most effective. Preliminary results are expected to appear in July, with the rest expected within two years.
“The reason we want to focus on primary medication nonadherence in the community is because of the large preponderance of patients who don’t have a health plan that’s integrated,” NACDS Foundation president Edith Rosato told Drug Store News. “We feel that community pharmacists can have a tremendous impact on helping patients become more adherent.”
Still, retail pharmacies already are finding ways to address the problem. Last month, Rite Aid joined forces with UnitedHealth Group’s Diabetes Prevention and Control Alliance to launch a program for diabetes patients at select stores in New York and Washington. Under the program, trained pharmacists will consult quarterly with enrolled patients to evaluate their medication adherence and review their test results for blood pressure, blood glucose and cholesterol. “By participating in the Diabetes Prevention and Control Alliance, Rite Aid is able to offer participating patients the benefit of one-on-one counseling from a Rite Aid pharmacist specifically trained in diabetes care and medication therapy management,” Rite Aid EVP pharmacy Robert Thompson said. “This type of care has been proven to better manage diabetes and improve overall health, lowering healthcare costs in the long run.”