Importance of the Flu Vaccine and Associated Complications

Troy Trygstad, PharmD, MBA, PhD; John Beckner, BSPharm, RPh; Ned Milenkovich, PharmD, JD; and Brian Hille, BSPharm, RPh, discuss the importance of getting an influenza vaccine and offer an overview of influenza-associated hospitalizations and deaths.

Troy Trygstad, PharmD, MBA, PhD: Thank you for joining this Pharmacy Times^® Peer Exchange^® panel discussion regarding the progression of immunization in pharmacy practice. Although most people who get the flu will not need medical care, some people can get flu complications that may result in hospitalizations and sometimes death. The flu can also cause complications when comorbidities exist. Community pharmacists are now playing a larger role in administering influenza vaccinations to patients. In addition to the influenza vaccine, importantly, the recommendations for additional immunizations are continuously growing. Perhaps the pharmacist can play an important role in changing requirements and keeping up-to-date on the other immunizations.

I’m Dr. Troy Trygstad, and I am the vice president of Pharmacy Programs for the Community Care of North Carolina in Raleigh, North Carolina. I’m also the editor-in-chief of Pharmacy Times^®. Joining me on the panel are John Beckner, senior director of strategic initiatives at the National Community Pharmacists Association in Alexandria, Virginia, and Brian Hille, vice president of Patient, Specialty, and Wellness Services at Albertsons Companies. Also joining us are Dr. Ned Milenkovich, chairman of Health, Drug and Pharmacy Practice, who’s a partner at Much Shelist in Chicago, Illinois, and, finally, Mindy Smith, president of the PrescribeCare Management Services Organization and the vice president of Pharmacy Practice Innovation for PrescribeWellness, which is in Irvine, California. Thanks everybody for joining us. Let’s get started.

So, John Beckner, what’s the importance of the influenza vaccine to the health care system and to preventing disease and progression of disease and death in the United States?

John Beckner, BSPharm, RPh: Well, flu is a significant health care problem each year. Everyone over the age of 6 months should get the flu vaccine. The very young people and those over the age of 65 are at greater risk; also, people with comorbid conditions such as diabetes and asthma are at greater risk. Another thing to consider is occupation. Health care workers, caregivers—all these folks should be vaccinated against the flu.

Troy Trygstad, PharmD, MBA, PhD: That’s a good point. We often think that 1 of our important roles is vaccination of the population, but we forget the importance of vaccinating ourselves as health care professionals, as well. Do you want to speak to that?

John Beckner, BSPharm, RPh: Well, I get a flu shot every year. People who come in contact with the public—pharmacists, physicians, nurses, people who work in hospitals—it’s very important for them to be protected.

Troy Trygstad, PharmD, MBA, PhD: And, Ned, we’re seeing an increasing number of health care sites, health systems, practices, pharmacies, etc mandate that their personnel get vaccinations beyond just hepatitis, etc, etc. Certainly, there are waivers, but can you speak a little bit about the provider community and the push to mandate or encourage folks to get vaccinations when you’re in a health care setting, so that when we’re providing health care we’re not having teratogenic effects?

Ned Milenkovich, PharmD, JD: Right. I think it’s pretty clear that the economic burdens of not having vaccinations is pretty significant. It has been estimated that there’s an annual $10.4 billion in direct costs for hospitals, as well as outpatient visits for adults. You couple that with 12,000 deaths a year, and it’s really significant. The work force is impacted adversely. Families are impacted adversely. Schools, children, the entire spectrum of society are adversely impacted and can be prevented by adhering to some of these immunization protocols.

Troy Trygstad, PharmD, MBA, PhD: Yes, certainly, productivity at work. You can see social media spikes, obviously, in flu season with a lot of key words. We all experience flu season in some way even if we’re not infected ourselves, right?

Ned Milenkovich, PharmD, JD: Precisely, yes. And the more severe statistics show, for example, that in the 2017-18 season, there were actually 178 influenza-associated pediatric deaths. It’s a terrible tragedy, completely preventable. People are making over 11 million medical visits to various health care providers throughout the year, so these are things we really need to take into consideration when we weigh the pros and cons of giving a vaccination to the general public.

Troy Trygstad, PharmD, MBA, PhD: Yes, we often forget that it’s still 1 of the leading causes of death in the United States, something that’s completely or mostly preventable. Brian, you have 1700 sites of care. What does preparing for flu season look like at Albertsons?

Brian Hille, BSPharm, RPh: Well, when we first started with flu season, it was a season. I would say now it never stops. We are preparing year-round, whether it’s the procurement side or it’s the preparation around tactics that we’re going to use for flu season or it’s the training—very specific to the flu season that we’re going into—that needs to occur with all of our pharmacists and technicians. So, it is a year-round event for us.

Troy Trygstad, PharmD, MBA, PhD: And you hit a groove now, right? So, we’ve got 10-plus years of experience with this. It’s become institutionalized and protocolized. Can you talk about that journey throughout your company and your sites of care? You had some initial sites of care, but now it’s through and through. How’s it different than it was a decade ago if I’m practicing pharmacy at Albertsons?

Brian Hille, BSPharm, RPh: Yes, even 2 decades, that’s really when we first got started. Of course, it was a few innovators that were out there. Today, it’s a standard of care really expected by our patients. And I think that’s what it always comes down to for me, that as health care providers, we’re always looking to do the right things for our patients. As John spoke about, everybody over 6 months, they should get a flu shot. Once in a while I’ll get people who ask, “Well, I know health care workers, they’re supposed to get a flu shot, too. Am I a health care worker?” I’ll get a technician asking me that. And I’m like “Well, yes, you are. You come in contact with those who are vulnerable and really could have complications due to flu, so you absolutely need to protect yourself, so you don’t pass it to your patients.”

Troy Trygstad, PharmD, MBA, PhD: Right. You know, John, you work for an organization that represents tens of thousands of pharmacies. We often forget that anybody walking in by virtue of being able to walk into that pharmacy should be getting a flu shot.

John Beckner, BSPharm, RPh: Exactly.

Troy Trygstad, PharmD, MBA, PhD: Right? And so, how do you coach 20-some-thousand-odd pharmacies that need to be front of mind? It’s not an exceptional case, it’s the regular case that we should be like “Have you gotten your flu vaccinations?” And off we go for everybody walking into that pharmacy.

John Beckner, BSPharm, RPh: As Brian mentioned, it has really become standard of care, and that has been an educational effort on the part of our organization—to instill in our members the importance of providing that service and educating their staff on communicating with the patients who come into the store how important it is. We represent the independent sector. Brian is with Albertsons and represents the chains. Today, everybody should be immunizing. It has become an issue of competitive parity. If you’re not immunizing, you’re not keeping up with the competition.

Troy Trygstad, PharmD, MBA, PhD: And it’s standard of practice at this point, which is pretty neat. That’s the whole idea of advancing practice. So, Brian, it’s not just everybody walking in. From your perspective and sites of care, there’s additional emphasis on some populations. What might those populations be? And how is it that you apply additional emphasis or additional encouragement or additional screening for those patients in circumstances who really need the flu shot even more than other populations?

Brian Hille, BSPharm, RPh: Yes. So, we’ve gotten more sophisticated with time, which is a wonderful thing, started using data to our benefit to identify patients who really can benefit from getting a flu shot, maybe even knowing some details about them—got one 2 years ago but not last year. They’re obviously open to getting a flu shot. And so, we do identify patients much more effectively than we did in the past, but certainly that over-65 population is an easy population to target. And then John was mentioning some of the chronic conditions really to make sure they’re being protected. And so, we make extra effort to make sure we’re identifying those patients and reaching out to them to invite them in to get their flu shot.