Patient Engagement Strategies for Immunization in a Community Pharmacy Setting

Prior to vaccines, immunity to a disease was acquired solely through contracting the illness.¹ However, sickness brought an elevated risk of death.¹ After immunizations were created and modernized, several diseases were virtually eradicated, including measles, diphtheria, mumps, smallpox, rubella, polio, and tetanus.¹ At the heart of the modern vaccination world are pharmacists who play a vital role in the health of their patients by recommending and administering appropriate immunizations.

Study results have shown that pharmacy-based vaccination service rates have increased, with programs becoming widely available in 97% of counties in the United States during the time of the study and offering a convenient option for patients to protect themselves from a preventable disease.² There are many strategies pharmacists can follow to engage patients in discussions about immunizations to further increase vaccination rates within communities.

Ways to Stay Up-to-Date as an Immunizer

When pharmacists are knowledgeable about current immunization recommendations, they can strong endorsements to patients regarding appropriate vaccinations. The authority on immunization recommendations in the United States is the CDC’s Advisory Committee on Immunization Practices, consisting of a group of 15 health experts who determine the official immunization schedules.³ These recommendations are updated and reissued annually and are organized according to many patient-specific factors, such as age and disease states.³ Staying current on this information can reinforce a pharmacist’s knowledge and help to ensure that proper recommendations are made to patients.

Patients who visit community pharmacies are prime candidates for immunizations. Following the most recent vaccine recommendations, pharmacists can screen patients by age, disease state, and vaccination history during the dispensing process to determine appropriate recommendations for patients when they arrive at the pharmacy. Since the recombinant, adjuvanted zoster vaccine (RZV; Shingrix) was approved by the FDA in October 2017, pharmacists have been able to use current information to recommend the immunization in patients who are immunocompetent and 50 years and older.⁴ Additionally, the CDC offers quizzes to help patients learn about vaccinations, specifically which vaccines are recommended for them and their families.^5,6

Pharmacists accessing statewide immunization databases can help to limit unnecessary vaccines by confirming vaccination history. A vaccine history printed from the database and given to the patient can serve as a personal record, reinforce a current recommendation, and even act as a reminder of future, scheduled vaccines. Because RZV is administered in 2 doses, a personal record can help a patient remember to get the second vaccination in the series. Patients may even come to the pharmacy requesting a specific vaccination. Examining the statewide database and recommending companion vaccines can be a helpful way to ensure that a patient who is ready and willing to receive a vaccine at the time catches up on other vaccines they may not know they are due to receive.

Patient Hesitancy Toward Immunization

Patients can exhibit a hesitancy toward receiving proper immunizations. Some avoid vaccinations because of a shortage of information, a perception of low priority, lack of accessibility, operational obstacles, and fear of immunizations.⁷ Identifying the reason why a vaccination has not been completed and tailoring the recommendations accordingly to educate the patient can lead to successful engagement between the pharmacist and the patient.

Many patients consider getting vaccinated a low priority because they fail to see the benefit of receiving immunizations. They may not have any external reinforcement during their everyday routines to remind themselves to get vaccinated.⁷ Some patients may not realize the importance of preventing illness, believing vaccination is not necessary because they are in good health and are not at risk of developing the conditions that immunizations prevent.⁷

Educational gaps can also contribute to not getting vaccinated. Some patients do not know that most pharmacies provide a range of vaccinations without an appointment. Between 2006 and 2010, the percentage of countries with pharmacy-based immunization services increased from 36% to 97% worldwide.² Because of the availability of pharmacy-driven immunizations, an additional 6.2 million influenza vaccines and 3.5 million pneumococcal vaccines are given annually.²

The cost of vaccinations and missing immunization records in pharmacies can contribute to operational obstacles that dissuade patients from being immunized. Patients may not be aware of affordable immunization options, or even free public vaccination programs, that may offer a less expensive alternative to treating the disease that the vaccine is designed to prevent.⁷ This can be an important discussion to have with patients, some of whom may be hesitant to spend the money.⁷

When making recommendations, it is beneficial for pharmacists to address any hesitancy a patient may have regarding a vaccine. Determining what is preventing patients from getting vaccinated and discussing their fears and uncertainties can make them feel more comfortable with a recommendation. It is also helpful to address unfounded myths that may be hindering a necessary vaccine.

Strategies to Improve Engagement

Pharmacists can use different strategies to engage with patients about vaccination opportunities to further increase immunization rates. Reminders, knowledgeable technicians, outreach programs, and marketing approaches can be useful tools for pharmacists to consider.

Developing a vaccine series completion reminder is an important step in ensuring proper vaccine administration. RZV is administered as a 2-shot series, with the second shot given 2 to 6 months after the first.⁴ Results from studies have shown that patients are more likely to be given the recommended immunizations after receiving a reminder.⁸ Pharmacists can ensure that patients receive the second shot in the recommended timeframe by providing reminders in person and through phone calls and text messages.

Pharmacists can also improve patient engagement by recruiting technicians to aid in the immunization process and identify individuals who may be eligible for a vaccine. Often during a community pharmacy visit, a patient will spend ample time with a technician, who may have more time than a pharmacist to do a screening on specific vaccinations. In certain states, technicians are also beginning to administer immunizations, creating engagement with patients that are more seamless and efficient.⁹ Although technicians can begin the patient identification process and administer vaccines in certain states, it is important to remember that only a pharmacist should be evaluating patients for vaccine appropriateness, making strong recommendations for required vaccines, and providing counseling.

Marketing techniques can also increase rates of immunization. Using posters or other visual aids around pharmacies helps promote vaccinations. Pharmacies can also add information about available immunizations to medication information when a patient visits the pharmacy. Grocery stores could implement overhead announcements to inform shoppers of vaccines that are available.

Pharmacists can advocate for vaccines outside the traditional pharmacy setting in health fairs and shot clinics. The latter is especially beneficial during influenza season. A pharmacy team can immunize hundreds of people within hours by traveling to a site and providing immunizations for a set amount of time, increasing the availability of vaccines to individuals who may not have a scheduled appointment with their provider or do not routinely visit a pharmacy. Pharmacists can work with local health departments and other associations to promote immunizations for high-risk populations. They may also provide education through seminars and brochures to spread information about the importance of vaccinations. For example, the Vaccine Information Statements from the CDC are a very informative and appropriate reference tool.¹⁰ They include information about specific vaccines and the diseases they target. They also cover common adverse effects associated with vaccines and provide references for more information.¹⁰

Of course, it is just as important to have proper stock of the vaccines. Keeping an adequate inventory of vaccines in the pharmacy is critical to ensuring that patients get their needed immunizations. A patient cannot get an immunization if the recommended product is not available. Proper ordering protocols should be in place for the pharmacy team when ordering and stocking immunizations.

Conclusion

Pharmacists can better engage patients by taking active, informed roles as immunizers and practitioners. Communicating vaccine schedules and making strong recommendations for necessary vaccines to patients is a vital aspect of the role of a pharmacist. Outreach efforts like marketing and creating clinics outside a traditional pharmacy setting also contribute to this goal. Patients may feel hesitant to get immunized, but having a discussion addressing specific barriers to immunization can be helpful in improving a patient’s receptiveness regarding immunizations. Pharmacists can make a significant difference in the lives of patients by encouraging immunizations, and using known strategies to better engage patients is an excellent way to do so.

NATHAN SPANN, PHARMD, is a pharmacist with Albertsons/Sav-on Pharmacy in Boise, Idaho.

References

• Vaccine benefits. National Institute of Allergy and Infectious Diseases website. www.niaid.nih.gov/research/vaccine-benefits. Updated March 6, 2014. Accessed July 5, 2018.
• D’Arrigo T. Pharmacy-based immunization services increase influenza, pneumococcal vaccination rates. American Pharmacists Association website. pharmacist.com/article/pharmacy-based-immunization-services-increase-influenza-pneumococcal-vaccination-rates. Published May 21, 2018. Accessed July 4, 2018.
• Advisory Committee on Immunization Practices (ACIP). CDC website. cdc.gov/vaccines/acip/about.html. Updated August 16, 2012. Accessed July 5, 2018.
• Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly. 2018;67(3):103-108. doi: 10.15585/mmwr.mm6703a5.
• The childhood vaccine quiz. CDC website. cdc.gov/vaccines/childquiz/. Updated February 6, 2018. Accessed July 5, 2018.
• The adult vaccine quiz. CDC website. www2.cdc.gov/nip/adultimmsched/. Updated February 21, 2018. Accessed July 5, 2018.
• Ventola CL. Immunization in the United States: recommendations, barriers, and measures to improve compliance. Part 2: adult vaccinations. P T. 2016;41(8):492-506.
• Jacobson Vann JC, Jacobson RM, Coyne-Beasley T, Asafu-Adjei JK, Szilagyi PG. Patient reminder and recall systems to improve immunization rates. Cochrane Database Syst Rev. 2018;(1):CD003941. doi: 10.1002/14651858.CD003941.pub3.
• WSU, Albertsons create first U.S. program allowing pharmacy technicians to administer immunizations. Washington State University website. news.wsu.edu/2017/04/18/pharmacy-technicians-to-immunize. Published April 18, 2017. Accessed July 5, 2018.
• Vaccine information statements (VISs). CDC website. cdc.gov/vaccines/hcp/vis/current-vis.html. Updated March 21, 2018. Accessed July 5, 2018.