Pharmacists Play Key Role in Flu Vaccination Efforts

In an interview, Kristi Veis, PharmD, RPh, vice president of pharmacy at Hi-School Pharmacy, discussed annual influenza vaccinations, the role of the pharmacist in vaccination, and ways pharmacists can increase vaccination rates.

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Q: For influenza vaccination, who is recommended to get a vaccine, and when is the preferred time frame for getting the vaccination?

Kristi Veis: Influenza vaccinations are recommended for all individuals 6 months and older. We allow our pharmacists to decide the youngest patient they feel comfortable vaccinating with the average age of 7 years old. Typically, we start vaccinating the Tuesday after Labor Day as this allows us to have a good supply on hand at all our locations. October is a big month for us promoting vaccinations to the 65+ community with a majority of our patients obtaining their influenza vaccination by the beginning of the New Year. We will never turn an arm away if we have influenza vaccine available, but our yearly cutoff is May due to expiration and credit.

Q: What is the role of the pharmacist in administering influenza vaccination?

Currently, our pharmacists are the primary vaccinators at our pharmacies and assist in the billing process as well as documenting the administration on the state portal. At a few select pharmacies, we have certified pharmacy technicians administer the vaccinations, but only after the pharmacist verifies the accuracy of the vaccine to be administered and answering any questions the patient may have.

Q: What are some strategies to best address concerns or questions that patients have about vaccination?

As was shown during the pandemic, vaccines are readily available at the pharmacy and help prevent many disease states prevalent in the US and abroad. When there’s a choice between 2 good vaccines, we typically stock 1 brand, based on price, availability, and reimbursement.

Typically, we do not advocate for one vaccine over another but will stock 1 vaccine per disease state for commonly asked vaccines thus allowing us to quickly answer questions. When questioned by patients which vaccine brand is best, we can confidently say that we only have X brand in stock, and both work similar in preventing Y. For example, we only purchased 1 brand of 65+ vaccine this year, and as it is not the high dose vaccine, our employees have been instructed to tell patients that we have regular flu vaccine or 65+ flu vaccine available. If patients have questions between high dose versus 65+, the pharmacist will go into detail on the differences. When patients ask questions about a vaccine, we give them simple details on what it typically prevents and the [adverse] effects that commonly occurs.

During the fall, patients come in for influenza, COVID, and other respiratory vaccines, so questions typically are asked about when they can get their dose, how long do they need to wait between different vaccines, or when can they get their next dose. Throughout the rest of the year patients come to the pharmacy because their [physician] told them to go get a vaccination which usually is one not stocked at the clinic. During this instance, we ask the patient if they know the name of the vaccine or if the [physician] was sending over a prescription for it. These are typically the patients with the most questions. Once we know the vaccine name, the pharmacist engages in conversation to answer any questions or concerns.

While vaccinating, I like to engage in conversation with patients to see if they’ve experienced [adverse] effects previously to the vaccine being administered or if they have heard of others experiencing [adverse] effects. I relay relevant information to other immunizers as well as patients that come to the pharmacy counter with similar questions. Trends are important for what is happening in the local community as that can influence whom will or will not get vaccinated for certain disease states as well as of who will want specific brands of vaccine (ie Pfizer versus Moderna) Social media also plays a part for influencing different [patient] groups.

When questions arise and the answer is not quickly available, we will investigate by using resources available to us including the drug manufacturer, CDC, and other reputable sites. We also print out information for patients who want to do their own inquiry on the vaccine prior to immunization.

Q: How can pharmacists help to increase vaccination rates in their communities?

A way that has helped in our community to increase vaccination rates is by having specific times for patients to stop in to be vaccinated instead of using an online or in-house scheduling platform. Another way is to go onsite to places, such as nursing homes, where the pharmacist can vaccinate patients at the facility or in a patient room. We work with local businesses as well as the local school districts to vaccinate teachers. Sometimes we go outside the pharmacy to a patient’s car to vaccinate. Working with other local health care and alerting local [physician’s] offices of our clinic hours and types of vaccines that the pharmacy stocks allows them to send their patients to the local pharmacy to be vaccinated.

Q: What are some challenges that pharmacists face when promoting vaccination?

Some of the challenges to promote vaccinations are reimbursement. Pharmacies need to get adequately reimbursed for the work that the pharmacist/pharmacy technician completes for the vaccination. Sometimes the local pharmacy cannot take the patient's insurance, which poses a problem for the customer who must go elsewhere to be vaccinated.

Having a dedicated vaccination room can pose a problem as it costs money to construct a room. Also, the pharmacy building itself may have a small footprint, so not enough chairs can fit for all the patients waiting to be vaccinated or for the pharmacist to watch for [adverse] effects after vaccinating. Another challenge is fridge space as we may either need to purchase bigger fridge, which costs money, or the staff must make room amongst all the current drugs and prescriptions stored within to stock the different types of vaccines needed for our patient population.

We desire to have enough people working in the pharmacy to safely engage in the practice of pharmacy as a whole. Some of the tasks during a normal business day for the pharmacy may include, time to counsel patients, check prescriptions, check in drug orders, and sell the prescriptions to patients. Sometimes there are not enough ancillary staff to do the daily tasks plus add in the time for the pharmacist to be pulled off the bench to vaccinate patients. Also, to run an offsite clinic there needs to be a second pharmacist available to work at the store. Right now, there are less pharmacists graduating from pharmacy school, and it is taking longer for them to pass their board exams thus creating a pharmacist shortage.

here are not enough hours in the day to do it all. Billing for the vaccine can take some leg work if there is insurance issues plus all the scanning of paperwork and inputting the data into the state registry takes time.