The Immunization Treatment Landscape

Troy Trygstad, PharmD, MBA, PhD, leads a discussion on the current rates of immunization amongst various age groups and how to effectively administer vaccines to the general population.

Troy Trygstad, PharmD, MBA, PhD: Hello everybody. Welcome to this Pharmacy Times® Peer Exchange®. The pharmacist’s role is growing in administration of immunization. This provides new business and opportunities for pharmacies as well as providing improved patient care. However, there are still many gaps to increasing the percentage of patients that get their recommended immunizations. With our panel of experts, we will discuss the unmet needs and find potential solutions to fill the gaps.

I’m Dr. Troy Trygstad, vice president of Pharmacy and Provider Partnerships for Community Care of North Carolina. I’m also the executive director of CPESN [The Community Pharmacy Enhanced Services Network] USA in Raleigh, North Carolina, as well as the Editor-in-Chief of Pharmacy Times®.

Joining me today are Michael Popovich, CEO of Scientific Technologies Corporation in Phoenix, Arizona.

Also, Dr. Dorothy Loy, director of immunization services for Walgreens in Chicago, Illinois.

We also have Dr. Tana Kaefer, director of clinical services for Bremo Pharmacies in Richmond, Virginia.

And last but not least, Emily Endres, director of payer relations at Pharmacy Quality Solutions in Durham, North Carolina.

Thank you so much for joining us. Let’s get started.

Let’s start off with the question that every public health official has on their mind, and what they think about every day. What are our current rates of immunization? Dorothy, where are the biggest gaps?

Dorothy Loy, PharmD, MBA: I think those rates vary drastically depending on the age of our population. If you look at adults between 18 and 64, their immunization rates on flu are about 43%. And for adults over the age of 65, it’s around 67%. And those are well below the 2020 goal of 70% flu coverage for healthy people. There definitely is an opportunity there. I think the biggest opportunity is probably with our adults between that middle age range. And that’s really just awareness of the vaccines which they do need, as well as having them come into our pharmacies, or just visiting their doctors to understand what vaccines they might need to get updated on.

Troy Trygstad, PharmD, MBA, PhD: Emily, your company looks at a lot of data, and so you see first-hand large gaps in populations of unimmunized patients that are recommended to get immunizations. What’s your reaction as a citizen, somebody that’s trying to help healthcare providers raise awareness?

Emily Endres: That’s a great question. When we look at this data across the vast dataset that we have, there’s certainly, to Dorothy’s point, a large gap in this care and coverage. It’s exciting to be able to finally bring together all of the data sources necessary to do some quality measurement in this arena, if you will, so that we can help to provide pharmacies with very tangible, targeted patient opportunities at their fingertips, to help immunize this gap. There are some recent studies, to your point Dorothy, that show that this population of middle-age adults are not going into the pharmacies often, and some other populations have a real opportunity there. It’s exciting to be able to bring that to the forefront for pharmacies to connect with that patient just in case they do happen to come into their store.

Troy Trygstad, PharmD, MBA, PhD: So, Tana, there are young patients that come into your pharmacy in Virginia who oftentimes interact with pediatricians, but you also still focus on them because that’s at the front of mind.

Tana Kaefer, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: You have a lot of elderly or at-risk patients, either because of their conditions or by virtue of being elderly, and there’s a focus there. What do you do with the 35-year-old otherwise healthy adult walking in the pharmacy? How do you develop a mindset amongst your team there at the pharmacy to say, “Don’t forget about this person as well”?

Tana Kaefer, PharmD: Right. We are engaging our staff to have those conversations around immunizations when they come in. And also obviously we’re very focused around flu vaccines. So when patients come in for flu vaccines, we really are empowering our staff to target other vaccines, and showing them how to do that based off our screening forms so that they feel comfortable and bring that information to the pharmacist so that we can in-turn have that conversation with a patient.

Troy Trygstad, PharmD, MBA, PhD: Sure. Dorothy, you’re responsible for roughly 9,000 Walgreens locations across the globe. In many ways, what is it you’re emphasizing with your staff, your pharmacists, your personnel, your stores? Patients are walking in. They’re getting their medications. There’s this enormous point of capture opportunity: how do you emphasize one of your roles as a healthcare professional, as well as part of your business, to take advantage of that point of capture and leverage it from a public health perspective, while also from a pharmacy business perspective?

Dorothy Loy, PharmD, MBA: I think this goes back to empowering my pharmacists and my technicians and all the people in our stores to be able to reach out to patients and let them know that pharmacies and pharmacists can offer immunizations in the first place. And then I think also empowering my pharmacists to use the tools that Emily talks about so that they have the facts, so that they can talk to our patients and tell them, “I have confidence that you have gotten this vaccine somewhere else, or that you’ve gotten it here. These are the other vaccines that you might need.”

So being able to use that data and that information, and make that awareness for our patients relevant for them, and getting that buy-in from the patient for why they should be getting vaccinated. And so those are some of the tools that we give our pharmacists, as well as the training. Making sure they’re confident in providing a recommendation, and a strong recommendation. Most of them are very well versed in administering a vaccine, but it’s actually taking the time to do an assessment for that patient. And similar to what Tana said, we also, at our pharmacies, make sure that our pharmacists are doing an assessment, especially during flu season.

It’s the best time to capture that patient’s attention. They’re coming in. They’ve already bought into the idea of the flu vaccine and getting that, so we know that they are one of the primary candidates for getting them up-to-date on all of their other vaccines. And so we really push that, especially during the Fall season, but we’ve been trying to do a better job of making it a year-round activity because there is no off season for immunization. It’s always going on, especially with the recent outbreaks. So making sure that that’s at the top of the mind of our pharmacists throughout the year has been something that we’ve been trying to do a lot of over the past few years.

Troy Trygstad, PharmD, MBA, PhD: Trying to condition folks, saying, “Hey, they’re not just coming in for their medications, they have a bunch of other unmet healthcare needs, including immunizations and vaccinations.”

Dorothy Loy, PharmD, MBA: Right.

Troy Trygstad, PharmD, MBA, PhD: Tana, you run travel clinics with more exotic vaccinations, if you will, that people aren’t as familiar with. What does that look like in your pharmacy practice?

Tana Kaefer, PharmD: We do pre-travel health consulting. Patients come in, hopefully before they travel, or more than 2 weeks before they travel, but that doesn’t always happen with the cohort we were talking about. They’re typically just showing up and saying they’re going to Africa next week. So we meet with them and we do an assessment, not just on vaccinations as well, which I think is a good opportunity for pharmacies. Obviously we’re here talking about immunizations, but how do we keep them safe when they’re traveling? That also can help your sales—when you’re recommending other products when patients are going to be traveling. And certainly, too, some of these immunizations they have to have, right, which they have to get through an airport or to get into a country. So making sure patients understand that.

Emily talked about targeting individuals that come into your pharmacy. What about the people that don’t come into your pharmacy? We need to engage those employer groups and not just give flu shots, but really screen them for the other immunizations, just kind of like what we’ve all been talking about. It’s an opportunity because, again, you have a captive audience, and these are patients that maybe aren’t coming into your pharmacy. So targeting them in other ways.

Troy Trygstad, PharmD, MBA, PhD: And you hand deliver out of your pharmacy, correct?

Tana Kaefer, PharmD: Yes.

Troy Trygstad, PharmD, MBA, PhD: Do you also screen when you’re delivering to a home?

Tana Kaefer, PharmD: That’s a great question. So as far as screening patients in our delivery programs, our synchronization program, we do that on a quarterly basis where we target something. So absolutely we would talk to them.

Troy Trygstad, PharmD, MBA, PhD: You prepare for it.

Tana Kaefer, PharmD: Exactly.

Troy Trygstad, PharmD, MBA, PhD: Ahead of time

Tana Kaefer, PharmD: Oh, absolutely.

Troy Trygstad, PharmD, MBA, PhD: You’re preparing for it as an appointment-based model. Therefore, you can say, “Here are the 3 that you’re eligible for,” and here are the 2 we really need to get them to buy into so that you’re preparing them when you go do that visit.

Tana Kaefer, PharmD: Absolutely. So, again, making sure the pharmacist feels comfortable, they know exactly what they’re going to do, they’ve done a screening of that patient, and it’s easy because you’ve got the patient, or they’re coming to your pharmacy anyway to pick up their medications. You are doing a comprehensive model so that they can see the value of pharmacists.

Michael Popovich: Can I add a quick note about the pharmacy and their outreach program to the employers? Because this is a great opportunity to engage individuals for other immunizations. What we’ve seen is if the pharmacist goes onsite to an employer and has information about who they’re giving the immunizations to, and they’re able to access the public health resources that will tell them what other immunizations they need, they can actually go to the employer’s site with the influenza vaccine. And by the way, the typical rate for influence uptake is 50%, but if a pharmacist going to an employer’s site, you can reach 80%, which is a big deal. But also if you come in with information, you know which individuals also need a tetanus or the whopping cough. You can have those scheduled and actually provide them. It creates a huge win, and there’s a high cost for employees missing work because of diseases or family flu and illness. And so that outreach and proactivity is what it is going to be all about.