Date Published: January 23, 2019
Publisher: Public Library of Science
Author(s): Sherilyn K. D. Houle, Dean T. Eurich, Italo Francesco Angelillo.
Pharmacists in a number of countries are being trained in the administration of injections with the aim of improving access and adherence to vaccinations. However, little is known about population-level adherence to multiple-dose travel vaccines, and whether the availability of pharmacist immunizers is associated with adherence. Health administrative data from Alberta, Canada, from April 2008 to May 2017 identified adults dispensed at least one vaccine for hepatitis A, hepatitis B, Japanese encephalitis, or rabies. Individuals were coded as completers or non-completers of the vaccine series based on the number of doses dispensed over a time period comprising the duration of the standard series plus 6 months to account for late doses. The association between the proportion of Alberta pharmacists with injection authorization (according to pharmacist registration data) and completion of vaccine series was assessed using linear regression. Over the study period, 24,164 patients initiated a vaccine series for hepatitis A monovalent, 195,480 for hepatitis B monovalent, 169,802 for combined hepatitis A&B, 1,726 for Japanese encephalitis, and 1,908 for rabies. There were fewer than 5 individuals receiving Japanese encephalitis vaccine per year from 2008–2010 or rabies vaccine from 2008–2009. While statistically significant positive associations were seen across all vaccines except for Japanese encephalitis, the magnitude of these associations was small. Each 1% increase in the proportion of injections-authorized pharmacists saw a corresponding increase in the proportion of individuals with completed vaccine series by 0.31% for hepatitis A monovalent, 0.19% for hepatitis B monovalent, 0.22% for combined hepatitis A&B, and 0.21% for rabies. This may suggest that challenges remain with implementing reminder systems to ensure adherence among travellers. Strategies to develop or improve patient and clinician reminder systems in pharmacies for travel vaccines should therefore be explored.
Healthcare providers, including pharmacists, are trusted sources of information on immunizations [1–3]; indeed, recommendation from a healthcare professional to be vaccinated is strongly associated with a patient’s decision to be vaccinated [4–5]. Greater availability of evidence-based information from a health professional and convenient access to vaccination services may help address concerns related to vaccine hesitancy and suboptimal vaccination rates . Due to their geographic accessibility, extended hours, and availability often without an appointment , pharmacists are widely consulted healthcare professionals. In an effort to improve patient access to immunizations by leveraging this accessibility and convenience, the state of Washington became the first jurisdiction to train pharmacists to administer vaccines in 1994. Currently, pharmacists in all US states and a number of other countries (Argentina, Australia, Canada, Philippines, South Africa, and the United Kingdom, among others) authorize some level of vaccination in pharmacies and/or by pharmacists . Legislation on specific vaccines that can be administered and eligible patient populations highly varies by region, but appears to be expanding from initial restrictions to influenza vaccinations for adults towards broader vaccine product eligibility and even adolescent and pediatric vaccination [9–10].
Over the study period, 24,164 patients initiated a vaccine series for hepatitis A monovalent, 195,480 for hepatitis B monovalent, 169,802 for combined hepatitis A&B, 1,726 for Japanese encephalitis, and 1,908 for rabies. Data on series completes and incompletes based on year of incident prescription is summarized in Table 2. As there were fewer than 5 individuals receiving the Japanese encephalitis vaccine per year from 2008–2010 and the rabies vaccine from 2008–2009, data for these cells is not provided. The proportion of Alberta pharmacists with authorization to administer injections and the proportions of individuals initiating each vaccine series who completed it, per year, are illustrated in Fig 1.
The availability of immunization-authorized pharmacists in Alberta was associated with small, statistically significant increases in the completion rates of vaccine series for hepatitis A and B monovalent vaccines, combined hepatitis A&B vaccine, and rabies vaccine, but not for Japanese encephalitis vaccine. The clinical significance of these findings is unclear, as long-term monitoring for the incidence of these vaccine-preventable diseases was not performed.