The use of pharmacy immunization services in rural communities
Introduction
Pharmacies have been recommended as alternative sites for the delivery of immunization services, especially to medically underserved adults and children in inner cities and rural communities. An assessment of factors that affect the utilization of pharmacy-based immunization programmes could be useful for increasing the effectiveness of programme strategies and acceptance of these services in communities. Pharmacists who have knowledge of community circumstances become valuable partners who can provide information to health services researchers and evaluators about communities, thus making it easier to develop programmes in other communities.
The pharmacy immunization programme (PIP) was a 5-year (1995–1999) demonstration project funded by the Centers for Disease Control and Prevention and developed through collaboration between the American Pharmaceutical Association and the West Virginia University School of Pharmacy. The objective of PIP was to expand the role of pharmacists as advocates for, and providers of, immunization services for children from birth to 2 years of age in rural West Virginia. Like many programmes developed in the 1990s to increase childhood immunizations, such as ‘Every Child by Two’ (ECBT), PIP focused on children aged 0–24 months. ECBT was founded in 1991 by former First Lady of the USA Rosalyn Carter and former First Lady of Arkansas Betty Bumpers in response to the 1989–1991 measles epidemic that resulted in 55 000 reported cases and 123 deaths. PIP focused on children aged 0–24 months because at the time when the project was implemented, the vaccination status of children was assessed at the age of 2 years, although national data were collected on children aged 19–35 months. A detailed description of the project can be found in Ref. 1. When the project began in 1995, state immunization coverage of children aged 19–35 months for the 4:3:1 series (4 DPT, 3 polio, 1 MMR) was only 73%, below the national average of 76%. West Virginia and Mississippi were the only states that did not achieve the 1995 Child Immunization Initiative coverage goal for the series.2 The five contiguous rural West Virginia counties that were selected for the demonstration project were Barbour, Grant, Pendleton, Randolph and Tucker. Child immunization rates in the counties in 1995 averaged 56%.3 These counties are poor and sparsely populated with few healthcare resources like most areas of West Virginia.4
According to the 1990 census, the median family incomes for Barbour, Grant, Pendleton, Randolph and Tucker counties were $19 106, $25 327, $22 500, $21 522 and $22 825, respectively, compared with the state's median family income of $25 602 and the US median family income of $35 225.5 In 1995, rates of unemployment in four of the five counties were all above the state's rate of 8%. The average population size of the five counties was 13 942 in 1990.
This article reports on a study of community and individual factors that influenced parents' utilization of pharmacies to obtain vaccinations for their children, and how well pharmacists' views matched the communities' needs.
The study assessed pharmacists' perceptions of community factors that influenced utilization of PIP. In addition, the study examines associations between these identified factors and use and non-use of PIP immunization services among PIP participants and non-participants.
Section snippets
Methods
In each county, an independent pharmacy owner, well regarded by the faculty in the West Virginia University School of Pharmacy as a progressive pharmacist practitioner, was identified and requested to work with the county health department (CHD) to provide childhood immunization services. These pharmacists were known through their leadership roles in the state pharmacy association or through their roles as preceptors in the School's experiential training programme. One pharmacy had two joint
Results
A total of 589 vaccines were administered at PIP pharmacies in the five counties from December 1996 to August 1998. In 1998, immunization coverage for the 4:3:1 series of children aged 19–35 months averaged 81% in the five counties, representing an absolute increase of 8% over the 1995 baseline data. Most vaccinations occurred in Randolph (n=181) followed by Grant (n=158) and Barbour (n=146). The most widely administered antigen was the hepatitis B vaccine, given either as a first or catch-up
Discussion
Our findings indicate that the most important factors associated with vaccinations in pharmacies are the convenience of the pharmacies' locations and times of vaccination. The convenience of times of vaccinations is particularly important among people who are employed and may have little time to go to health clinics during their regular work hours. Our data indicate that people who have full- or part-time employment are more likely to appreciate or take into consideration the convenience of
Limitations
The study had several limitations. The five counties of West Virginia where PIP was implemented were not selected using criteria that would create a systematic sample. Therefore, we do not assume that our findings are applicable to all rural counties. The degree of their transferability to other areas will depend on the similarity of contexts.18
The number of cases used to analyse the commitment and distance from pharmacy factors were low. A possible explanation may be that since some of the
Conclusions
Pharmacists have been found to play effective roles as facilitators, hosts, motivators or educators in immunization programmes.1., 11., 12., 13. For example, an increasing number of adults are receiving vaccines, particularly influenza and pneumococcal vaccines, in non-traditional settings, including pharmacies.14., 16., 18., 19. As far as PIP is concerned, the number of vaccines delivered is modest but nevertheless significant considering that the project was the first of its kind and is in
References (20)
Role of pharmacists in childhood immunizations
J Am Pharm Assoc
(1997)- et al.
Pharmacy immunization partnerships: a rural model
JAMA
(2002) National, state, and urban areas vaccination coverage levels among children aged 19–35 months—United States
MMWR
(1995)Results of quality assurance reviews
(1995)Depressive symptoms in rural West Virginia: labor market and health services correlates
J Health Care Poor Underserved
(2001)The 55 West Virginias: a guide to the State's Counties
(1988)Social cognitive theory and exercise of control over HIV infection
(1994)Understanding attitudes and predicting social behavior
(1980)The analysis of subjective culture
(1972)Transforming qualitative information
(1998)
Cited by (32)
Expansion of community pharmacies’ role in public vaccine delivery to children: Opportunities and need
2022, Journal of the American Pharmacists AssociationCFIR framework in pharmacy and health services research
2022, Contemporary Research Methods in Pharmacy and Health ServicesWho receives influenza vaccinations at the Pharmacy? An analysis of the Texas Behavioral Risk Factor Surveillance System
2021, VaccineCitation Excerpt :This includes those who are employed, insured, and non-Hispanic Whites. [13] Certain groups of individuals, such as those living in rural communities, low-income earners, and the uninsured may still be missed by current practices and additional promotion of alternative vaccination locations might be needed to improve vaccination rates in these groups. [13,18,20,23–25] Research further suggests that providing vaccination services at alternative locations like pharmacies is cost effective and beneficial to society at large. [26]
Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic
2018, VaccineCitation Excerpt :Finding ways to further increase pharmacy vaccination rates, such as training pharmacy technicians to vaccinate patients or creating special queues, could be important and may further increase the value of pharmacies. Pharmacies have potential advantages as immunization sites, including numerous locations in closer proximity to residential neighborhoods, extended operating hours seven days a week, and ability to serve individuals on a walk-in basis, including those without an established healthcare provider [16,18,22,50]. Another advantage is improved access, especially to those residing in medically underserved areas [17,21,51].
Pharmacies versus doctors’ offices for adolescent vaccination
2018, VaccineCitation Excerpt :To improve HPV vaccine uptake among adolescents, the President’s Cancer Panel and the National Vaccine Advisory Committee recommended expanding HPV vaccine provision in pharmacies [1,2]. Pharmacy-located vaccination presents advantages for adolescents over vaccination in traditional medical settings given their convenient locations within communities [3–5] , longer operating hours [3], and ability to administer vaccines with no appointment and short wait times [4] . Past studies have identified why pharmacies may be acceptable to parents as vaccination settings for their children [6–10].
Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists
2018, Preventive MedicineCitation Excerpt :Pharmacies have tremendous potential reach within communities; consumers make an estimated 250 million visits to pharmacies each week (American Pharmacists Association, 2014a), and about 93% of U.S. residents live within five miles of a community pharmacy (National Association of Chain Drug Stores, 2010). Pharmacies also have longer operating hours and are easier to access within communities compared to traditional medical settings when considering vaccination services (Dempsey and Zimet, 2015; Goad et al., 2013; Ndiaye et al., 2003; Postema and Breiman, 2000). A recent study found that almost one third of parents were willing to get their children HPV vaccine at pharmacies (Calo et al., 2017).