Jeffery A. Goad

Vaccinations Administered During Off-Clinic Hours at a National Community Pharmacy: Implications for Increasing Patient Access and Convenience

PURPOSE Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience. METHODS We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am–6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours. RESULTS During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions. CONCLUSIONS A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, accessed a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience.

Intravenous Artesunate for the Treatment of Severe Malaria

Objective: To review the pharmacodynamics and pharmacotherapeutic use of intravenous artesunate for the treatment of severe malaria. Data Sources: Literature was retrieved through PubMed (1999–March 2010), MEDLINE (1996–March 2010), and the Centers for Disease Control and Prevention (CDC), using the search terms artemisinin, artesunate, malaria, and severe malaria. In addition, reference citations from publications identified were reviewed. Study Selection and Data Extraction: All articles in English that were identified from the data sources were reviewed. Focus was placed on postmarketing trials examining the safety and efficacy of artesunate in comparison with other regimens. Data Synthesis: The treatment of severe malaria requires prompt, safe, and effective intravenous antimalarials. Many oral and intravenous agents are available worldwide for the treatment of malaria; however, quinidine has been the only option for parenteral therapy in the US. Furthermore, this products lack of availability as well as its adverse safety profile have created a treatment option gap. Recently, intravenous artesunate was approved by the Food and Drug Administration (FDA) for investigational drug use and distribution by the CDC. Three major studies regarding the use of intravenous artesunate are reviewed, in addition to the World Health Organizations malaria treatment guidelines. While there are no published head-to-head trials of intravenous artesunate versus intravenous quinidine for severe malaria, several international studies comparing intravenous quinine and artesunate concluded that artesunate has the highest treatment success, with lower incidence of adverse events. In addition, other literature is reviewed regarding counterfeit and other issues associated with artesunate. Conclusions: Artesunate, a new antimalarial currently available through the CDC, appears to be highly effective, better tolerated than quinidine, and not hampered by accessibility issues. If it were to be FDA approved and commercially available, it would be the preferred agent for the treatment of severe malaria in the US.

Vaccination delivery by chain pharmacies in California: Results of a 2007 survey.

Objective To better understand the practice standards and scope of pharmacist-administered vaccination services at chain pharmacies in California.

Special FeatureVaccination delivery by chain pharmacies in California: Results of a 2007 surveyDisclosureAcknowledgments

Objective To better understand the practice standards and scope of pharmacist-administered vaccination services at chain pharmacies in California.

The Role of Community Pharmacy-Based Vaccination in the USA: Current Practice and Future Directions

Community pharmacy-based provision of immunizations in the USA has become commonplace in the last few decades, with success in increasing rates of immunizations. Community pharmacy-based vaccination services are provided by pharmacists educated in the practice of immunization delivery and provide a convenient and accessible option for receiving immunizations. The pharmacist’s role in immunization practice has been described as serving in the roles of educator, facilitator, and immunizer. With a majority of pharmacist-provided vaccinations occurring in the community pharmacy setting, there are many examples of community pharmacists serving in these immunization roles with successful outcomes. Different community pharmacies employ a number of different models and workflow practices that usually consist of a year-round in-house service staffed by their own immunizing pharmacist. Challenges that currently exist in this setting are variability in scopes of immunization practice for pharmacists across states, inconsistent reimbursement mechanisms, and barriers in technology. Many of these challenges can be alleviated by continual education; working with legislators, state boards of pharmacy, stakeholders, and payers to standardize laws; and reimbursement design. Other challenges that may need to be addressed are improvements in communication and continuity of care between community pharmacists and the patient centered medical home.

The Anti-vaccine Movement: A Pharmacist’s View

Pharmacists are widely known as the most accessible health care providers, and are often called upon to serve as the liaison between other health care professionals, patients, and caregivers to facilitate communication, clarify purpose of therapy, and dispel myths and misconceptions. In the last decade, pharmacists have begun to play an integral role in the provision of vaccinations, and are uniquely positioned to educate the public about vaccines and the current evidence to support their safe use. Currently, all 50 states allow pharmacists to administer vaccines. There are barriers to the continuing expansion of pharmacists in this role, including turf wars with other health care providers, lack of public understanding/acceptance of the pharmacist in that role, lack of understanding regarding the education and training of pharmacists, and lack of structure for compensation of pharmacists from insurers. Nevertheless, pharmacists have demonstrated the ability to increase vaccination rates.

Vaccine-Preventable Diseases in Travelers

Opinion statementTravel from the developed world to developing countries is increasing, placing travelers at risk for both vaccine-preventable and non-vaccine-preventable diseases. Between 2007 and 2011, the GeoSentinel network reported 737 returning travelers with a vaccine-preventable disease. While the use of vaccines is essential in preventing travel-related disease, clinicians should also be aware that the vast majority of travel-acquired diseases are non-vaccine-preventable. Immunizations for vaccine-preventable diseases can be divided into three groups: routine travel vaccines, special travel vaccines, and routine vaccines in the context of travel. Routine travel vaccines include hepatitis A and B, and typhoid; special travel vaccines include yellow fever, meningococcal disease, rabies, polio, and Japanese encephalitis; and routine vaccines include influenza and tetanus-diphtheria-pertussis. Providers should employ a patient- and itinerary-specific approach when recommending vaccines for travel.

Tuberculosis in the 90's

were reported to the Centers for Disease Control from the 50 states (including the District of Columbia) which represented a net 6.4% decrease from 1994.3 Some states, though, actually experienced a significant increase in the number of cases (Arizona and New Hampshire, 28.1% and 35.3% respectively). Although this is the third consecutive year we have had a decrease in the number of new cases, we need to continue steadfast in our commitment to decrease the incidence and severity of this disease.