Macary W. Marciniak

Provider communication and HPV vaccination: The impact of recommendation quality

BACKGROUNDnReceiving a healthcare providers recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.nnnMETHODSnIn 2014, we conducted a national, online survey of 1495 parents of 11-17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥ 1 dose), follow through (3 doses, among initiators), refusal, and delay.nnnRESULTSnAlmost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR=9.31, 95% CI, 7.10-12.22) and over three times the odds of follow through (17% vs. 44%, OR=3.82, 95% CI, 2.39-6.11). Low-quality recommendations were more modestly associated with initiation (OR=4.13, 95% CI, 2.99-5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.nnnCONCLUSIONSnHigh-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.

Retrospective analysis of estimated cost avoidance following pharmacist-provided medication therapy management services.

Objective: To compare the estimated cost avoidance (ECA) of pharmacist-provided medication therapy management (MTM) services among common disease states encountered in community pharmacy practice. Design: Retrospective analysis. Setting: Nine community pharmacies in North Carolina. Patients: Three hundred and sixty-four patients who are 65 years of age or older, a Medicare Part D beneficiary and a North Carolina resident. Interventions: An MTM pharmacist-provider conducted medication reviews to eligible patients between July 2009 and October 2009. For each encounter, patient interventions, pharmacist recommendations, and ECA were recorded. Main outcome measure: ECA. Results: In 9 pharmacy locations, 634 MTM interventions were documented during the study period. The ECA in a 4-month period yielded approximately

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

494 000. Comprehensive medication reviews, new prescription counseling and appropriate medication administration, and technique counseling made up nearly two-thirds of interventions. Overall, the probability that an MTM intervention would result in an ECA greater than

Parents' willingness to get human papillomavirus vaccination for their adolescent children at a pharmacy

0 was .35. Conclusions: Pharmacist-provided MTM effectively reduced costs associated with patient medication use. Such interventions reduced costs in overall health care specifically in the areas of cardiovascular, gastroesophageal reflux disease, pulmonary, and diabetes groups.

Evaluating the economic impact of a targeted medication intervention program

ABSTRACT Background: We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. Methods: In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. Results: Overall, 28% of parents reported that they had ever “refused or decided not to get” HPV vaccine for their child, and an additional 8% of parents reported that they had “delayed or put off getting” HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48–0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50–0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65–4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08–2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. Conclusions: Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy.

An integrated approach to research and manuscript development

Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their accessibility and existing infrastructure for vaccine delivery. We sought to examine parents willingness to get HPV vaccination for their children at pharmacies. In 2014, we conducted a national, online survey of 1255 parents of 11- to 17-year-old adolescents in the United States. We used multivariable logistic regression to model parents willingness for getting HPV vaccinations in pharmacies. Overall, 29% of parents would be willing to get HPV vaccine for their children at a pharmacy. Parental willingness was associated with believing that pharmacists are skilled at administering vaccines (OR=2.05, 95% CI:1.68-2.51), HPV vaccine was at least as important as other adolescent vaccines (OR=1.48, 95% CI:1.10-1.98), and getting vaccines in pharmacies would give children more opportunities to get health care (OR=2.17, 95% CI:1.63-2.89). Parental willingness was also more common among parents of adolescents ages 13-17 or who had already initiated the HPV vaccine series. Parents most often indicated that they would like to learn about HPV vaccination in pharmacies from their childrens doctor (37%). Offering HPV vaccine in pharmacies may increase uptake as a meaningful number of parents would get the vaccine for their children in these settings. Physician referrals for completing the HPV vaccine series may serve as an important source for increasing awareness of and demand for adolescent vaccination services in pharmacies.

Pharmacies versus doctors’ offices for adolescent vaccination

Objective: To calculate the return on investment (ROI) for a targeted medication intervention program developed by corporate management of a community pharmacy. Design: Retrospective analysis and cross-sectional survey. Setting: Regional community pharmacy chain in North Carolina. Participants: Targeted medication interventions completed from February 1, 2010, to July 31, 2010, were included in the retrospective analysis. Community pharmacists employed by the pharmacy chain that completed the questionnaire were included in the cross-sectional analysis. Intervention: Targeted medication intervention services were provided to the patient and documented by the pharmacist. Main Outcome Measure: The ROI for a community pharmacist-provided targeted medication intervention program. Results: Of the 180 pharmacists, 69 completed the questionnaire (38% response rate). The average time to complete one targeted medication intervention was calculated to be 22.63 minutes. The total cost for providing a targeted medication intervention program during the study time frame was

Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists

15 760.86. Total revenue was

Impact of Pharmacists on Access to Vaccine Providers: A Geospatial Analysis: Impact of Pharmacists on Access to Vaccines

15 216.00; therefore, the program resulted in an ROI to the pharmacy chain of negative 3%. Conclusion: This 6-month study resulted in an ROI to the pharmacy chain of negative 3%. Under the current reimbursement model, for this program to break even, the average time to complete one targeted medication intervention must equal 21.85 minutes or less.

Support for pharmacist-provided HPV vaccination: National surveys of U.S. Physicians and parents

PURPOSEnA stepwise process for planning, writing, and submitting a research manuscript to a peer-reviewed journal is described.nnnSUMMARYnThe research project and writing-related activities should be conducted concurrently along a clear timeline developed with input from all members of the writing team. Issues of conformance to standards of scholarly publishing (e.g., ordering of the author list, contributor acknowledgments, disclosure statements) should be resolved and agreed on by all authors before manuscript development begins. After deciding on an appropriate hypothesis or research question, members of the writing team should meet to craft a detailed manuscript outline and identify a target journal. In addition to writing or coordinating the writing of the various manuscript sections, one designated team member (typically the lead, or primary, author) should be responsible for ensuring consistency of data presentation and overall article cohesion. Before submitting the manuscript to a journal, the writing team should solicit internal and external review and feedback from colleagues with expertise in statistical analysis and the research topic. Once an article is accepted by a journal, the corresponding author has primary responsibility for communicating with editors and coordinating the teams response to peer reviewer concerns and requests for revisions.nnnCONCLUSIONnThe process of writing and securing journal acceptance of manuscripts should proceed along a well-defined pathway integrating all research and writing tasks. Close adherence to the target journals instructions for authors and prompt response to reviewer comments help avoid delays in the publication of accepted articles.