Michael D. Hogue

Pharmacist Involvement with Immunizations: A Decade of Professional Advancement

OBJECTIVE To review achievements in pharmacist-administered immunizations, emphasizing the period 1995 to 2004. DATA SOURCES Published articles identified through PubMed (1995-2004) using the search terms pharmacist, pharmacy, and vaccine, immunization, or shots. Additional sources were identified from personal bibliographies collected by the authors during this decade, as well as the bibliographies of the retrieved articles. The later two sources resulted in manuscripts of primarily historical significance. STUDY SELECTION More than 300 manuscripts were identified. The authors selected 15 studies that most clearly document the effect of pharmacist-administered immunizations for review. DATA EXTRACTION By the authors. DATA SYNTHESIS While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, only 10 years have passed since pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine administration in 1994. On November 1, 1996, the American Pharmaceutical (now Pharmacists) Association (APhA) began its nationally recognized training program for pharmacists, Pharmacy-Based Immunization DELIVERY: A National Certificate Program for Pharmacists. By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement. CONCLUSION Pharmacists have made significant strides in immunizations over the past decade. Limited activities in the hospital sector have been particularly well documented, as have the perceptions of patients regarding acceptance of pharmacists as immunizers. The activities of community pharmacists are less well documented. More research is needed into novel approaches to pharmacist involvement in public health-focused immunization initiatives, along with continued research evaluating the current practice of pharmacist-administered immunizations.

The nontraditional role of pharmacists after Hurricane Katrina: process description and lessons learned.

In the week before Hurricane Katrinas landfall in August 2005, emergency management officials in Jefferson County (Birmingham), Alabama, began to make plans for the potential influx of evacuees from the Gulf Coast. No pharmacy component to the plan was in place at that time. The Jefferson County Department of Health (JCDH) discovered that local pharmacies and hospital emergency departments were dealing with significant requests for medication refills. JCDH, in cooperation with a local school of pharmacy, developed a plan for addressing the unforeseen need for routine prescription refills by evacuees. This article discusses this novel pharmacy plan and lessons learned from the event, and may serve as a model for other municipalities and/or states interested in preparing a pharmacy response to future natural disasters.

Pharmacist engagement in medical home practices: Report of the APhA–APPM Medical Home Workgroup

OBJECTIVES To identify factors that have led to successful involvement of pharmacists in patient-centered medical home (PCMH) practices, identify challenges and suggested solutions for pharmacists involved in medical home practices, and disseminate findings. DATA SOURCES In July 2011, the American Pharmacists Association Academy of Pharmacy Practice & Management convened a workgroup of pharmacists currently practicing or conducting research in National Committee for Quality Assurance-accredited PCMH practices. DATA SYNTHESIS A set of guiding questions to explore the early engagement and important process steps of pharmacist engagement with PCMH practices was used to conduct a series of conference calls during an 8-month period. CONCLUSION Based on knowledge gained from early adopters of PCMH, the workgroup identified 10 key findings that it believes are essential to pharmacist integration into PCMH practices.

Update on preventing pneumococcal disease in adults

Abstract Invasive pneumococcal disease (IPD) is responsible for substantial clinical and economic burden in adults. Despite the safety and effectiveness of pneumococcal vaccines in protecting against these serious infections, immunization of eligible adults remains largely underused. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has recently expanded the use of the pneumococcal vaccine to include adults with asthma and all cigarette smokers, in addition to persons previously designated as at-risk. Improving adult pneumococcal immunization rates will require efforts from a broad range of healthcare providers. Clinicians should take a proactive approach in recommending the vaccine to eligible adults and should implement strategies that remove barriers to immunization efforts.

Development of a medication therapy management superbill for ambulatory care/community pharmacy practice

OBJECTIVES To explain the purpose of superbills, suggest strategies for incorporating superbills into pharmacy practice, and propose a model superbill for consideration by practitioners. PRACTICE DESCRIPTION Ambulatory pharmacies in the United States. PRACTICE INNOVATION Superbills have been used by physicians and other health care providers for many years as a way of efficiently communicating to the office staff, the patient, and even the insurer the types of services that have been provided at the point of care. The profession of pharmacy has not routinely used superbills in the past; however, given the recognition of pharmacists as providers of medication therapy management (MTM) services, immunizations, disease management, and other specialty preventive health services, the time has come for pharmacists to begin using superbills. MAIN OUTCOME MEASURES Not applicable. RESULTS A sample superbill, suitable for adaptation by individual providers of medication therapy management and other clinical pharmacy services, is provided in this article. CONCLUSION Superbills may or may not improve the pharmacists overall ability to receive insurance remuneration, but the authors believe that greater recognition by patients of the nondispensing activities of pharmacists can be achieved by using a superbill and that this may lead to more opportunities for payment for MTM in the future. Research is needed to assess whether incorporating superbills into a variety of pharmacy practice settings improves patient perceptions of the pharmacist and to discover how superbills effect practice efficiency.

Experience With a Drug Screening Program at a School of Pharmacy

Abstract Substance use and abuse among pharmacy students is a concern of pharmacy schools, boards of pharmacy, and training sites alike. Pharmacy students must complete approximately 30% of their academic coursework in experiential settings such as community pharmacies, hospitals, and other health systems as part of any accredited pharmacy schools curriculum, and these training sites are starting to require drug testing of pharmacy students as part of their contractual agreements with schools of pharmacy. The authors describe the implementation of a mandatory random urine drug screening program at their school as well as the changes that occurred owing to assessment of the program. The authors report the basic results to date of the drug screening program. The authors also speculate on secondary benefits of the drug screening program. Finally, the authors describe current and future evaluations that they are undertaking regarding this program.

Vaccines and Immunization Practice

Vaccines are among most cost-effective public health strategies. Despite effective vaccines for many bacterial and viral illnesses, tens of thousands of adults and hundreds of children die each year in the United States from vaccine-preventable diseases. Underutilization of vaccines requires rethinking the approach to incorporating vaccines into practice. Arguably, immunizations could be a part all health care encounters. Shared responsibility is paramount if deaths are to be reduced. This article reviews the available vaccines in the US market, as well as practice recommendations of the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices.

Attitudes of Matriculating First-Year Pharmacy Students Toward a Mandatory, Random Drug-Screening Program

Objective. To determine the attitudes of incoming pharmacy students toward a mandatory, random urine drug-screening program. Methods. This was an anonymous, voluntary survey of students at the McWhorter School of Pharmacy (MSOP) using an instrument composed of 40 items. The instrument was administered during orientation week prior to the session during which the policies and procedures of MSOPs drug-screening program were to be discussed. Results. The survey instrument was completed by all 129 (100%) students in the class. Two-thirds of the students were aware of MSOPs drug-screening program prior to applying, but only a few felt uneasy about applying to the school because of the program. The greatest concerns expressed by the students included what would happen if a student unintentionally missed a drug screen or was busy with other matters when called for screening, how much time a drug-screening would take, and the possibility of false-positive drug screen results. The vast majority of students agreed with statements regarding the potential benefits of drug testing. Students who consumed alcohol in a typical week and those with current or past use of an illegal substance held less favorable attitudes toward MSOP’s mandatory drug-screening program compared with students who did not share those characteristics. Conclusion. Although there were definite concerns expressed regarding pragmatic issues surrounding drug screening, the first-year pharmacy students held generally favorable opinions about the schools mandatory drug-screening program.

Dissemination and implementation of the ICAMP

The current rate of immunizations for older adults does not meet the immunization goals for Healthy People 2020. Using a Social Ecological Model and Social Cognitive Theory, the purpose of this study was to disseminate and implement the Immunization Champions, Advocates and Mentors Program (ICAMP) into a variety of health care settings. This study used a single group pre-/post-test design. Champions were recruited nationally. Five geographically diverse face-to-face meetings were held to train health care providers to be ICAMP immunization champions. Dissemination and implementation of ICAMP was evaluated using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. Participants were surveyed at baseline for descriptive information and were asked to gather immunization rates for at least one particular vaccine and provide follow-up data on progress toward goal achievement. A total of 212 champions from 82 settings participated in ICAMP. The majority were nurses (111/212, 52%). With regard to reach, we obtained 212 applications from individuals in a variety of settings interested in becoming champions. With regard to effectiveness, the majority of the champions (n = 178/212, 84%) used ICAMP material, 88% (n = 186/212) made changes related to immunization processes within their setting, and all reported that immunization practices improved. The majority used the toolkit materials up through 60 days following ICAMP. Sustained use of materials after the 60-day follow-up was less evident. ICAMP was implemented as intended and was effective in changing processes around immunizations. Ongoing work is needed to determine whether ICAMP improves immunization rates.

Approaches and Attitudes: Assessing the Mindset of Pharmacy

As a practicing pharmacist in an indigent care public health clinic, I am often astounded by the significant need and circumstances of the patients I serve. Patients who receive their primary medical care in our clinic do so because the health care system has no other place for them. Most fall at or below the federal poverty level, and many have lived in poverty for most or all of their lives. Life has often dealt them a tough hand. Remarkably, some of these patients come to the clinic with a smile on their face and a cheerful disposition. They are, in a word, happy. They have somehow found a way to rise above negative circumstances and have positive outlooks on life. They have hope. This is generally undergirded by a strong sense of belonging, to a church, synagogue, social organization, or to an extended family, which expands their focus to a cause greater than themselves. This phenomenon has always intrigued me and will continue to provide encouragement in my work in health care. Lately, though, I have been reflecting on the profession of pharmacy and thinking about how there are lessons to be learned by the profession from my public health clinic patients. These are lessons that will hopefully help pharmacists’ collective professional attitude and outlook. They are personal lessons for individual pharmacists, because by reflecting upon one’s own attitude, most of us will likely find a mirror to the collective attitude of the profession.