December 11, 2017
Kerry LaPlante, PharmD, a professor of pharmacy at the University of Rhode Island, developed a pharmacist-led educational program to improve adult pneumococcal vaccination rates across her home state of Rhode Island.
The program centered on the development of a clinical decision-support tool designed to simplify the Centers for Disease Control and Prevention’s complex pneumococcal vaccine administration schedules and indications. Pharmacists who took part in the educational program said it increased their knowledge of the PCV13 and PPSV23 pneumococcal vaccines and awareness of vaccination recommendations. The program also helped increase vaccination rates and decrease pneumococcal disease across Rhode Island, according to Dr. LaPlante.
She recently talked about the educational campaign’s success and how it has helped pharmacists increase vaccination coverage among patients who need to be protected from this serious bacterial infection.
How did you identify the need for this program?
There are two pneumococcal vaccines available, and it was a challenge for our community pharmacists and practitioners to understand the CDC’s guidance on when to administer them, and which vaccine patients should receive. Our goal was to create a vaccine recommendation pathway and share that document with as many providers as possible across the state. When we launched the program, the rate of invasive pneumococcal disease in Rhode Island was around 11.9%, which was higher than the national average. We wanted to lower that rate through academic detailing and increased vaccination rates, and we did.
How did you know what to focus on when developing the program?
We conducted small focus groups with community pharmacists to determine what barriers they faced with respect to administering the vaccine. Their feedback, combined with our own and national data, indicated there was confusion centered on when to give the vaccine and which patient population should receive it. In addition, some patients couldn’t remember if they had already been vaccinated. That’s why we also created laminated wallet cards, which pharmacists could fill out to document when patients were vaccinated and which vaccine they received. Patients could then use the cards to update providers or other pharmacists about their vaccination status.
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What makes your guidance document easier to understand?
The CDC correctly developed pneumococcal vaccine recommendations, but they’re incredibly complicated, because these two different vaccines are used differently, which is why our guidance document was needed. However, simplifying the recommendations was no easy task—it took us approximately 6 months of constant and constructive feedback from pharmacists and other experts to break down the CDC’s guidance into manageable buckets: healthy adults older than age 65, adults with underlying medical conditions, and adults with immune compromising conditions. Those three categories allow pharmacists to more easily digest how to vaccinate patients.
Why does the decision-support tool help improve vaccination rates?
Community pharmacists are process oriented, and, from a liability standpoint, must work with care recommendations that are clear and easy to follow. In the past, they might not have offered the pneumococcal vaccine because of the confusion surrounding the CDC’s recommendations. Pharmacists with access to our guidance document are now more comfortable having healthy conversations with patients and offering the vaccine.
They can show them the pathway and say, for example, You smoke, you’re older than 65, and this vaccine can prevent you from dying from a severe bacterial infection. Hopefully, those types of messages help convince patients to accept the vaccine. Our guidance document gives pharmacists more confidence in the care they provide and empowers them to have vaccine-related discussions with patients.
How are pharmacists incorporating the tool into their patient care routines?
Pharmacists have told us they use the guidance document as they’re dispensing medications, when they’re already talking to patients and get a sense about their health conditions based on the prescriptions that are being filled. The prescribed medications offer clues about what conditions patients have and prompt conversations during which pharmacists can offer the vaccine and assess patients’ health history to determine which vaccine they should receive.
In addition to working with community pharmacists, we shared the guidance document with clinical pharmacists at the 12 acute care hospitals in Rhode Island. The pharmacists, who were interested in increasing pneumococcal vaccination rates, asked for hard copies of the guidance document and the wallet cards, and incorporated both into the patient care protocols in their hospitals’ outpatient settings.
Addition information about this guidance document and the wallet cards can be found at http://bit.ly/2f9BElX.