Learning Objectives for this Presentation:
By the end of the presentation participants will be able to (1) describe how pharmacists' perceptions of support for pharmacy-based immunization differ across states (2) describe how state-level and pharmacy-level factors relate to pharmacy-based immunization participation rates.

Background:
Pharmacists' perceptions of external support of pharmacy-based immunization were found to relate to provision of such services. Immunization delivery by pharmacists is regulated by state laws which, in turn may influence external support for this activity. Local pharmacy associations that advocate for such activity may inspire pharmacists to provide immunization services. Such influences may make important differences across the states.

Objectives:
To examine the relationship of pharmacist perceived external support to the provision of pharmacy-based immunization, accounting for variability due to state difference.

Methods:
A sample of 2,558 community pharmacies in 17 states was randomly selected to participate in a telephone interview. States were purposively selected to maximize variability vis-à-vis state immunization laws. Data were collected from 7/05-2/06. Overall, 1,707 completed interviews were included in analysis that employed hierarchical linear modeling (HLM) with level-1 as pharmacy-level and level-2 as state-level. In-house immunization participation (Yes/No) was the dependent variable. Predictors were: perceived support from pharmacy professional groups, public health groups, and pharmacy colleagues (level-1); urban/suburban/rural pharmacy location (level-1); and flexibility of immunization laws and policy involvement of pharmacy professional associations (level-2).

Results:
Perceived support was significantly related to the flexibility of state laws governing immunization by pharmacists. Perceived external support and state law flexibility were significantly associated with participation in pharmacy-based immunization.

Conclusions:
Rates of participation in pharmacy-based immunization change based on pharmacists' perceived external support for this activity. Perceptions were shaped by the actual practice environment. This provides policy makers and the pharmacy profession potential strategies to increase community pharmacist provision of in-house immunization.