Reaching adults with asthma and diabetes: a pharmacy immunization intervention

Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to:
• Describe the target population and intervention
• Determine the impact of the intervention.

Background:
In Oregon, only 34% and 55% of people with asthma and diabetes reported influenza vaccination, while 48% of persons with diabetes reported pneumococcal vaccination, well below the 60% national goal (2003 BRFSS). A project targeting 18-64 year olds with asthma and diabetes was piloted in 4 retail pharmacy stores in 2006-07.

Objectives:
• Increase influenza and pneumococcal immunization rates of 18-64 year–olds with asthma or diabetes.
• Understand the challenges of immunization services in retail settings.

Methods:
Four high traffic retail pharmacies implemented a direct pharmacist-client intervention. Clients seeking asthma and/or diabetes prescriptions were surveyed regarding interest in vaccines and counseled by the pharmacist on the importance of vaccination. Clients were offered immediate immunizations or the opportunity to schedule an appointment later. Prescription data from the 2005-06 and 2006-07 influenza seasons were compared for 4 pilot sites and 2 control sites, and interviews were conducted with pharmacy staff.

Results:
The total number of influenza doses administered increased by 29% from 2005-06 to 2006-07 at pilot stores. The percent of target clients immunized at the pilot stores increased by 2% overall, with the highest individual increase from 9.7% to 15.8%, compared to no measurable change at control sites. Over 75% of clients' surveyed expressed interest in flu vaccine, however only 30% considered pharmacist administration. Likewise with pneumococcal, 53% were interested but only 15% considered pharmacist administration. Implementation was difficult and variable, with good lessons learned about the feasibility of future interventions.

Conclusions:
Despite challenges in pharmacy implementation, some limited increases in influenza vaccination occurred, indicating this population is amenable to pharmacy flu shots. Pneumococcal rates did not increase, suggesting reimbursement and medical management may influence client decisions.