Willingness of Canadian community pharmacists to adopt a proactive life-course approach to vaccination services.

BACKGROUND: Most Canadian jurisdictions authorize pharmacists to administer vaccines, with differences in vaccine and patient age eligibility. Vaccination rates could be further optimized if pharmacists took a more proactive role in life-course vaccine screening and administration. Health professional vaccine fatigue following the COVID-19 pandemic may negatively impact service delivery. OBJECTIVES: To assess vaccine fatigue among Canadian pharmacists, understand their willingness to provide proactive life-course vaccination services and identify associated vaccine practice facilitators. METHODS: One-on-one interviews were conducted with pharmacists recruited through a national community pharmacist Facebook group. Purposive sampling was used to select a diverse sample considering gender, province, and years of practice. Online interviews were conducted using a semi-structured guide with questions about vaccination experiences, perceptions of assuming a more proactive vaccinator role for adults and children, and current level of fatigue related to offering vaccination services. Interviews were audio-recorded, transcribed, and coded independently by 2 researchers; content analysis was used to identify themes. RESULTS: In spring 2023, interviews were conducted with 24 pharmacists from 5 Canadian provinces. Participants were receptive to a more proactive vaccinator role, feeling that vaccine fatigue had lessened, but strongly advocated for system and practice modifications to facilitate successful implementation. They emphasized the need for patient vaccination history access, the ability to administer all publicly funded vaccines, and fair compensation. Participants requested the development of electronic tools that connected to pharmacy systems that helped them navigate complex vaccine guidelines and clinical decision making, and the required documentation/billing. They also spoke of logistical concerns related to the incorporation of vaccination into their workflow and adequate staffing. Most participants were willing to vaccinate younger children if legislated age limits were lowered, provided they were trained and compensated appropriately. CONCLUSION: Pharmacists are interested in furthering their vaccination services offerings, including proactive screening and vaccination of young children.

Herpes zoster and human papillomavirus vaccination opportunities identified using electronic prompts at the time of scheduling influenza or COVID-19 vaccines.

Background: Due to workload and competing priorities, vaccination-related interactions in community pharmacies tend to be more reactive than proactive. The aim of this study is to determine the proportion of users of a web-based scheduling system for influenza and COVID-19 vaccines who may be eligible for herpes zoster or human papillomavirus (HPV) vaccination and interested in discussing these vaccines with a pharmacist. Methods: Individuals scheduling an influenza or COVID-19 vaccine at a pharmacy using the MedEssist platform between October 2021 and March 2022 were asked about their vaccination status against HPV (if aged 9-45) or herpes zoster (if aged ≥50). Those who were unvaccinated or unsure were asked to indicate their willingness to discuss this with a pharmacist. Logistic regression was performed to identify patient characteristics associated with responses to these screening questions. Results: Among 36,659 bookings by those aged 9 to 45 and 55,728 by those aged ≥50 that included responses to screening questions, 70.1% and 55.5% were potentially unvaccinated against HPV and herpes zoster, respectively, with approximately 1 in 5 also indicating willingness to have a discussion with the pharmacist. Those scheduling appointments for COVID-19 vaccines were significantly less likely to be vaccinated against HPV or herpes zoster and less willing to discuss this with a pharmacist than those seeking influenza vaccination. Discussion: Automated prompts while booking influenza or COVID-19 vaccinations have the potential to identify vaccine-willing individuals who may benefit from further discussion on their vaccination needs. Conclusion: Community pharmacies can leverage available technology to support the efficient and effective identification of individuals eligible for vaccination.

The Association between Academic Performance and Entry-to-Practice Milestones within a Co-Operative Education PharmD Program.

Research on associations between student performance in pharmacy programs and entry-to-practice milestones has been limited in Canada and in programs using a co-operative (co-op) education model. Co-op exposes students to a variety of opportunities both within direct patient care roles and in non-traditional roles for pharmacists, such as policy, advocacy, insurance, research, and the pharmaceutical industry. The purpose of this research is to analyze associations between student grades and evaluations achieved in the University of Waterloo (UW) Doctor of Pharmacy (PharmD) co-op program and success rates on entry-to-practice milestones, including the Pharmacy Examining Board of Canada (PEBC) Pharmacist Qualifying Examination and performance on final-year clinical rotations. Grades and evaluations from courses, co-op work terms, clinical rotations, and PEBC exam data from three graduating cohorts were obtained. A multiple regression analysis was performed to explore associations between student evaluations and PEBC Pharmacist Qualifying Examination and clinical rotation performance. Holding all other variables constant, grades in anatomy/physiology were negatively correlated with scores on the PEBC Pharmacist Qualifying Examination, while grades in one of the professional practice courses showed a positive relationship with the same examination. Students with higher grades in a problem-based learning capstone therapeutics course, in their first co-op work term, and in the direct patient care co-op work term tended to score higher on clinical rotations. Co-op performance was not significant in predicting PEBC performance. However, complimentary descriptive analysis underscored that students with a co-op rating of good or below were more likely to fail courses, midpoint evaluations, Objective Structured Clinical Examinations (OSCEs), and PEBC measures. Multiple predictors of performance on final-year clinical rotations and the PEBC Pharmacist Qualifying Examination were identified. This predictive model may be utilized to identify students at risk of underperforming and to facilitate early intervention and remediation programs, while also informing curricular revision.

Uptake and outcomes of VaxCheck, an adult life-course vaccination service: A study among community pharmacists.

Vaccination rates among Canadian adults remain suboptimal. Community pharmacists have increasingly adopted an active role in vaccination and are trusted by the public to provide vaccination-related advice and care. The aim of this prospective descriptive study was to develop and test a novel clinical service, VaxCheck, to support proactive life-course vaccination assessments by community pharmacists. From October 2022-May 2023, 123 VaxCheck consultations were performed at 9 community pharmacies within the Wholehealth Pharmacy Partners banner in Ontario, Canada. Patient age averaged 60 years and 35.8 % had at least one chronic disease risk factor, 17.7 % had lifestyle-related risk factor(s), and 15.4 % were immunocompromised. 95.1 % of VaxCheck consultations resulted in at least one vaccine recommendation, averaging three vaccines per patient. Most frequently recommended vaccines were those against pneumococcal disease, tetanus/diphtheria, herpes zoster, COVID-19, and influenza, with acceptance rates highest for those available without a prescription and at no charge at the pharmacy. Patient feedback was positive with 85 % of respondents agreeing or strongly agreeing that they would recommend the service to others. Vaccine administration at the time of the consultation occurred with only 5.9 % of recommended vaccines, frequently impacted by limitations to scope of practice related to pharmacist ability to prescribe and/or administer the vaccine and lack of pharmacy access to publicly funded vaccine supply for those meeting eligibility criteria. Community pharmacists performing a VaxCheck consultation can proactively identify indicated vaccines for patients. Expansion in scope of practice and access to publicly funded vaccine is recommended to further support vaccine uptake.