Shared clinical decision making on vaccines: Nothing has really changed for pharmacists.

Recently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices has begun utilizing a new recommendation known as "Shared Clinical Decision-Making." This recommendation from Centers for Disease Control and Prevention calls upon health care providers, including pharmacists, to have more engaged conversations with patients regarding their vaccine needs. This commentary is designed to provide pharmacists with clarifications on the intent behind this terminology, and dispel myths that have frequently been attributed to the category of recommendation. Pharmacists must continue to take action to immunize patients and not be confused by a new approach to recommendation terminology.

MMR Vaccine: When Is the Right Time for the Second Dose?

Outbreaks of measles have been reported over the past 5 years, particularly affecting children between the ages of 1 and 5 years. Most of these children are younger than the age recommended by the Advisory Committee on Immunization Practices for the second dose of measles-mumps-rubella (MMR) vaccine. Question may arise as to whether strict adherence to the scheduled second dose is required or whether there is opportunity for earlier immunization under special circumstances (e.g., traveling abroad, poor response as evidenced by titer levels). The history of measles, its characteristics, and its evolving past and current immunization policies will be reviewed, focusing on the original intent of the recommended schedule and presenting a case in which deviating from current practice could be justified.

The Offering, Scheduling and Maintenance of Elective Advanced Pharmacy Practice Experiences.

The Accreditation Council for Pharmacy Education (ACPE) provides standards for colleges of pharmacy to assist in the provision of pharmacy education to student pharmacists. An integral part of all college educational programs includes the provision of experiential learning. Experiential learning allows students to gain real-world experience in direct patient care during completion of the curriculum. All college of pharmacy programs provide several Advanced Pharmacy Practice Experiences (APPEs), which include a balance between the four required experiences and a number of other required or elective APPEs. Required APPEs include advanced community, advanced institutional, ambulatory care, and general medicine. The elective APPEs include a myriad of opportunities to help provide a balanced education in experiential learning for student pharmacists. These unique opportunities help to expose student pharmacists to different career tracks that they may not have been able to experience otherwise. Not all colleges offer enough elective APPEs to enable the student pharmacist to obtain experiences in a defined area. Such an approach is required to produce skilled pharmacy graduates that are capable to enter practice in various settings. Elective APPEs are scheduled logically and are based upon student career interest and site availability. This article describes the offering, scheduling and maintenance of different elective APPEs offered by The University of Tennessee College of Pharmacy.

Effect of pharmacist intervention on herpes zoster vaccination in community pharmacies.

OBJECTIVE: To evaluate the effectiveness of community pharmacy-based interventions in increasing vaccination rates for the herpes zoster vaccine. DESIGN: Prospective intervention study with a pre-post design. SETTING: Three independent community pharmacies in Tennessee, from December 2007 to June 2008. PATIENTS: Patients whose pharmacy profiles indicated that they were eligible for the vaccine and patients presenting to receive the vaccine at study sites. INTERVENTION: Pharmacists promoted the herpes zoster vaccine through a press release published in local newspapers, a flyer accompanying each prescription dispensed at participating pharmacies, and a personalized letter mailed to patients whose pharmacy profiles indicated that they were eligible for the vaccine. MAIN OUTCOME MEASURES: Comparison of vaccination rates for the herpes zoster vaccine during the control and intervention periods and patients' indication for their sources of education and influence in receiving the vaccine. RESULTS: Vaccination rates increased from 0.37% (n = 59 of 16,121) during the control period to 1.20% (n = 193 of 16,062) during the intervention period ( P < 0.0001). Cochran-Armitage trend analyses, including the months before and after the interventions, confirmed a significantly higher vaccination rate during the intervention month than other months analyzed. More patients indicated that they were educated about the herpes zoster vaccine by one of the pharmacist-driven interventions than by a physician, family/friend, or other source during the intervention period ( P < 0.0001 for all comparisons). Also, more patients were influenced to receive the vaccination as a result of one of the pharmacist-driven interventions than influenced by a physician ( P = 0.0260) or other source ( P < 0.0001). No difference in the effectiveness of patient influence was found when the pharmacy interventions were compared with family/friends ( P = 0.1025). CONCLUSION: Three pharmacist-driven interventions were effective in increasing vaccination rates for the herpes zoster vaccine.

The use of capacity ratios in introductory pharmacy practice experiences.

OBJECTIVE: To describe the use of capacity ratios following the assignment of introductory pharmacy practice experiences (IPPEs) to a rising third-year pharmacy (P3) class. METHODS: Practice experience availability for IPPEs was collected by means of preceptor response to requests. Following assignment of IPPEs to the rising P3 class, capacity ratios from the IPPEs available across the entire state and within each of 4 geographic zones were calculated. Capacity ratios for both community pharmacy and institutional pharmacy also were calculated. RESULTS: The capacity ratio for IPPEs across the entire state was 2.11, which documents solvency. When the capacity ratios were calculated individually for community pharmacy and institutional pharmacy, solvency was also achieved. Likewise, IPPE capacity ratios were solvent in all 4 geographic zones. CONCLUSIONS: Capacity ratios are helpful in evaluating IPPE availability as they can be used to determine practice experience need in either type of practice experience or geographic zone.

Annual influenza vaccination: offering protection beyond infection.

Cardiovascular disease (CVD), the leading cause of death in the world, is largely preventable. An increasing amount of evidence suggests that annual vaccination with inactivated influenza vaccine reduces morbidity and mortality associated with CVD; however, immunization rates in patients with CVD fall consistently below the goals established by Healthy People 2020. This review outlines the importance of vaccination and summarizes the available literature on the role of seasonal influenza vaccination and the incidence of coronary artery disease and stroke.

Revisiting the influenza vaccine.

The Centers for Disease Control and Prevention (CDC) has declared the decline in preventable diseases through vaccination to be 1 of the 10 great public health achievements in the past decade in the United States. Still, influenza epidemics occur every year in the United States and are associated with high rates of morbidity and mortality. A substantial portion of the US population chooses not to get vaccinated against influenza despite the illness and death associated with the disease. Low rates of vaccination are of particular concern in high-risk patients. The CDC's Advisory Committee on Immunization Practices has broadened its influenza vaccine recommendations to include all individuals older than 6 months. Education of patients about the value of influenza vaccination will help to increase vaccination rates.