The use of pharmacy immunization services in rural communities.

Pharmacies have been recommended as alternative sites for the delivery of immunization services, especially to medically underserved adults and children in inner cities and rural areas. Currently, 35 of 50 states in the USA have legalized the administration of vaccines by pharmacists on the basis of certain training requirements and specific protocols. Since the role of pharmacists is expected to expand, it is important to assess the factors that would enable them to improve the delivery of immunization services and the acceptance of these services by communities. It is particularly important for pharmacists to have knowledge of community circumstances and be able to respond to community needs. This case study of a pharmacy immunization programme (PIP) in rural West Virginia assessed how well pharmacists were aware of community circumstances and which community factors affected the utilization of pharmacy-delivered immunizations. Our findings suggest that although pharmacists played important roles as facilitators, hosts and motivators in PIP, they overestimated the trust placed in them by community members. The convenient locations of pharmacies and the convenient times when they offered immunization services were found to be the determining factors of mothers' decisions to take their children to these places for their vaccinations. The study concludes that as the use of pharmacies as sources of immunization is expected to continue to expand, pharmacists should take these factors into consideration when they decide to offer immunizations.

Extraimmunization among US children.

CONTEXT: Little is known about the extent of extraimmunization, ie, vaccine doses given in excess of the recommended schedule, and whether it should be a public health concern. OBJECTIVES: To determine the extent and cost of extraimmunization in children and to identify its associated factors. DESIGN, SETTING, AND PARTICIPANTS: United States 1997 National Immunization Survey, in which telephone interviews were conducted with parents of 32742 19- to 35-month-old children and vaccination histories were collected from health care providers for 22806 of these children (overall response rate, 68.5%). Estimates were weighted to represent the full sample. MAIN OUTCOME MEASURES: Frequency of extraimmunization compared by vaccine type as well as with adequate immunization; factors associated with extraimmunization; and vaccine and visit costs associated with extraimmunization. RESULTS: Frequency of extraimmunization was less than 5% for each vaccine considered except poliovirus (14.1%). Overall, 21% of children were extraimmunized for at least 1 vaccine vs 31% underimmunized for at least 1 vaccine. In a multivariate model, the strongest contributors to extraimmunization were having more than 1 immunization provider (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.4-3.2) and having multiple types of providers (eg, private and public health department; OR, 2.0; 95% CI, 1.6-2.4). Children seen only in public health department clinics were significantly less likely to be extraimmunized (OR, 0.3; 95% CI, 0.2-0.3). Annual costs associated with extraimmunization for this cohort of children were estimated conservatively at $26.5 million. CONCLUSIONS: These data indicate that extraimmunization can be costly. The challenge is to reduce extraimmunization without interfering with more important efforts to combat underimmunization. Improvements in immunization record keeping and sharing practices may help reduce extraimmunization.