Canadian research on adult vaccinations has proven the adage: “If you build it, they will come.” In this case, when pharmacists are authorized and reimbursed to put more shots in arms, more people will go to pharmacies to get immunized.
“This study conclusively states what we intuitively know: both pharmacists and patients are comfortable with more vaccinations in the pharmacy, beyond the flu shot,” says lead researcher John Papastergiou. “However, it also spells out that certain enabling factors need to be in place.”
The research team conducted a retrospective analysis of data from pharmacies across Canada for 351,852 patients. The data captured vaccines dispensed and injection fees billed for five multi-dose vaccines (Energix B®, Gardasil®, Havrix®, Shingrix® and Twinrix®), from April 2017 to April 2018. The International Journal of Pharmacy published the resulting research article, “Factors Affecting Pharmacist-Administered Vaccine Injection and Adherence Rates in Canada,” in October 2021.The Canadian Foundation for Pharmacy funded the research through a grant from its Innovation Fund in 2018. Papastergiou is an assistant professor at the University of Toronto, an adjunct assistant professor at the University of Waterloo and associate-owner of four Shoppers Drug Mart pharmacies in Toronto, Ontario.
The study’s objectives were two-fold: to determine if provincial legislation and public funding increased immunization levels; and to compare follow-up injection adherence rates between pharmacist-administered vaccines and those administered by doctors and other healthcare providers.
As expected, results varied significantly by province. Alberta posted the strongest results, with a “first-injection rate” by pharmacists of 73.2%. This reflects the fact that pharmacists in that province have been able to prescribe and inject multiple vaccines since 2006. Public funding levels are also relatively high for the studied vaccines.
The results are lowest in the provinces with no prescribing rights or public funding, i.e., Saskatchewan (14.1%), Newfoundland and Labrador (13.8%) and Ontario (10.7%). Remaining provinces fall somewhere in the middle, with first-injection rates by pharmacists ranging from 49.3% (B.C.) to 38.2% (Manitoba).
Follow-up injection adherence rates also varied by province, with Alberta again at the forefront. In that province, pharmacists exceeded other providers in providing follow-up injections by 12%. Pharmacists in Manitoba (8%), B.C. (6%) and New Brunswick (3%) also reported higher rates of follow-up injections when compared to other healthcare providers.
When results are considered by vaccine, the first-injection rate by pharmacists was significantly higher for Shingrix (59.6%), ranging from 84.5% in Alberta to 22.6% in Ontario. The authors speculated that pharmacists “are more comfortable with recommending Shingrix than the other multi-dose immunizations studied.” As well, since the lack of public funding for Shingrix in most provinces means that patients need to pay for the vaccine regardless of the provider, “the accessibility of pharmacist services…may be a factor.”
However, the study also noted an overall adherence rate of less than 50% for the second Shingrix injection, a finding that “demonstrates an urgent need for improved systems of follow-up in this area for all healthcare providers.”
For all of the vaccines, well under half of patients (31%) completed the entire regimen. "There is a huge opportunity here. Patients are falling through the cracks," says Papastergiou.
In their conclusion, the authors suggest that, to improve immunization levels nationally, “all provinces should aspire to the Alberta model of care,” where pharmacists are most enabled by legislation and public health coverage.