By Linda Griskell, Project Manager, HealthInsight QIN-QIO
In the 1990s, only nine states allowed pharmacists to administer vaccines. Due to major changes over the past two decades, pharmacists in all 50 states, Washington, D.C., and Puerto Rico are now allowed to administer vaccines. Patients with chronic conditions visit a pharmacy 35 times per year on average, giving pharmacists multiple opportunities to assess a patient’s preventive care status and administer recommended vaccinations. To better support patients, HealthInsight — the QIN-QIO serving Nevada, New Mexico, Oregon and Utah — is collaborating with community pharmacies in its four-state region to increase immunization rates.
While primary care physicians and certain specialists are aware of the importance of providing this preventive service to patients, barriers such as managing vaccine inventory, storage and other factors can make it challenging for physician offices to ensure patients receive recommended vaccines in a timely manner. One innovative solution that emerged from our pharmacy collaboration was connecting pharmacists with physicians to host on-site vaccine clinics in physician offices.
The vaccine clinic model, which is being offered across all HealthInsight states, allows a greater number of physician offices to offer convenient access to their patients without the burden of vaccine inventory, storage and disposal. The physician office promotes a one-day event and schedules 10-15 minute appointments on that day. A pharmacist sets up in the physician office in an available room, being mindful of Health Insurance Portability and Accountability Act (HIPAA) regulations for privacy. The pharmacist assesses patients for eligibility using the state registry, reviews and bills insurance, administers vaccines and enters administered shots into the state registry. The physician office then updates their electronic health records (EHR) with vaccines provided. Patients win because they are immunized and protected; pharmacies win because they are helping their patients and reaching their immunization goals; and physician offices win by providing convenient access for their patients while improving their quality scores.
In southern Nevada, HealthInsight is coordinating a collaborative project with a pharmacy chain and an accountable care organization (ACO) to conduct on-site vaccine clinics. These vaccine clinics are offered by non-immunizing offices and those that do provide vaccines, thereby creating an additional access point for patients. Immunizing offices may also want to host a clinic if their vaccine inventory runs out too early. We encourage cardiology and pulmonology offices to team up with pharmacists to host vaccine clinics, because their patients are more vulnerable to complications due to influenza and pneumonia.
"Pharmacies continue to play a greater role in the care and administration of immunizations, and they offer additional access points and convenience for their customers."
Another intervention currently being piloted with pharmacies in HealthInsight’s four states — Nevada, New Mexico, Oregon and Utah — is a script for technicians to help them discuss vaccines with their customers. The idea here is for technicians to ask a customer if they would like a flu shot, and to phrase the question and dialogue for the best results. If the patient says “no” because of some concern, the technician can refer him or her to the pharmacist for additional information. If the patient says “no” because of lack of time, store hours and vaccine availability are provided along with additional education. Due to the fast-paced nature of pharmacy stores and the technician role, staff education is often logistically difficult. This tool is a small laminated document that can be attached to a monitor from which staff can read. The hope is that after about a week of use, technicians are trained on how to better promote vaccines to patients. To get our pharmacies ready for the upcoming flu shot season, HealthInsight will be providing motivational interviewing curriculum for its staff.
In addition to these interventions, HealthInsight is also using data analytics to bring about quality improvement and change. By providing flu and pneumonia immunization rates compared to previous years and national targets, we can identify areas of opportunity. Community immunization rates and goals are presented to pharmacists and technicians, accompanied with materials and techniques for improving vaccine rates.
Pharmacies continue to play a greater role in the care and administration of immunizations, and they offer additional access points and convenience for their customers. Most people with a prescription will walk into a pharmacy at least once a month, creating an ongoing opportunity to engage patients — not only about vaccines, but also medication safety and other chronic care management opportunities such as diabetes education. As the pharmacist role continues to expand in the health care continuum, so will opportunities for preventive services and quality improvement. HealthInsight appreciates its pharmacy partnerships and looks forward to seeing these collaborations grow with future scopes of work.