a Department of Public Health Sciences, Penn State College of Medicine , Hershey , PA , USA.
b Penn State Cancer Institute , Hershey , PA , USA.
Hum Vaccin Immunother. 2019;15(7-8):1831-1838. doi: 10.1080/21645515.2019.1602433. Epub 2019 May 7.
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states by mapping process evaluation results onto key implementation science constructs: service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability. Pilot projects were planned in North Carolina (k = 2 pharmacies), Michigan (k = 10), Iowa (k = 2), Kentucky (k = 1), and Oregon (no pharmacy recruited) with varying procedures and recruitment strategies. Sites had open enrollment for a combined 12 months. Despite substantial efforts in these states, only 13 HPV vaccine doses were administered to adolescents and three doses to age-eligible young adults. We identified two major reasons for these underperforming results. First, poor outcomes on service penetration and appropriateness pointed to engagement barriers: low parent demand and engagement among pharmacy staff. Second, poor outcomes on feasibility, adoption, and sustainability appeared to result from administrative hurdles: lacking third party reimbursement (i.e., billing commercial payers, participation in Vaccines for Children program) and limited integration into primary care systems. In summary, pilot projects in five states all struggled to administer HPV vaccines. Opportunities for making pharmacies a successful setting for adolescent HPV vaccination include expanding third party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists' immunization training, and improving care coordination with primary care providers.
译文：
由于其人口覆盖面广、便利且拥有现成的疫苗接种基础设施， 药店是推广人乳头瘤病毒（HPV）疫苗的有潜力的替代场所。然而， 美国的药店很少用于为青少年接种 HPV 疫苗。我们旨在通过将实施性评估结果映射到关键的实施科学结构（服务渗透、可接受性、适宜性、可行性、保真度、采用和可持续性）来记录在美国五个州实施药店定位 HPV 疫苗接种服务所面临的挑战和机遇：北卡罗来纳州（k=2 家药店）、密歇根州（k=10 家）、爱荷华州（k=2 家）、肯塔基州（k=1 家）和俄勒冈州（无药店招募）制定了不同的程序和招募策略。这些地点总共进行了 12 个月的开放注册。尽管这些州付出了巨大努力，仅为青少年接种了 13 剂 HPV 疫苗，为符合条件的年轻成年人接种了 3 剂。我们确定了这些结果不佳的两个主要原因。首先，服务渗透和适宜性的结果较差表明存在参与障碍：家长需求低，药店工作人员参与度低。其次，可行性、采用和可持续性的结果较差似乎是由于行政障碍造成的：缺乏第三方报销（即向商业支付者计费、参与疫苗接种儿童计划），以及与初级保健系统的整合有限。总之，五个州的试点项目都难以接种 HPV 疫苗。使药店成为青少年 HPV 疫苗接种的成功场所的机会包括扩大第三方报销范围，涵盖药剂师接种的所有疫苗，提高公众对药剂师免疫接种培训的认识，并改善与初级保健提供者的协调。
