National Quality Forum, Washington, DC.
Harvard Medical School; Harvard T.H. Chan School of Public Health; and Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Manag Care Spec Pharm. 2019 Sep;25(9):989-994. doi: 10.18553/jmcp.2019.25.9.989.
Pharmacies have a unique opportunity to address suboptimal adult vaccination rates, but few solutions have proven effective. Such strategies are challenged by the lack of access that many pharmacies have to a patient's complete immunization history; consequently, they are unable to identify which of their patients actually require vaccination. A pharmacy-based strategy that leverages such information could enhance efforts to increase rates of guideline-based vaccination.
To determine the effect on vaccination rates of an automated telephonic intervention for adults in need of either pneumococcal vaccination or herpes zoster vaccination, or both.
Over a 1-year period, patients with identified vaccine gaps at 246 pharmacies of 3 pharmacy chains were randomly assigned to receive either usual care or an automated telephonic prompt for pneumococcal and/or herpes zoster vaccines based on patient records contained in state immunization registries and pharmacy data. The primary outcome was the proportion with administration of at least one of the vaccines offered between March 2016 and January 2017 based on intention-to-treat principles. Subgroup analyses included vaccination rates by age and sex. An as-treated analysis was also performed.
21,971 patients were included in the study, 57% of whom were female, with a mean age of 63 years. Vaccine administration proportions were 0.0214 (236/11,009) in the intervention group, and 0.0205 (225/10,962) in the control group (OR = 1.05, 95% CI = 0.87-1.26). Results did not differ in subgroup analyses based on patient age, sex, or individual pharmacy chain. Among intervention patients, 3,666 (0.333) completed the call by listening to the entire prompt. In an as-treated analysis comparing individuals who completed calls versus control, the intervention increased the odds of vaccination by 26% (OR = 1.26, 95% CI = 1.00-1.61).
The automated prompt did not significantly increase vaccination rates. Potential barriers included intervention technical flaws, low rates of connecting with patients, insufficient follow-up by the pharmacy, and patients placing a relatively low priority on being vaccinated.
This project was funded by Pfizer and Merck through a grant from the Pharmacy Quality Alliance. Stolpe was an employee of the Pharmacy Quality Alliance at the onset of this project and an employee of Scientific Technologies Corporation during the data collection phase of the project. Stolpe has also served on the advisory board for Merck. Choudhry has no conflicts of interest to declare.
药店有一个独特的机会来解决成人疫苗接种率不理想的问题，但很少有解决方案被证明是有效的。由于许多药店无法获得患者完整的免疫史，因此这些策略面临着挑战；因此，他们无法确定哪些患者实际上需要接种疫苗。一种基于药店的策略，如果能够利用这些信息，就可以加强努力，提高基于指南的疫苗接种率。
确定针对需要接种肺炎球菌疫苗或带状疱疹疫苗或同时需要接种这两种疫苗的成年人的自动化电话干预措施对疫苗接种率的影响。
在为期一年的时间里，从 3 家连锁药店的 246 家药店中，随机抽取有疫苗接种空白的患者，按照州免疫登记处和药店数据中记录的患者信息，接受常规护理或基于肺炎球菌和/或带状疱疹疫苗的自动化电话提示。主要结局是根据意向治疗原则，在 2016 年 3 月至 2017 年 1 月期间，至少接种一种所提供疫苗的患者比例。亚组分析包括按年龄和性别划分的接种率。还进行了治疗分析。
共有 21971 名患者入组研究，其中 57%为女性，平均年龄为 63 岁。干预组疫苗接种比例为 0.0214（236/11009），对照组为 0.0205（225/10962）（OR=1.05，95%CI=0.87-1.26）。基于患者年龄、性别或个别药店连锁的亚组分析结果无差异。在干预患者中，有 3666 人（0.333）完成了电话，听完了整个提示。在比较完成电话与对照组的治疗分析中，干预组增加了 26%的接种几率（OR=1.26，95%CI=1.00-1.61）。
自动化提示并没有显著提高疫苗接种率。潜在的障碍包括干预技术缺陷、与患者连接率低、药店随访不足以及患者对接种疫苗的相对低优先级。
本项目由辉瑞公司和默克公司通过药房质量联盟的一项拨款资助。Stolpe 在项目开始时是药房质量联盟的员工，在项目数据收集阶段是 Scientific Technologies Corporation 的员工。Stolpe 还曾担任默克公司的顾问委员会成员。Choudhry 没有利益冲突需要披露。
