J Am Pharm Assoc (2003). 2022 Sep-Oct;62(5):1499-1513.e16. doi: 10.1016/j.japh.2022.06.008. Epub 2022 Jun 24.
The underutilization of immunization services remains a big public health concern. Pharmacists can address this concern by playing an active role in immunization administration.
We performed a systematic review and meta-analysis to assess the impact of pharmacist-involved interventions on immunization rates and other outcomes indirectly related to vaccine uptake.
A systematic literature search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception to February 2022 to identify randomized controlled trials (RCTs) and observational studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Meta-analyses were performed using a random-effects model.
A total of 14 RCTs and 79 observational studies were included. Several types of immunizations were provided, including influenza, pneumococcal, herpes zoster, Tdap, and others in a variety of settings (community pharmacy, hospital, clinic, others). Pooled analyses from RCTs indicated that a pharmacist as immunizer (risk ratio 1.14 [95% CI 1.12-1.15]), advocator (1.31 [1.17-1.48]), or both (1.14 [1.12-1.15]) significantly increased immunization rates compared with usual care or non-pharmacist-involved interventions. The quality of evidence was assessed as moderate or low for those meta-analyses. Evidence from observational studies was consistent with the results found in the analysis of the RCTs.
Pharmacist involvement as immunizer, advocator, or both roles has favorable effects on immunization uptake, especially with influenza vaccines in the United States and some high-income countries. As the practice of pharmacists in immunization has been expanded globally, further research on investigating the impact of pharmacist involvement in immunization in other countries, especially developing ones, is warranted.
免疫服务的利用不足仍然是一个重大的公共卫生关注点。药剂师可以通过在免疫管理中发挥积极作用来解决这个问题。
我们进行了系统评价和荟萃分析，以评估药剂师参与的干预措施对免疫接种率和其他与疫苗接种间接相关的结果的影响。
从建库到 2022 年 2 月，我们使用 MEDLINE、Embase 和 Cochrane 对照试验中心注册数据库进行了系统文献检索，以确定涉及药剂师参与免疫过程的随机对照试验 (RCT) 和观察性研究。如果没有报告对照，则排除研究。两位审查员使用标准化表格独立完成数据提取和偏倚评估。使用随机效应模型进行荟萃分析。
共纳入 14 项 RCT 和 79 项观察性研究。提供了多种类型的免疫接种，包括流感、肺炎球菌、带状疱疹、Tdap 等，在各种环境中（社区药房、医院、诊所等）。来自 RCT 的汇总分析表明，药剂师作为免疫接种者（风险比 1.14 [95%置信区间 1.12-1.15]）、倡导者（1.31 [1.17-1.48]）或两者（1.14 [1.12-1.15]）与常规护理或非药剂师参与的干预措施相比，显著提高了免疫接种率。这些荟萃分析的证据质量被评估为中等或低等。观察性研究的证据与 RCT 分析的结果一致。
药剂师作为免疫接种者、倡导者或两者的角色参与对免疫接种的接受度有积极影响，尤其是在美国和一些高收入国家的流感疫苗。随着全球范围内药剂师在免疫接种方面的实践不断扩大，有必要进一步研究在其他国家，特别是发展中国家，药剂师参与免疫接种的影响。
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