Department of Pharmacy, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.
Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
Pediatr Pulmonol. 2023 Apr;58(4):1145-1151. doi: 10.1002/ppul.26306. Epub 2023 Jan 13.
Members of an integrated pharmacy team (pharmacists and pharmacy technicians) have roles that have been identified in the literature as part of the multi-disciplinary cystic fibrosis (CF) care team. One role that has not specifically addressed is the administration of routine and recommended immunizations to people with CF (PwCF). According to care guidelines, PwCF of all ages should be provided all age-appropriate and recommended immunizations. Pharmacists and pharmacy technicians can administer immunizations per state laws. The Primary Children's CF Center decided to implement a comprehensive pharmacy-driven immunization care process model to impact immunization rates.
A 24-month retrospective analysis was conducted with pediatric (≤18 years) PwCF at the Primary Children's CF Center. The primary outcome measures were the percentage (%) of PwCF who received PPSV23, and/or HPV, and/or meningococcal conjugate vaccine (MCV) immunizations 1-year post-care process model implementation (October 1, 2021, to September 30, 2022) as compared to baseline values. The secondary outcome measures are the total number of immunizations, the number of each immunization provided, and the financial impact of pharmacy-driven immunization care process model 1-year post-implementation.
During the 1-year post-care process model implementation (October 1, 2021, to September 30, 2022), a total of 523 immunizations were provided to 243 pediatric PwCF. The most frequent immunizations provided were PPSV23 (160/523, 31%) and Coronavirus Disease 2019 (COVID-19) (154/523, 29%). The baseline percentages of eligible PwCF of PPSV23, HPV, and MCV were 27% (58/217), 43% (32/74), and 24% (8/34), respectively. The 1-year post-implementation percentages of PPSV23, HPV, and MCV were 99% (217/218, p < 0.00001), 91% (67/74, p < 0.00001), and 97% (33/34, p < 0.00001), respectively. For COVID-19 immunizations, 56% of eligible PwCF (181/321) have received their first dose. Of these 181 PwCF, 70% (126/181) have received at least one dose of their primary series or booster during the 1-year post-implementation period. The rate of those PwCF who have received at least one dose of a COVID-19 immunization from the age of 6 months to 4 years, 5-11 years, and 12-18 years, was 37% (30/82), 60% (78/129), and 66% (73/110), respectively. For the financial impact generated during the 1-year immunization care process model post-implementation period, 404 non-VFC immunizations were given for an estimated profit of $11,930.
The implementation of a pharmacy-driven immunization care process model is a way for integrated pharmacy teams to evolve with the CF center care model and have a role expansion in the care provided to PwCF.
综合药房团队（药剂师和药剂技术员）的成员在文献中被确定为多学科囊性纤维化（CF）护理团队的一部分。其中一个尚未明确的角色是为 CF 患者（PwCF）常规和推荐免疫接种。根据护理指南，所有年龄段的 PwCF 都应接种所有适合年龄和推荐的免疫接种。药剂师和药剂技术员可以根据州法律进行免疫接种。主要儿童 CF 中心决定实施全面的药房驱动免疫护理流程模型，以提高免疫接种率。
对主要儿童 CF 中心的儿科（≤18 岁）PwCF 进行了为期 24 个月的回顾性分析。主要结局指标是在实施护理流程模型后 1 年（2021 年 10 月 1 日至 2022 年 9 月 30 日）接受肺炎球菌多糖疫苗 23 型（PPSV23）和/或人乳头瘤病毒（HPV）和/或脑膜炎球菌结合疫苗（MCV）免疫接种的 PwCF 的百分比（%）与基线值相比。次要结局指标是免疫接种总数、每次免疫接种的数量以及实施药房驱动免疫护理流程模型后 1 年的财务影响。
在实施护理流程模型后的 1 年期间（2021 年 10 月 1 日至 2022 年 9 月 30 日），共有 523 剂免疫制剂提供给 243 名儿科 PwCF。最常提供的免疫制剂是肺炎球菌多糖疫苗 23 型（160/523，31%）和 2019 年冠状病毒病（COVID-19）（154/523，29%）。PPSV23、HPV 和 MCV 合格 PwCF 的基线百分比分别为 27%（58/217）、43%（32/74）和 24%（8/34）。实施后 1 年的 PPSV23、HPV 和 MCV 百分比分别为 99%（217/218，p<0.00001）、91%（67/74，p<0.00001）和 97%（33/34，p<0.00001）。对于 COVID-19 免疫接种，56%的合格 PwCF（181/321）已接受第一剂疫苗。在这 181 名 PwCF 中，70%（126/181）在实施后的 1 年期间接受了初级系列或加强剂的至少一剂。在 6 个月至 4 岁、5-11 岁和 12-18 岁的 PwCF 中，至少接种一剂 COVID-19 疫苗的比例分别为 37%（30/82）、60%（78/129）和 66%（73/110）。在实施免疫护理流程模型后的 1 年期间产生的财务影响方面，为 404 名非 VFC 免疫接种者提供了估计 11930 美元的利润。
实施药房驱动的免疫护理流程模型是综合药房团队与 CF 中心护理模式一起发展的一种方式，并在为 PwCF 提供的护理中发挥了作用的扩展。
