J Am Pharm Assoc (2003). 2024 Nov-Dec;64(6):102202. doi: 10.1016/j.japh.2024.102202. Epub 2024 Aug 3.
Although pneumococcal vaccine is recommended for everyone 65 years of age and older, only 58% of Canadians in this age group have been vaccinated, well below the Public Health Agency of Canada's target of 80%. To improve uptake, a stepped-wedge cluster randomized trial testing the effectiveness of a community pharmacist intervention was developed.
This prespecified sub-study aimed to uncover and quantify factors contributing to vaccine hesitancy by exploring the nature of patient-pharmacist conversations about pneumococcal vaccine.
Beginning each month (April- August 2023), participating pharmacies were randomly selected to receive an education package designed to enhance pharmacists' knowledge, skills, and abilities in promoting pneumococcal vaccination. Pharmacists provided usual care (control stage) until they received the educational package and transitioned to the intervention stage. Weekly scorecards tracked patient-pharmacist conversations about pneumococcal vaccination. Chi-squared tests compared time taken for each conversation and patient-reported reason(s) for refusal between control and intervention stages.
Thirteen pharmacies from across Alberta were included in the analysis, reporting 656 patient-pharmacist conversations (control stage n = 271, intervention stage n = 385). Time taken for pneumococcal vaccine conversations decreased after pharmacies received the education package (65% of conversations resulting in vaccination took <20 minutes in the control stage, compared to 88% in the intervention stage [P = 0.004]). The most common patient-reported reason for refusal, needing more time to think about the vaccine, remained similar between stages (P = 0.23). However, during the intervention stage, fewer patients refused vaccination due to lack of time to receive it today (P = 0.016) and perceived lack of benefit (P = 0.035), but more patients refused vaccination due to cost barriers (P = 0.026).
The education provided in this study changed the reasons for refusing vaccines, suggesting the nature of patient-pharmacist conversations became more efficient and informed. Similar interventions could be adopted across Canada and the United States to help combat vaccine hesitancy.
尽管肺炎球菌疫苗被推荐用于所有 65 岁及以上人群，但该年龄段的加拿大仅有 58%的人接种了疫苗，远低于加拿大公共卫生局设定的 80%目标。为了提高接种率，我们开发了一项采用阶梯式楔形集群随机试验测试社区药剂师干预措施效果的研究。
本预先设定的子研究旨在通过探索患者与药剂师关于肺炎球菌疫苗的对话性质，揭示并量化导致疫苗犹豫的因素。
从 2023 年 4 月至 8 月，每个月开始时，参与的药房会被随机选择接受旨在增强药剂师在促进肺炎球菌疫苗接种方面的知识、技能和能力的教育包。在收到教育包并过渡到干预阶段之前，药剂师提供常规护理（对照阶段）。每周记分卡跟踪患者与药剂师关于肺炎球菌疫苗接种的对话。卡方检验比较了对照阶段和干预阶段每次对话所用的时间以及患者报告的拒绝原因。
来自艾伯塔省各地的 13 家药房参与了分析，报告了 656 次患者与药剂师的对话（对照阶段 n=271，干预阶段 n=385）。药房收到教育包后，肺炎球菌疫苗接种对话所需的时间减少（对照阶段 65%的接种对话在 20 分钟内完成，而干预阶段则有 88%的对话在 20 分钟内完成[P=0.004]）。患者报告的最常见拒绝接种疫苗的原因（需要更多时间考虑疫苗）在两个阶段之间保持相似（P=0.23）。然而，在干预阶段，由于今天没有时间接种疫苗而拒绝接种疫苗的患者较少（P=0.016），由于缺乏益处而拒绝接种疫苗的患者也较少（P=0.035），但由于费用障碍而拒绝接种疫苗的患者更多（P=0.026）。
本研究提供的教育改变了拒绝接种疫苗的原因，表明患者与药剂师对话的性质变得更加高效和有信息依据。类似的干预措施可以在加拿大和美国推广，以帮助克服疫苗犹豫。
