Description of the characteristics of pharmacist-based immunization services in North Carolina: Results of a pharmacist survey
To describe the characteristics of pharmacist immunizers and pharmacist-based immunization services in North Carolina based on immunizing pharmacist survey responses and to identify barriers and challenges to pharmacist-based immunization services in North Carolina.
Descriptive, nonexperimental, cross-sectional study.
All pharmacists with an active pharmacist license in North Carolina in early 2007.
Settings in which pharmacist respondents practiced, types of immunization services offered, level of participation in immunization services, and perceptions of possible barriers and challenges to providing pharmacistbased immunization services.
1,274 (12.8%) responses were included in the final analysis. Approximately 22% of respondents (n = 286) had completed an immunization certificate training program. Of these respondents, more than half (n = 148) had administered vaccinations in the past year (active immunizers). The majority (52%) of active immunizers had been in practice for fewer than 10 years and worked in either community chain or independent pharmacies. Almost all respondents actively involved in administering immunizations offered inactivated influenza immunizations (95.9%). A smaller percentage of pharmacists (39.2%) offered pneumococcal vaccinations at their practice site. All respondents were likely to perceive time and area/space as barriers to providing immunization services; each group also had several distinct perceived barriers. Many factors were perceived as barriers to pharmacists' ability to provide care by active immunizers. The majority of active immunizers were willing to provide additional vaccine types.
This research has provided information about the number of pharmacists providing immunization services and characteristics of the services they provide. The demographics and settings of pharmacists in relationship to their engagement in immunization services are also provided. Last, the current work helps assess the perceived barriers to providing immunization services and pharmacist interest in expanded opportunities.
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ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.
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ABSTRACT: To compare earlier (sustainers) and later (new) adopters in terms of pharmacy characteristics and characteristics of in-house vaccination services and to identify how sustainers modified their in-house vaccination services over time.
Nonexperimental multistage study.
Washington State during 2003, 2004, and 2006-2007.
Community pharmacies included in this study's analyses must have participated in all data collection stages and provided in-house vaccination services during the third stage. Based on key informants' self-reports, those who had provided in-house services before or since 2003 were sustainers and those who started their services after 2004 were new adopters.
Pharmacy characteristics and characteristics of in-house vaccination services offered in 2003 and 2006 were measured in terms of service accessibility, scope, and supportive personnel.
A total of 37 sustainers and 27 new adopters met the inclusion criteria. The majority of independent and supermarket pharmacies were sustainers, whereas the majority of chain and mass merchant pharmacies were new adopters. In-house services offered by sustainers were broader in service accessibility and scope and involved a greater number of pharmacists trained in immunization delivery than services offered by new adopters in the same year. Further, when comparing sustainers' in-house services offered in 2003 and 2006, the 2006 services were expanded to provide year-round services, involved a greater number of settings, included services to adolescents, and involved a greater number of trained pharmacists.
Community pharmacies started their in-house vaccination services on a small scale and later expanded to a larger scale. Pharmacies with expanded in-house services can make greater contributions to their business, their patients, and the profession by bringing in additional revenues, improving vaccination rates among high-risk patients, and facilitating the growth of pharmacy-based services.
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ABSTRACT: To determine community pharmacists' attitudes and knowledge on providing immunizations including perceived barriers to immunizing. The study also examined the percentage of Arkansas pharmacists providing immunizations and the utilization of student pharmacists.
Arkansas community pharmacies from February to March 2009.
Perceived barriers to providing immunizations, pharmacists' attitudes regarding immunizations, number of immunization-certified pharmacists, immunization administration rates within the last year, and senior student pharmacists utilization.
A total of 350 surveys were mailed, and 129 were returned. In all, 79% of the respondents believed administering immunizations has advanced or significantly advanced the profession. Being certified and attitude toward providing immunizations were correlated; 37% of the respondents held certification to immunize, of which 77% reported immunizing within the last year. Commonly reported barriers included time (76%) followed by reimbursement and legal liability. Only half the respondents realized fourth year student pharmacists could immunize and only 33% of certified pharmacists utilized student pharmacists to immunize.
Pharmacists perceive many barriers to providing immunizations. Training student pharmacists to give immunizations may not result in them providing immunizations upon graduation. Additional education on overcoming potential barriers and using senior student pharmacists to administer immunizations is needed.
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