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Implementation of a comprehensive pharmacy-driven immunization care process model in a pediatric cystic fibrosis
Jeffery T Zobell1,2, Justin Moss1,2, Jenna Creelman3
1Department of Pharmacy, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.
Insights
A pharmacy-driven immunization program significantly increased vaccination rates in pediatric cystic fibrosis patients, achieving near-universal coverage for key vaccines like PPSV23, HPV, and MCV. This model expands the role of integrated pharmacy teams in cystic fibrosis care.
Area of Science:
- Pharmacology and Pharmaceutical Sciences
- Immunology
- Pediatric Medicine
Background:
- Integrated pharmacy teams are recognized components of multidisciplinary cystic fibrosis (CF) care.
- The administration of routine immunizations to people with CF (PwCF) by pharmacists and technicians is an under-addressed role.
- CF care guidelines mandate all age-appropriate immunizations for PwCF.
Purpose of the Study:
- To evaluate the impact of a comprehensive pharmacy-driven immunization care process model on vaccination rates in pediatric PwCF.
- To assess the feasibility and financial implications of expanding pharmacy services to include routine immunizations for PwCF.
Main Methods:
- A 24-month retrospective analysis of pediatric PwCF (≤18 years) at a CF center.
- Primary outcomes: Percentage of PwCF receiving PPSV23, HPV, and/or meningococcal conjugate vaccine (MCV) 1-year post-implementation compared to baseline.
- Secondary outcomes: Total immunizations, specific vaccine counts, and financial impact.
Main Results:
- Post-implementation, vaccination rates for PPSV23, HPV, and MCV in eligible PwCF increased significantly, reaching 99%, 91%, and 97% respectively (p < 0.00001).
- A total of 523 immunizations were administered to 243 pediatric PwCF within the first year.
- The model generated an estimated profit of $11,930 from 404 non-VFC immunizations.
Conclusions:
- A pharmacy-driven immunization care model effectively enhances vaccination rates among pediatric PwCF.
- This model represents a valuable role expansion for integrated pharmacy teams within CF care settings.
- Implementation supports adherence to vaccination guidelines and contributes positively to the CF care model.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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