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CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of effectiveness outcomes from a
Anna Taddio1,2, James Morrison3, Charlotte Logeman2
1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Insights
The Comfort Ask Relax Distract (CARD) system significantly improved the vaccination experience in community pharmacies, with more recipients reporting better experiences and reduced pain, fear, and dizziness. This evidence-based protocol is recommended for standard care to enhance vaccine delivery.
Area of Science:
- Pharmacy Practice
- Public Health
- Clinical Intervention
Background:
- Community pharmacies are key vaccination sites but can be stressful for recipients and providers.
- The Comfort Ask Relax Distract (CARD) system is an evidence-based protocol to mitigate vaccination-related stress.
- Improving the vaccination experience is crucial for vaccine acceptance and public health.
Purpose of the Study:
- To evaluate the effectiveness of the CARD system in improving the vaccination experience in community pharmacies.
- To assess the impact of the CARD system on vaccine recipient symptoms, including pain, fear, and dizziness.
- To determine the utilization of coping strategies within the CARD system intervention.
Main Methods:
- A hybrid effectiveness-implementation cluster randomized trial was conducted in 25 Ontario pharmacies.
- Pharmacies were randomized to receive CARD training and resources or serve as controls.
- Effectiveness outcomes included vaccine recipient experience ratings, symptom scores (pain, fear, dizziness), and recorded coping strategies.
Main Results:
- More vaccine recipients in the CARD group reported a better vaccination experience compared to the control group (48.8% vs. 28.0%, p=0.003).
- Lower mean pain scores were observed in the CARD group across multiple age groups and for females.
- Reduced fear and dizziness scores were noted in younger adults (20-39 years) in the CARD group, with increased coping strategy use.
Conclusions:
- The CARD system significantly enhances the vaccination experience in community pharmacies.
- Implementing the CARD system can lead to reduced pain, fear, and dizziness among vaccine recipients.
- The CARD system is recommended as the standard of care for community pharmacy vaccinations to improve patient outcomes.
Abstract:
While community pharmacies are an efficient setting for vaccinating large numbers of individuals, they can be stressful for vaccine recipients and providers, creating challenges for vaccine delivery. The CARD system (Comfort Ask Relax Distract) is an evidence-based protocol for vaccination delivery designed to improve the vaccination experience. A hybrid effectiveness-implementation cluster randomized trial was conducted between November 2023 and January 2024 whereby 25 pharmacies in Ontario (Canada) were randomly allocated to CARD training and resources (n = 12) or control (n = 13). This paper reports on the effectiveness outcomes of the trial. Vaccine recipients rated their vaccination experience compared to their last vaccination (primary outcome) and symptoms (fear, pain, dizziness). Sub-group analyses were performed according to age (0-19, 20-39, 40-59, ≥60 years) and sex (male, female). Pharmacy professionals recorded coping strategies utilized. Altogether, 2206 individuals received vaccinations. More vaccine recipients in the CARD group (vs. control) reported a better experience: 48.8% vs. 28.0%, p = .003 (intracluster correlation = 0.21). Mean pain score was lower in the CARD group in vaccine recipients aged 20-39, 40-59 and ≥60 years, and females (p < .03, all analyses). Mean fear and dizziness scores were lower in the CARD group in individuals aged 20-39 years (p = .03 and p = .007, respectively). More coping strategies were used in the CARD group (p < .05, all analyses). CARD is recommended as the standard of care for community pharmacy-based vaccinations to improve vaccine recipient experiences and symptoms.Trial Registration: NCT06098703.
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