Structured Pharmacist-Led Vaccine Recommendation and Coadministration in Community Pharmacies: Real-World Evidence...

Background and Objectives: Community pharmacies in Poland administer an expanding range of adult vaccines, including influenza, COVID-19, respiratory syncytial virus (RSV), herpes zoster and pneumococcal vaccines. While pharmacist vaccination services are increasingly available, evidence on structured approaches supporting vaccine coadministration remains limited. This study assessed whether a structured pharmacist-led recommendation and coadministration protocol was associated with greater uptake of multiple vaccines and same-day coadministration in routine community pharmacy practice. Methods: This non-randomized real-world study used anonymized vaccination records from three community pharmacies in northern Poland between 1 August 2025 and 31 March 2026. One pharmacy implemented a multicomponent protocol combining proactive identification of eligible patients, presumptive recommendation and same-day coadministration, while two comparator pharmacies operated under routine practice. Outcomes included the mean number of vaccine types per patient, the proportion of patients receiving at least two of five analyzed vaccines, same-day coadministration among multi-vaccine patients, and the RSV-to-(influenza + COVID-19) vaccination ratio. A Poisson regression model with robust standard errors was used to assess relative RSV uptake. As the dataset comprised only patients who received at least one vaccination, these findings describe vaccination patterns among presenting, already-vaccinated patients rather than uptake relative to the total eligible or registered pharmacy population, for which denominators were not available. Results: Overall, 3248 patients contributed 5505 unique patient-vaccine events. The intervention pharmacy achieved a higher mean number of vaccine types per patient than comparator pharmacies (2.08 vs. approximately 1.54). The proportion of patients receiving at least two vaccine types was 73.6% (685/931) in the intervention pharmacy compared with 42.7% (990/2317) in comparator pharmacies. Among multi-vaccine patients, same-day coadministration occurred in 92.7% (635/685) of intervention-site patients versus 73.1% (724/990) in comparator pharmacies. Triple-vaccine coadministration visits were observed exclusively in the intervention pharmacy. RSV uptake was higher in the intervention pharmacy (incidence rate ratio 2.17; 95% CI 1.67-2.84; p < 0.001). An age- and sex-adjusted analysis of multi-vaccine uptake yielded a materially unchanged association (adjusted OR 4.42; 95% CI 3.71-5.28) relative to the unadjusted estimate (OR 3.73; 95% CI 3.16-4.41). The exploratory temporal-interaction analysis was not statistically significant when all months were included (interaction IRR 0.84; 95% CI 0.69-1.02; p = 0.085), whereas a sensitivity analysis excluding March 2026 suggested a narrowing relative RSV-rate advantage over time (interaction IRR 0.79; 95% CI 0.70-0.89; p < 0.001). Conclusions: A structured pharmacist-led recommendation and coadministration protocol was associated with substantially greater uptake of multiple vaccines among vaccinated patients, more frequent same-day coadministration and higher RSV uptake compared with routine practice. These findings suggest that workflow organization, proactive patient identification and systematic recommendation strategies may improve the efficiency of adult vaccination delivery in community pharmacies. Larger multicenter studies are warranted to confirm these findings and evaluate individual protocol components.