With less than three years until the re-evaluation of HealthyPeople2020 Immunization targets, Benjamin Blumi, Senior Vice President of the American Pharmacists Association (APhA) Foundation, and his colleagues reported a dramatic breakthrough: in a study run from the fall of 2016 through spring of 2016, the number of pharmacist-administered adult vaccinations increased by more than 40 percent. A significant contributor to this success was Project IMPACT (IMProve American Communities Together), which features real time, bidirectional immunization information systems (IIS). The full breadth of this success, however, lies not exclusively with technology but with the adept interaction between information systems and patient-care processes.
There is a patient education and comfort component that complements the pharmacy systems to drive increases in pharmacist-administered adult vaccinations. These patient-care processes beg the question of how an innovative pharmacist-based system will work in conjunction with traditional physician-based medical care. As the number of pharmacy-administered vaccines increases and disrupts traditional physician-based medicine, physicians are in a quandary about how to best care for patients given dual points of medical administration. The critical question that impacts the broader health care structure, not to mention patient needs, center on how pharmacists and physicians can work together to deliver quality and cost-effective vaccine care.
As Project IMPACT scales, it is likely to increase the number of pharmacy administered vaccines due to the wide range of pharmacies included and the information technology support provided. In the pilot study, researchers tested the “innovative care model” in retail chain, community, specialty, and independent pharmacies, including Quality Food Center, ReliantRx, Kirk’s, Cheney-Owl, Island Lopez, Kelly-Ross, and Tieton Village Drug. Pharmacists’ access to the point-of-care real-time immunization registry allows them to assess the patient’s record in conjunction with their own clinical evaluation of the patient’s suitability for a vaccine. The next step of Project IMPACT will be scaling to 50 sites, at which point it will test its financial feasibility. Walmart has already performed its own pilot vaccination study, in conjunction with Scientific Technologies Corporation, successfully testing real time faxing to a patient’s primary care physician and using bidirectional IIS in all 37 states in which IIS is available. Expanding to the large retail chain pharmacies would obviously have a dramatic effect.
However, success of the scale will not be due to technology alone. Dr. Scott Hamstra, an infectious disease specialist affiliated with Sells Indian Hospital in Tucson, Arizona, and co-author of the recent APhA Foundation publication, noted that patient education significantly affects immunization rates. Patients need to feel comfortable having pharmacists as vaccinators.
Going beyond patient education and comfort with pharmacist vaccination, there is the question of how pharmacists and physicians work together to deliver vaccine care. Fuld + Company’s recent survey of physicians, indicated eight out of ten have strong reservations about the increasing fragmentation of where vaccines are administered. Although not the number one concern, there is the issue of physician lost revenue. If physician vaccine revenue dollars are lost, the physician can capture that value by caring for patients through a value based system.
Survey results indicate the primary two physician concerns center on pharmacist training and the fragmenting of the patient medical home. Potential solutions to these concerns, building on the cutting-edge immunization registry systems, include electronic health record and payer notification technologies, as well as educating physicians on pharmacist vaccination capabilities. It will be essential, as Project IMPACT scales, that it addresses physicians’ concerns regarding pharmacist-administered vaccines such that these two groups can work together to deliver quality, cost-effective care.