Bridging immunization disparities: A model for pharmacist-patient engagement

Racial and ethnic disparities in adult immunizations exist in the African American and Hispanic communities. Older Hispanic and African-American adults are much less likely to be vaccinated against influenza, pneumococcal disease and herpes zoster than their white counterparts. Barriers to adult immunization include not knowing immunizations are needed, misconceptions about vaccines, and lack of recommendations from health care providers. Community pharmacies located in urban settings can address the multiple factors attributed to low vaccination rates through unique patient engagement strategies. Abundant accessibility, high public trust, and the ability to identify need have led to a high percentage of patients receiving vaccination after pharmacist recommendation. This project is a public-private partnership between the state department of public health, the state university pharmacy school and an urban community pharmacy, with the goal of increasing pneumococcal and herpes zoster immunization rates in elderly African American and Hispanic communities. The project consisted of three major components: pharmacy staff education, patient identification through eligibility criteria, and patient engagement strategies. Pharmacist and staff education included attributes of vaccine and disease, methods to address health literacy issues including cultural barriers and vaccine misconceptions, and techniques to identify patient vaccine eligibility by age, drug or disease state. Pharmacy database screening identified 1700 patients as potential candidates to receive vaccine. Stratifying for age 50-95, and for prescriptions received in the previous six months for specific disease states (arrhythmia, angina, CHD, CAD, CHF, HIV, diabetes, COPD, asthma, and immunosuppression) resulted in 1200 vaccine eligible patients. Patient engagement strategies were divided into three groups of 400 patients. One group received a mailed letter informing them of the project and their vaccine eligibility, a second group received an initial phone call with a follow-up call two weeks later and a third group received communication at point of service in the pharmacy. This group, identified by a pop-up message to the pharmacy staff at time of prescription fill, keys the staff to engage the patient in a culturally and linguistically appropriate manner to speak with the pharmacist about immunization. Marketing efforts affecting all patients included bag stuffers, posters and flyers at local businesses and apartment complexes, and radio/television ads and public service announcements at the most popular stations. Identified barriers included physician collaboration, reimbursement, and patient misconceptions. Increased vaccine rates will quantify project success.