TY - JOUR
T1 - Implementing pharmacy-located HPV vaccination
T2 - findings from pilot projects in five U.S. states
AU - Calo, William A.
AU - Shah, Parth D.
AU - Gilkey, Melissa B.
AU - Vanderpool, Robin C.
AU - Barden, Sarah
AU - Doucette, William R.
AU - Brewer, Noel T.
N1 - Funding Information:
This study was funded by Merck Sharp & Dohme Investigator Studies Program (grant #50928 to North Carolina) and the American Cancer Society (grant #32608 to Iowa, Kentucky and Oregon). Authors’ time were supported in part by training or career development awards from the National Cancer Institute (K22 CA186979 to Gilkey and R25 CA116369 to Calo) and the Agency for Healthcare Research and Quality (T32 HS000032 to Shah). Funders played no role in: 1) study design; 2) the collection, analysis, and interpretation of data; 3) the writing of the report; or 4) the decision to submit the manuscript for publication; American Cancer Society [#32608]; Merck Sharp and Dohme [#50928].
Funding Information:
Dr. Brewer has received commercial research grants from Merck and Pfizer and served as a paid advisory board member for Merck. He is chair of the National HPV Vaccination Roundtable which is funded by CDC and hosted by the American Cancer Society. The other authors have no financial disclosures or potential conflicts of interest to report.
Funding Information:
Appropriateness of pharmacy-located HPV vaccination varied by pharmacy site and stakeholder. Participating pharmacists were knowledgeable about vaccines in general not just HPV vaccine, had the training to immunize adolescents, and were able to report vaccines administered to state immunization registries. In addition, in Michigan, the study team conducted four stakeholder surveys with providers, parents, patients, and pharmacists about HPV vaccination in pharmacies. The appropriateness of delivering HPV vaccines in pharmacies was supported by a majority of those interviewed. However, some pharmacy staff exhibited resistance to offering HPV vaccination, which challenged the implementation of the pilot projects. Three pharmacy locations in Michigan, for example, had pharmacy staff who did not fully engage in the project because they did not approve of the vaccine. The Iowa project also encountered some reluctance from a physician who had concerns about the potential revenue loss caused by sending existing patients to complete dose series at a pharmacy. This concern was alleviated during recruitment of clinics into the study when the clinic manager expressed interest in participating in the project. Limited time was also a significant challenge for researchers and pharmacy teams. In Iowa, Kentucky, and Oregon, investigators faced delays in funding disbursement that impeded their ability to commence planned recruitment of adolescents and young adults to get HPV vaccination.
Publisher Copyright:
© 2019, © 2019 Taylor & Francis Group, LLC.
PY - 2019/8/3
Y1 - 2019/8/3
N2 - Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states by mapping process evaluation results onto key implementation science constructs: service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability. Pilot projects were planned in North Carolina (k = 2 pharmacies), Michigan (k = 10), Iowa (k = 2), Kentucky (k = 1), and Oregon (no pharmacy recruited) with varying procedures and recruitment strategies. Sites had open enrollment for a combined 12 months. Despite substantial efforts in these states, only 13 HPV vaccine doses were administered to adolescents and three doses to age-eligible young adults. We identified two major reasons for these underperforming results. First, poor outcomes on service penetration and appropriateness pointed to engagement barriers: low parent demand and engagement among pharmacy staff. Second, poor outcomes on feasibility, adoption, and sustainability appeared to result from administrative hurdles: lacking third party reimbursement (i.e., billing commercial payers, participation in Vaccines for Children program) and limited integration into primary care systems. In summary, pilot projects in five states all struggled to administer HPV vaccines. Opportunities for making pharmacies a successful setting for adolescent HPV vaccination include expanding third party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists’ immunization training, and improving care coordination with primary care providers.
AB - Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states by mapping process evaluation results onto key implementation science constructs: service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability. Pilot projects were planned in North Carolina (k = 2 pharmacies), Michigan (k = 10), Iowa (k = 2), Kentucky (k = 1), and Oregon (no pharmacy recruited) with varying procedures and recruitment strategies. Sites had open enrollment for a combined 12 months. Despite substantial efforts in these states, only 13 HPV vaccine doses were administered to adolescents and three doses to age-eligible young adults. We identified two major reasons for these underperforming results. First, poor outcomes on service penetration and appropriateness pointed to engagement barriers: low parent demand and engagement among pharmacy staff. Second, poor outcomes on feasibility, adoption, and sustainability appeared to result from administrative hurdles: lacking third party reimbursement (i.e., billing commercial payers, participation in Vaccines for Children program) and limited integration into primary care systems. In summary, pilot projects in five states all struggled to administer HPV vaccines. Opportunities for making pharmacies a successful setting for adolescent HPV vaccination include expanding third party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists’ immunization training, and improving care coordination with primary care providers.
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U2 - 10.1080/21645515.2019.1602433
DO - 10.1080/21645515.2019.1602433
M3 - Article
C2 - 30945968
AN - SCOPUS:85065531769
VL - 15
SP - 1831
EP - 1838
JO - Human Vaccines and Immunotherapeutics
JF - Human Vaccines and Immunotherapeutics
SN - 2164-5515
IS - 7-8
ER -