Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial

As technology grows, innovations within the pharmaceutical fields also grow. A new trend in community pharmacies to incorporating technologies like handheld devices into maintaining healthcare is steadily expanding. A study was conducted to develop methods for conducting cluster randomized trials of text messaging interventions utilizing routine electronic health records at low cost and to assess the effectiveness of text messaging influenza vaccine reminders in increasing vaccine uptake in patients with chronic conditions. This study included 156 general practices who used text messaging software who had not previously used text messaging influenza vaccination reminders. Eligible patients of these practices were within 18-64 years old. 77 practices out of 156 were assigned to the intervention group (random) and 79 practices were assigned to the standard care group. The results found that text messaging increased absolute vaccine uptake by 2.62% (95% CI −0.09% to 5.33%).

This study found that text-messaging, a very low cost method, resulted in moderate improvements in influenza vaccine uptake. Although the changes were not drastic, it shows that implementation of these new intervention types could have a positive impact within the community setting. Hopefully, a better intervention method using technologies like this will grow in the future.

Herrett E., Williamson E., Staa T., et al. Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial. BMJ. 2016; 6

Pharmacist Education and Inpatient Influenza and Pneumococcal Vaccination Acceptance Rates

The United States is vastly affected by pneumococcus pneumonia, invasive pneumococcal infections, and seasonal influenza each and every year. Although there are vaccines that prevent these diseases, approximately 70 million high-risk adults are vulnerable to pneumococcus by by remaining unvaccinated. The number of deaths related to influenza has been steadily increasing in the United States since 1990. If patients qualify, patients can receive both the influenza and pneumonia vaccinations to protect themselves from these disease, however, less than half of adults 18 years of older were vaccinated during the 2012 to 2013 flu season. It is apparent that pharmacists, as immunizers in the community setting, are increasing the current vaccination rates in the population today.

A study was conducted to determine just how effective pharmacist-driven education programs were at increasing vaccination rates. Patients in a small community hospital who initially rejected vaccinations upon admission were educated by pharmacists and pharmacy interns and reoccurred the vaccination. As a result, 39.2% of patients changed there minds and decided to receive the influence and pneumococcal pneumonia vaccines.

This study proves the importance of patient education. Pharmacists need to provide patients with all the available information in order for patients to make the right decisions in regards to their health care. I am proud to be going in to a profession that has such a big influence on its patient population.

Journal of Pharmacy Practice (2016): n. pag. Web.

Link to article

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

This study was designed to examine the effectiveness of a collaborative agreement between physicians and community pharmacists to treat influenza-like illness (ILI). Every year in the US, there are at least 48,000 deaths and 226,000 hospitalizations resulting from influenza. Normally neuraminidase inhibitors are used to treat it by preventing the cleavage of virions from infected cells, therefore halting the spread of the virus within the body. However, this does not eradiate the virus. Studies found that early detection of the disease if critical to achieving optimal outcomes for treatment, but this is challenging. Many people use OTC products to alleviate symptoms instead of seeking immediate medical attention, delaying actual treatment of the infection. When patients come into the pharmacy to obtain OTC products, this is an opportunity for pharmacist intervention. A study conducted during the 2007-2008 and 2008-2009 flu seasons found that a pharmacist-physician collaborative program resulted in more immediate identification and treatment for patients with ILI. This study conducted from October 2013 to May 2014 and examined clinical outcomes and healthcare utilizations.

The study took place across fifty-five pharmacies in Michigan, Minnesota, and Nebraska. The pharmacists screened adult patients that came to pharmacies presenting symptoms of ILI. Then, they carried point-of-care rapid influenza diagnostic test (RIDT), completed a brief physical examination, and provided a corresponding treatment or referral through an established collaborative practice agreement (CPA) with a local licensed prescriber. After the encounter, pharmacists followed up 24 to 48 hours afterwards with the patient to assess their status and if any further intervention is needed. The outcomes measured were the number of patients screened, tested, and treated for ILI.

There were 121 patients screened overall. Of these patients, 75 were eligible for participation, and 8 had a positive RIDT and were managed accordingly. Of the tested patients 38.7% visited a pharmacist outside of normal office hours and 34.6% did not have a primary care physician. Just 3% said they felt worse at the follow-up. This study found that using a CPA enabled pharmacists to provide timely treatment to patients with and without influenza. One limitation of this study is that it did not use confirmatory testing of the RIDT results. Therefore, there was a possibility that patients were misclassified of having or not having influenza. This study demonstrated that the improved performance of CLIA-waved RIDTs and increased clinical training for pharmacists have made an opportunity for pharmacists and physicians to use a CPA to improve early detected and treatment for patients with influenza. Overall, a CPA could improve the number of patients visiting a physician for causes that only require management of symptoms. If more studies regarding this topic are conducted, hopefully this will lead to better management of patients presenting ILI.

Klepser ME, Klepser DG, Dering-Anderson AM, et al. Effectiveness of pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 2016;56(1):14-21.

High-dose influenza vaccine in older adults

Older adults (those over age 65) are more greatly affected by illnesses/infections than the younger population. This is due to changes in immunity and immunosenesence during aging. For this reason, the older population benefits more from a high-dose flu shot.

Antibody levels correlate to vaccine effectiveness, and older patients have lower antibody levels. 31 studies found that older adults were 2-4 times less likely to produce sufficient protection against influenza.

Fluzone High Dose is am HD trivalent influenza vaccine from Sanofi Pasteur. It gained FDA approval in 2009. A report showed that the HD vaccine resulted in a 24.2% improvement in older adults as compared to the standard (SD) vaccine. This shows that the HD vaccine prevents influenza more in older adults. Another study comparing the effectiveness of the HD and SD vaccines was performed in a long-term care facility; researchers concluded that the geometric mean titers for those who received the HD vaccine were significantly higher than for those who received the SD vaccine.

Medicare data supported the same viewpoint. Over the 2012-2013 influenza season, investigators identified 929,730 individuals who received the HD influenza vaccine and 1,615,545 individuals who received the SD influenza vaccine. Results showed that those who received the HD influenza vaccine were 22% less likely to have influenza infections as well as 22% less likely to be admitted to the hospital for influenza. However, a study at the Veteran’s Administration showed no differences in hospitalization rates for HD and SD groups.

The HD flu shot is safe. The phase II and III studies “noted some increase in reported adverse events, but not at a level that merited concern.” The most common adverse reaction was pain at the injection site. “The relative risk of developing at least one serious adverse event after receiving the HD versus SD influenza vaccine was 0.92.”

Although the cost of the HD vaccine is about twenty dollars higher than the SD vaccine, the HD vaccine is associated with cost-savings in the long run. By preventing influenza, it results in less hospital visits and less medicine. It reduces medical costs by about $120 on average.

In summary, both the SD and the HD flu shots are appropriate for adults. The HD flu shot has shown greater efficacy in the older population, and is associated with cost savings. It is important for patients to get their flu shot annually and to get vaccinated well before flu season, since antibodies that provide protection to the body may take 2 weeks or more after vaccination to form.

The question I will pose is:  Can the HD flu shot be given to younger adults as well? And if not, why?


Wang JM, Orly V, Joseph AZ. High-dose influenza vaccine in older adults. Journal of the American Pharmacist’s Association. 2016;56:95-97  http://www.japha.org/article/S1544-3191(15)00014-X/fulltext

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

As we progress further through flu season, it is important to consider different options to prevent contracting it or how to treat it if preventive measures fail. This study looked at the effectiveness of physicians and pharmacists working together as a team to diagnose patients with flu-like symptoms and prescribe treatments to them via established collaborative practice agreements. The study found that only 11% of the 121 patients screened tested positive for the flu, but the pharmacists were able to provide timely treatment to patients with the flu and also those who only required symptomatic treatments.

The study looked at community pharmacies throughout Michigan, Minnesota, and Nebraska that offered rapid influenza diagnostic tests, brief physical assessments, then used results to determine a diagnosis for each patient and recommended treatment or prescribed medications by the collaborative practice agreement. The study concluded that pharmacists using the data collected from the evidence-based collaborative practice agreements provided a very streamlined treatment experience to patients, and could possibly overtake urgent care and emergency room visits for these types of health care problems.

This practice set-up is one way that patients who have a hard time accessing health care providers can easily receive treatment for the flu. 34.6% of the patients included in the study who came to the pharmacy to get screened for influenza didn’t have a primary care physician and would have gone to urgent care or the emergency room to seek treatment, which is much less efficient and much more expensive. This also shows how health care providers working together can streamline a patient’s health care experience significantly, and also how pharmacists can use their accessibility to provide much more health care to patients than they normally do now. If this practice became the norm for pharmaceutical care, how do you think the role and the views of pharmacists would change?

Citation: Klepser ME, Klepser DG, Dering-Anderson AM et al. Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 56: 14-21.


Less than half of U.S. kids under age two fully vaccinated against flu

Vaccination rates among children under the age of 2 years have been alarmingly low for the past decade, if not more. In the 2011-2012 flu season, only 45 percent of infants aged 7 to 23 months were vaccinated. While compared to the 5 percent rate in 2002-2003, this is step in the right direction, but more needs to be done to continue raising the vaccination rates among infants. In some states, the vaccination rate is as low as 24 percent, meaning that 3 in 4 babies are at risk to influenza. A contributing factor to these low vaccination rates is that for an infant’s first vaccination, they need two doses of the vaccine. Nearly 36 percent of children end up only receiving the first dose and end up not being fully vaccinated.

Pharmacists have already began seeing changes in immunization laws over the past couple years, especially in the restrictions on patient-age. At the beginning of 2015, only 27 states allowed pharmacists to vaccinate patients of any age, while there were 8 states where pharmacists could only vaccinate people older than the age of 18, Pennsylvania being one of them (until June 26th, where a bill was passed lowering the minimum age to 9). These changes can prove to be instrumental in raising vaccination rates across the country. Increasing the access to these immunization services can make a huge impact on the country’s health and encourage more people to stay current on their vaccinations. Hopefully in the near future, legislators will realize the potential of pharmacists immunizing and allow for them to do so all over the country, and not just in select states.

Pediatrics. 2016; 137(3): .

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

The pharmacist-physician relationship is crucial to the collaborative efforts towards providing the best patient care as soon as possible.  This study is a prospective multicenter cohort study in which pharmacists working under collaborative practice agreements (CPAs) with a licensed physicians were able to administer simple physicals, and point of care rapid influenza diagnostic tests.  There were six overseeing physicians that signed the collaborative practice agreement, and fifty five pharmacies (both chain and independent) in Minnesota, Michigan, and Nebraska that volunteered to be a part of the study.  Those adult patients who showed signs of influenza like illness, and did not have an excluding condition were able to get screened.

There were 121 patients that volunteered for this study, but 45 were excluded due to predetermined exclusion factors.  Of the 76 patients eligible, one was sent to emergency care due to a systolic blood pressure of 83 mmHg.  Only 5 patients at CPA sites tested positive for influenza like illness, and they were given oseltamivir.  After treatment, 78% of all patients in the study were contacted within 48 hours, and reported feeling better.  A large third-party payer was found saying that treatment for upper respiratory tract infections at a physician’s office is on average $130-$180 whereas for emergency care treatment the cost is closer to $510-$635.  One important finding is that 35% of the patients in the study reported not having a primary care provider.

The study mentions that factors such as inconvenience, cost, and treatment delays add to a patient’s dissatisfaction with the health care system.  In the study the average time a pharmacist spent per patient was 10 minutes with a follow-up phone call lasting less than 2 minutes.  It also states that under this CPA model, the pharmacists were able to avoid the patient pressures for prescriptions that physicians often encounter.  The pharmacists were recorded saying that they felt they were able to better guide patients toward effective OTC medications instead of unnecessary prescriptions.  The final conclusion drawn from this study was that more exploration of collaborative models is warranted.

As a patient, would you feel comfortable seeing a pharmacist for treatment of what you believe to be the flu?  How would collaborative practice agreements impact the physician-pharmacist relationship?  Do you feel that a community pharmacist would be able to add this additional service to their day, or what changes to the current community setting would need to be implemented?

J Am Pharm Assoc. 2016;56(1);14-21.