Supporting Innovation in Pharmacy for a Healthier Canada

Injection affection


Kristen Watt administers an injection at Kirsten's Pharmacy in Southampton, Ont.

NOVEMBER 2020 (originally published in CFP’s 2020 Changing Face of Pharmacy report) — For pharmacist-owner Kristen Watt, vaccinations are a key part of the services offered at Kirsten’s Pharmacy in Southampton, Ont. “We know a vaccinated population is a healthier population, so we’ve made this a robust part of our business from the very beginning, even connecting with Public Health to do vaccinations,” says Watt, who opened her pharmacy in March 2017. “There were times we had patients without physicians get their tetanus shots here too.”

When the pandemic hit in March, Watt “saw the writing on the wall” and the potential threat that vaccinations during COVID-19 could have on public safety. As a result, for three months starting in late March, the pharmacy stopped offering most vaccine services. “It was disappointing we couldn’t do them, although I did have people come through the back door for their regular allergy and birth control injections, as well as doing a prostate cancer shot,” she says.

Kristen’s Pharmacy was able to resume vaccine services in July. Watt and her team focussed on implementing new safety protocols and then called everyone with outstanding vaccinations to book an appointment. The day before, the pharmacist or technician calls the patient to go through the screening questions and arrange for payment up front. The day of, patients can cancel until up to 10 that morning; after that time, staff begin prepping the vaccines.

“Because it is already paid for and prepped, we can minimize the time the patient is in the store,” says Watt, noting that she has gained customers since COVID-19 because people feel safer with the pharmacy’s new procedures. She also expects this vaccine protocol to remain even after the pandemic subsides. “Doing it this way allows us to be more nimble, and pre-screening and prepayment mean we can spend more time on counselling.”

Watt’s is a good example of how pharmacies are stepping up to become a vaccine destination for more patients, even in pandemic times. “When the doctor’s offices weren’t open, we were,” she says. “Even when we weren’t providing vaccinations, we were answering the phone and getting every health question under the sun from patients.”

Flu season frenzy

With the flu season underway, pharmacist-owner Carlene Oleksyn expects vaccinations to become an even bigger staple in community pharmacy’s service offerings. “Now that we feel more comfortable in terms of personal protective equipment (PPE) and social distancing, the demand for vaccinations is even higher as we engage patients on the importance of vaccines,”

says the owner of Mint Health+Drugs Meridian Pharmacy in Stony Plain, Alta. “Yes, COVID is a big threat to public health, but so are other things like pneumonia and shingles that need to be looked after.”

In addition to gearing up for flu season, Olekysn has been offering asymptomatic COVID-19 testing in her pharmacy since August (a government-funded service in Alberta since late July). She conducted 100 tests within the first three days alone. “Last year we did 1,200 flu shots and we’ve been looking at strategies to manage the patient load, especially since we’ll be combining with COVID testing this year.”

Some of these strategies include providing two different rooms for vaccinations to allow more time in between patients for sanitizing, as well as dedicating specific times to seniors and other vulnerable populations. “We have decided not to do only an appointment-based model as it’s hard to change cultural expectations of those expecting to walk in for a flu shot,” says Oleksyn, noting that physical distancing protocols will be adhered to. The pharmacy will also offer a COVID-19 test to some who get their flu shot, based on the program’s eligibility criteria. “And with the COVID test we’re assessing patients we may not have seen otherwise and can initiate conversations about what vaccines may be needed too.”

Yet even with many pharmacists gearing up to provide more immunizations in the months ahead, provincial inconsistencies in community pharmacy access to vaccines is an ongoing issue. A 2019 review of pharmacists as immunizers (PAI) across Canadian jurisdictions showed that discrepancies in vaccines as well as remuneration create confusion not only for pharmacists and other vaccine providers, but also for the public.(1) The study’s authors recommend a uniform PAI scope of practice to “empower the profession and contribute to reductions in vaccine-preventable disease and complications through increased patient access and uptake of vaccines.”

For more on pharmacist’s injection authority province to province, see the Canadian Foundation for Pharmacy’s services chart.

A 2020 white paper by the International Pharmaceutical Federation (FIP), “Give it a shot: Expanding immunisation coverage through pharmacists,” reported that pharmacists involved in immunizations are more likely to be involved in vaccine advocacy. The report also concluded there is ample evidence proving the benefits of pharmacists as immunizers in terms of improved accessibility and vaccination rates, public acceptance and trust in vaccines.

Preliminary results from the National Adherence Research Study, led by Ontario pharmacist-owner John Papastergiou and supported by the Canadian Foundation for Pharmacy, show that pharmacists have a more positive influence on adherence rates to multi-dose vaccinations (Engerix-B, Gardisil 9, Shingrix and Twinrix) in provinces where they have vaccination authority the longest and have the most advanced scope. For example, in Alberta where pharmacists have had the authority to administer injections since 2007 (the longest of any province), adherence rates for patients receiving their shots from a community pharmacist were significantly higher than those getting immunizations from their primary care provider.

“Our study shows that pharmacists can have a significant impact on multi-dose adult vaccine adherence rates when they become actively involved in immunization programs,” says Papastergiou, adding that pharmacists’ “unique relationship with their patients” is likely a contributing factor to improved immunization rates.

Pharmacists also provide the convenience and accessibility that patients demand, which he says is a key driver to improving vaccination rates. “I hope our work continues to encourage pharmacists to implement vaccinations programs into their practice as this is an area where we can have a significant impact on overall health.”

Pharmacists should also not wait for more government support to seize opportunities to be educators and immunizers, adds Oleksyn. “Every patient needs to be told about the benefits of vaccines and what is recommended for them, whether funded or not,” she says. “Historically, we’ve waited for patients to come to us, but it’s time to be proactive.”

Reference
1. Fonseca J, Pearson Sharpe J, Houle S, et al. Time for harmonization: Pharmacists as immunizers across Canadian jurisdictions. CPJ. 2019 Nov-Dec;152(6):395-400.