Enhancing Adult Immunization In Minnesota Pharmacy Settings National Immunization Conference Presenter: Annie Fedorowicz, MPH September 29, 2014
Immunization in Pharmacies Practice of Pharmacy Act (Minn. Stat. §151, subd. 27, Article 5) • Pharmacists allowed to administer vaccines under: – Vaccine protocols (MN version of standing orders) – Patient-specific orders (prescriptions)
• Vaccine type & age designations: – Seasonal influenza vaccine to individuals 10 & up ‒ All recommended vaccines to adults 18 & up
In 2014: • 1,274 licensed pharmacies • 564 pharmacies in MIIC • 5 MnVFC pharmacies
2014 Practice of Pharmacy Act Changes Worked in collaboration with the MN Board of Pharmacy & pharmacy partners to amend the Practice of Pharmacy Act by: • Expanding the definition of who can sign vaccine protocols for pharmacists • Providing guidance on the criteria to include in vaccine protocols • Clarifying that pharmacists should complete an immunization training course that aligns with best practice standards
• Assuring that submitting immunizations to the Minnesota Immunization Information Connection (MIIC) is an acceptable method to fulfill reporting requirements
• Ensuring pharmacists comply with the Advisory Committee on Immunization Practices (ACIP) immunization best practice standards
MN Prevention & Public Health Funds (PPHF) Project Goals • Enhance adult immunization in: – Pharmacy settings – Workplace settings – Community health centers – Health care facilities (hospitals & nursing homes)
• Long-term outcome: – MN sees higher adult immunization coverage rates
Needs Assessment Summary Issues Identified • Pharmacists are: – Busy – Hard to reach
• Educational needs: – Vaccine administration – Storage & handling of vaccines
– MIIC utilization MN’s Immunization Information System (IIS)
Pharmacists were unfamiliar or had not heard of MIIC
Pharmacy Advisory Group Purpose: Advise the MDH Immunization Program on how to better collaborate with pharmacists to provide immunization best practices resources. • Members represented key pharmacy stakeholder groups: – Board of Pharmacy – Pharmacist professional associations
– Community-based pharmacists – Health system pharmacists – University of MN College of Pharmacy – MDH Office of Emergency Preparedness – MN Retailers Association (represented chain & drugstore pharmacies)
Project Goals 1. Support proposed pharmacy legislation changes 2. Create pharmacy-specific educational resources to promote immunization best practices 3. Increase utilization of MIIC
4. Understand billing & reimbursement barriers
Web page & Factsheet
Available at: http://www.health.state.mn.us/divs/idepc/immunize/registry/pharmacies.html
MIIC & Pharmacies MIIC can make it easy for pharmacies to ensure patients are up-to-date on their immunizations & that patient immunization records are complete & accurate.
• Pharmacists can use MIIC to: ‒ Submit immunizations given ‒ View immunization histories ‒ Recommend appropriate vaccines based on the patient’s age & immunization history Forecaster (clinical decision support) tool
‒ Print an official copy of a patient’s immunization history
Pharmacies using MIIC Organizations in MIIC, July 2003- July 2014 1000 Primary Care Clinic
Number of Active Organizations
900 School/School-Based Clinic
800 700
Childcare, Headstart, Preschool
600 Pharmacy
500 400
Nursing Home, Long Term Care, Home Care
300
Specialty Provider
200 100
Hospital
0 2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
MIIC in Pharmacy Settings Film • Purpose: – Communicate that MIIC is an easy tool that can be used in current pharmacy practice to better coordinate patient immunization care
• Target audience: – Pharmacists
The Film & the Adult Standards • Film promotes the Standards for Adult Immunization Practice: – MIIC can be used to assess patients’ immunization needs Can be incorporated into existing pharmacy practice Assessment using MIIC is key to sharing a strong recommendation & administering vaccines or referring patients to other immunizing providers
‒ Pharmacies encouraged to document immunizations administered in MIIC
Creating the film Partnerships developed through the Pharmacy Advisory Group were key! • Conducted key informant interviews with community & health system pharmacists
• Developed a script – Used scripted scenarios to derive themes & develop interview questions
• Hired a film director • Recruited volunteer actors & found filming locations at no cost • Developed a film promotion plan
Film Viewing
Film Promotion Plan • Plan to make the film available: – MDH YouTube channel Embedded in MIIC & Pharmacies Web page Cross-linked to Immunization Delivery in Pharmacy Settings Web page
– Integrate into pharmacy trainings provided by MIIC Regional Coordinators – Promote to pharmacy partners that provide MIIC training to students & pharmacists
Lessons Learned • Establish an advisory group to guide your work – Low cost – Leverage members’ networks in planning, developing & disseminating useful resources
• Communicate how the IIS can enhance pharmacy immunization practice – Easily fits into existing pharmacy practice – Easy tool to use Does not disrupt workflow
– Submitting immunizations given to MIIC fulfills MN reporting requirements – Using MIIC to make appropriate immunization recommendations creates a trusted relationship between pharmacists & patients
Acknowledgements • MDH Leadership – Kris Ehresmann
• CDC – Sam Graitcer
– Margo Roddy
• Film Director
– Denise Dunn
– Scott Jenson
• MDH Film Project Team
• Pharmacy Partners
– Andrea Ahneman
– Kathryn Schultz
– Angie Discher
– Michelle Johnson
– Annie Fedorowicz
– Ann Philbrick
– Chris Van Bergen
– Pharmacy Advisory Group members
– Lisa Harris
Questions or Comments? • Presenter contact information: – Annie Fedorowicz, MPH Adult Immunization Outreach Specialist Email:
[email protected] Office phone: 651-201-3525