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      Evaluation of the impact of immunization policies, including the addition of pharmacists as immunizers, on influenza vaccination coverage in Nova Scotia, Canada: 2006 to 2016

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          Abstract

          Background

          Influenza is a serious public health concern, resulting in morbidity, mortality and significant expense to healthcare systems worldwide. Annual vaccination is the most effective way to prevent influenza. The National Advisory Committee on Immunization in Canada recommends that everyone six months of age and older without contraindications should be vaccinated. The Canadian province of Nova Scotia implemented a publicly-funded universal influenza vaccination program in the 2010–2011 influenza season. In 2013, pharmacists in Nova Scotia gained the authority to provide a variety of vaccinations, including the publicly-funded influenza vaccine. This study aimed to investigate any changes in influenza vaccine coverage following the implementation of each policy change: 1) universal publicly-funded program and 2) universal publicly-funded program with the addition of pharmacists.

          Methods

          Influenza seasons evaluated were from 2006-2007 to 2015–2016. Coverage was estimated by examining Nova Scotia census data with aggregate immunization administration data, including the total number of vaccinations administered according to vaccine provider (physician, public health or pharmacist), geographic region, vaccine recipient age and year.

          Results

          The analysis showed an increase in influenza vaccine coverage immediately following the implementation of the two studied policy changes. Vaccine coverage increased from 36.4 to 38% following the implementation of the universally funded vaccine policy. Following the implementation of pharmacists as immunizers, coverage increased from 35.7 to 41.7%. Vaccine coverage was highest in those 65 years of age and older during all years evaluated. Physicians provided the highest proportion of vaccines during all study periods, however a decreasing trend through all periods was observed. Physicians proportionately provided more vaccines in urban areas; whereas pharmacist and public health immunization providers in rural areas provided proportionately more vaccinations than their urban counterparts.

          Conclusions

          The addition of a universally funded vaccination policy and the addition of pharmacists as providers of the influenza vaccine resulted in increases in vaccine coverage initially. Additional research is needed to determine the long-term impacts of the policy changes on vaccination coverage and to identify other important factors affecting vaccine uptake.

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          Most cited references19

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          The role of pharmacists in the delivery of influenza vaccinations.

          The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines.
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            Impact of Pharmacist Immunization Authority on Seasonal Influenza Immunization Rates Across States.

            The goal of this study was to investigate the impact on immunization rates of policy changes that allowed pharmacists to administer influenza immunizations across the United States.
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              “It’s easier in pharmacy”: why some patients prefer to pay for flu jabs rather than use the National Health Service

              Background There is a need to increase flu vaccination rates in England particularly among those under 65 years of age and at risk because of other conditions and treatments. Patients in at risk groups are eligible for free vaccination on the National Health Service (NHS) in England, but despite this, some choose to pay privately. This paper explores how prevalent this is and why people choose to do it. There is moderate to good evidence from several countries that community pharmacies can safely provide a range of vaccinations, largely seasonal influenza Immunisation. Pharmacy-based services can extend the reach of immunisation programmes. User, doctor and pharmacist satisfaction with these services is high. Method Data were collected during the 2012–13 flu season as part of a community pharmacy private flu vaccination service to help identify whether patients were eligible to have their vaccination free of charge on the NHS. Additional data were collected from a sample of patients accessing the private service within 13 pharmacies to help identify the reasons patients paid when they were eligible for free vaccination. Results Data were captured from 89,011 privately paying patients across 479 pharmacies in England, of whom 6% were eligible to get the vaccination free. 921 patients completed a survey in the 13 pharmacies selected. Of these, 199 (22%) were eligible to get their flu vaccination for free. 131 (66%) were female. Average age was 54 years. Of the 199 patients who were eligible for free treatment, 100 (50%) had been contacted by their GP surgery to go for their vaccination, but had chosen not to go. Reasons given include accessibility, convenience and preference for pharmacy environment. Conclusions While people at risk can access flu vaccinations free via the NHS, some choose to pay privately because they perceive that community pharmacy access is easier. There are opportunities for pharmacy to support the NHS in delivering free flu vaccinations to patients at risk by targeting people unlikely to access the service at GP surgeries.
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                Author and article information

                Contributors
                (902) 494-8916 , jennifer.isenor@dal.ca
                bt476535@dal.ca
                susan.bowles@nshealth.ca
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                26 June 2018
                26 June 2018
                2018
                : 18
                : 787
                Affiliations
                [1 ]ISNI 0000 0004 1936 8200, GRID grid.55602.34, College of Pharmacy, Faculty of Health, , Dalhousie University, ; 5968 College Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
                [2 ]ISNI 0000 0004 1936 8200, GRID grid.55602.34, Canadian Center for Vaccinology, Nova Scotia Health Authority, IWK Health Centre, , Dalhousie University, ; Halifax, NS Canada
                [3 ]ISNI 0000 0004 4689 2163, GRID grid.458365.9, Department of Pharmacy, Nova Scotia Health Authority, ; 1276 South Park Street, Halifax, NS B3H 2Y9 Canada
                Author information
                http://orcid.org/0000-0003-1648-7362
                Article
                5697
                10.1186/s12889-018-5697-x
                6019522
                29940903
                e10b0922-3bf9-45c1-908f-73468a55b192
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 January 2018
                : 12 June 2018
                Funding
                Funded by: Dalhousie Pharmacy Endowment Fund
                Award ID: Not Applicable
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                influenza,vaccination,public health,policy,physician immunizers,pharmacist immunizers,canada
                Public health
                influenza, vaccination, public health, policy, physician immunizers, pharmacist immunizers, canada

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