APhA honors 2014 Immunization Champions

Abstract

Pharmacists are uniquely positioned to educate patients on the importance of vaccines and to provide many of those vaccines themselves. They expand the “immunization neighborhood”—an APhA-coined term—and increase the accessibility and convenience of vaccines for patients from all walks of life. Their work eliminates the perceived barriers of appointments, physicians’ offi ces, and prescriptions. Pharmacists are uniquely positioned to educate patients on the importance of vaccines and to provide many of those vaccines themselves. They expand the “immunization neighborhood”—an APhA-coined term—and increase the accessibility and convenience of vaccines for patients from all walks of life. Their work eliminates the perceived barriers of appointments, physicians’ offi ces, and prescriptions. Since 2008, APhA’s Immunization Champion Awards have recognized pharmacists, their team members, clinician colleagues, community partners, and friends who have made extraordinary contributions towards improved vaccination rates in their communities. This year’s awardees and honorable mentions have made great accomplishments in vaccine advocacy, education, community outreach, and vaccine administration. The clinicians and their partners find innovative solutions to bureaucratic problems. They are outspoken about the value of vaccines and of pharmacists as vaccine providers. And they often give of their own time to ensure that vaccines reach everyone who is eligible for them, not just those who can seek them out and pay for them.The following individuals and organizations are the 2014 APhA Immunization Champion awardees and honorable mentions.Individual Practitioner National AwardeesWhen Eric Crumbaugh, PharmD, was a child, his grandfather told him how 5 of his own 10 brothers and sisters had died of measles or whooping cough before they were 5 years old. Crumbaugh’s grandfather went on to work for the Shelby County Department of Health in Tennessee, and Crumbaugh gives him the credit for his initial interest in public health. “His story resonated with me. We don’t see that with children anymore because of school vaccination mandates,” Crumbaugh said. “It would be great if we could do something similar to improve adult immunization rates.”Crumbaugh has done his part to improve adult vaccination rates. As a pharmacist at Kroger, he helped launch the first pharmacist-run international travel vaccine clinic in Arkansas, and he was the first pharmacist in the state certified to administer yellow fever vaccine.Now immunization grant coordinator at the Arkansas Pharmacists Association, Crumbaugh led an initiative with the goal of increasing the number of influenza, pneumococcal, and shingles vaccines given by Arkansas pharmacists by 10% from 2012 to 2013. By the end of the first year of the program, Arkansas pharmacists had increased the number of flu, pneumonia, and shingles immunizations by 80%, 114%, and 298%, respectively. He has led dozens of immunization-related continuing pharmacy education programs and trained hundreds of pharmacists to immunize.Crumbaugh credits his Arkansas colleagues with his success. “The reason we’ve been so successful is that we have great pharmacists here in Arkansas.”Serving Genoa Healthcare’s patients with mental illness all around Minnesota, Julie Gambaiani, PharmD, BCACP, runs a mobile medication therapy management (MTM) program. Vaccines are the first item on the agenda at each MTM session.View Large Image Figure ViewerDownload (PPT)Julie GambaianiView Large Image Figure ViewerDownload (PPT)“People with mental illness die 25 years earlier than the rest of the population. And they’re not dying of schizophrenia or bipolar,” Gambaiani said. “They die because medically they’re not being taken care of. Preventive care can make a difference.”Gambaiani said that people with mental illness often do not get the same quantity and quality of primary care that people in the general population do. Through her practice, Gambaiani supports Minnesota’s 10 x 10 Initiative to increase the life expectancy of people with mental illness by 10 years in 10 years.“They die because medically they’re not being taken care of. Preventive care can make a difference.”That’s why vaccines are one of her top priorities. The first pharmacist to register to use Minnesota’s immunization database, Gambaiani checks it before each MTM session to see if her patient is due for any vaccines, and she brings the necessary vaccine with her. Gambaiani also empowers her patients to stay informed about their health care by giving them easy access to their immunization records. She travels with her printer wherever she goes to ensure she’s always able to print a copy of her patients’ records for them to keep.Individual Practitioner Honorable MentionsLt. Carlisha GentlesView Large Image Figure ViewerDownload (PPT)When seniors on the Navajo reservation in Tsaile, AZ, saw members of their community suffering from shingles, they went to Tsaile Health Center to ask for a vaccine. Lt. Carlisha Gentles, PharmD, BCPS, hated to turn them away, but the Indian Health Service (IHS) clinic didn’t stock the pricey vaccine, and pharmacists couldn’t Lt. Carlisha Gentles vaccinate anyway. Patients’ only option was to visit a community pharmacy 2 to 4 hours away.“This population is underserved in general, but they should have just as many chances at health care and preventive services as anyone outside the reservation does,” Gentles said.Gentles acquired a small amount of the zoster vaccine to conduct a demonstration study. Following the Institute for Healthcare Improvement’s Plan, Do, Study, Act model, Gentles demonstrated to medical staff that a pharmacist-led zoster vaccine program was sustainable. Her efforts led the health center’s medical staff to add the vaccine to the formulary in 2013. That year, she and a pharmacist colleague vaccinated 150 people, while continuing their duties in the extremely understaffed clinic. This year, they expect to vaccinate 400 people by midsummer.“This population is underserved in general, but they should have just as many chances at health care and preventive services.”Adding pharmacist-administered vaccines to the services offered at the health center improves both disease prevention and coordination of care. “Offering the vaccine right here at IHS, we stay updated and have a record of everything they’ve had. This can prevent them from repeating the vaccine unnecessarily elsewhere.”Todd McWilliamsView Large Image Figure ViewerDownload (PPT)Just months after he graduated pharmacy school in 2011, Todd McWilliams, PharmD, ran his first school flu clinic in rural Gibson County, TN. He offered influenza vaccines to seventh graders, school faculty, and parents. The next year, the clinics covered three counties and included hepatitis vaccines at a detention center. Today, when he’s not behind the counter at CVS, McWilliams spends his personal time running comprehensive immunization clinics for seventh graders and meningitis clinics for seniors at 11 schools.“It gives underprivileged kids the opportunity to be vaccinated when they otherwise might not have,” McWilliams said. He offers seventh graders immunizations against influenza, hepatitis A and B, HPV, pertussis, measles, and chicken pox.McWilliams also sees the clinics as a public service to schoolteachers. “Our teachers do so much for our kids, but there’s not a lot going on for them. We can get the vaccines to the schools to protect them from sickness, so they don’t have to take a day off to do it.”The job requires intensive legwork. McWilliams sends letters to parents to announce the opportunity. Parents then return forms indicating their interest. McWilliams then collects consent forms and insurance information. He processes the insurance information for every child and alerts parents to any required copays. But McWilliams is undaunted. He personally immunizes every participating student, parent, and teacher to the tune of about 1,400 shots a year. He hopes his program will someday reach the entire state.George VeltriView Large Image Figure ViewerDownload (PPT)George Veltri, BSPharm, launched an innovative plan to increase shingles immunization rates and pharmacy technician awareness of the vaccine at Cannon Pharmacies in George Veltri North Carolina. He organized a contest to see which store could immunize the most patients that month.Pharmacy techs were encouraged to go after the low-hanging fruit first. They performed an analysis to identify all vaccine candidates whose insurance plans didn’t require a copay for the shot. “When we filled a prescription for one of those patients, we’d ask them if they’d ever had chicken pox and then counsel them on the importance of the vaccine. Many would agree to get it right then,” Veltri said.Regardless of a patient’s copay for the vaccine, pharmacists and pharmacist technicians made sure they had copay information ready for all shingles vaccine candidates whenever they came into the store.During the contest, Cannon Pharmacies administered 300 shingles vaccines. As Veltri intended, vaccine awareness and enthusiasm carried over to the following month, when pharmacists administered 200 more vaccines.The initiative raised so much awareness of shingles vaccines in the community that some physicians wrote vaccine subscriptions that included the instruction, “Go to Cannon Pharmacies.”“We have a good relationship with our doctors,” Veltri said. “We made it well known that we always had the vaccine available, that no appointments were necessary, and we could do it on the spot.”Friend of PharmacyWilliam SchaffnerView Large Image Figure ViewerDownload (PPT)“I’ve long been a strong supporter of vaccinations in pharmacies … and any other reasonable place that makes it easier for adults to follow the U.S. im-munization schedule,” said William Schaffner, MD, in a blog post, “Leading by Sharing the Load.” “So you can imagine how troubled I was to read that some doctors are opposing changes that would allow pharmacists to administer more vaccines to adults.”Schaffner, who is an infectious disease specialist at Vanderbilt University, believes there is quite a load to be shared when it comes to vaccinating the adolescent and adult populations, and he is outspoken in his support of sharing that load with pharmacists.“We have an enormous gap in this country between the number of adults and adolescents who should be vaccinated and those who actually are, so I was very excited when pharmacists began to get licensed to immunize,” Schaffner said.Schaffner speaks out in support of pharmacists as immunizers in frequent local and national media appearances, including as a medical expert on CBS News, and in his roles as past president of the National Foundation for Infectious Diseases and active member of its board, and on committees of the American College of Physicians.Corporation/Institution National AwardeeView Large Image Figure ViewerDownload (PPT)Safeway, Inc., has been a leader in immunizations since it began offering the services in 2000. The national community pharmacy was among the first to issue APhA immunization certificates; certify trainers to train pharmacists; receive centralized billing status for Medicare Part B; and to make immunizations a standard of practice.Pharmacists assess every patient who receives a vaccine at Safeway for any other necessary vaccines. “Assessing status of all patients across all demographics every time we administer a vaccine has protected hundreds of thousands from vaccine-preventable diseases they did not realize they needed protection against,” said Brian Hille, Vice President for Patient Care Services at Safeway.The community relies on Safeway as a public health partner. When Washington state closed its travel clinics in 2013, pediatric patients had no source for travel vaccines. Spokane County reached out to Safeway, which then collaborated with Washington State University’s College of Pharmacy to design training for pharmacists to administer pediatric travel vaccines.Corporation/InstitutionView Large Image Figure ViewerDownload (PPT)Honorable MentionWhen state law changed last year to allow Iowa pharmacists to administer all ACIP adult immuni zations, as well as influenza vaccines, to patients aged 6 years and older, Osterhaus Pharmacy acted immediately to expand access to preventive health care in the four rural counties they serve.“We focus on prevention, and that includes vaccines. A lot of patients are unaware of the vaccines they need and of the benefits. Pharmacists are in a great place to have that conversation,” said Osterhaus pharmacist Angela Spannagel, PharmD.To make the greatest impact, Osterhaus partnered with two local medical practices to coordinate vaccine histories, identify patient needs, vaccinate, educate, and document. Recognizing that the state’s immunization database was not always up to date, the pharmacy and the clinics created a form to streamline communication and record keeping. Besides improving local vaccination rates, the collaboration improved pharmacist relationships with local health care providers and improved patients’ perception of their health care providers as a team.“It was really a team effort from everyone in the pharmacy and the community that made this happen,” Spannagel said.Partnership National AwardeeSusan WinklerView Large Image Figure ViewerDownload (PPT)Public school influenza clinics, mandated in Arkansas in 2009, were a triumph for public health but a challenge for an already-taxed health care workforce. Susan Winkler, MS, the administrator at the White County Local Health Unit, saw what seemed like a logical opportunity to bring in pharmacists and students from Harding University’s College of Pharmacy to help staff the ambitious project. The health care workforce needed support, and the university students had been seeking public service opportunities.In 2010, pharmacy students offered clerical and organizational support at the clinics. However, in 2011, when Winkler and partners at Harding College of Pharmacy attempted to move trained pharmacy students into vaccine-provider roles, they were met with resistance from public health nurses and extensive red tape. But Winkler pressed on.“It was resistance to a traditional and accepted way of life, so we got creative,” she said.Susan WinklerJumping through every hoop placed before her, Winkler saw that each piece of required paperwork was filed through the proper channels in time for the 2012–13 influenza season. That year, working side by side, pharmacists, student pharmacists, and public health nurses provided 4,800 influenza vaccinations. This influenza season, that number rose to 5,750. And school absenteeism is down by 50%, thanks to the in-school vaccination clinics.Winkler’s push for pharmacists and student pharmacists to staff influenza clinics and administer vaccines has a three-pronged effect. It increases access to vaccines, promotes the role of pharmacists, and allows nurses to continue to run the local health unit while pharmacists support vaccine clinics.Lifetime Health medical groupPartnership Honorable MentionIn 2013, Lifetime Health Medical Group of Rochester, NY, identified a challenge in fully meeting their patients’ Zostavax needs. Staff pharmacists weren’t certified to immunize, yet physicians struggled to bill for the expensive shingles vaccination, as many patients were eligible for it under Part D prescription drug plans.“We started an initiative to have our pharmacists certified to immunize because we recognized an opportunity to better serve our patients by allowing them to get an immunization without an office appointment,” said Jason Smith, PharmD.Convening a team that included Lean Six Sigma Black Belt project managers, pharmacists, nurses, practice managers, billing specialists, and IT specialists, the medical group devised a plan for workflow and seamless execution of pharmacist-provided vaccines from administration of the immunization to billing. That year, pharmacists administered almost 1,400 shingles vaccines. Pharmacist-administered immunizations at Lifetime don’t require an appointment, and they free up nonpharmacist clinicians to provide care in other areas.Community Outreach National AwardeeMonali MajmudarView Large Image Figure ViewerDownload (PPT)Monali Majmudar, PharmD, gets vaccines out to her community far beI yond the doors of Walgreens in Norcross, GA, where she is pharmacy manager and district immunization trainer. Through partnerships with Georgia’s Head Start Program and the Hispanic Health Coalition of Georgia, Majmudar has helped get thousands of vaccines to people who might not seek them out themselves or who might otherwise be unable to afford them.When she began the initiative, she provided enough Walgreens influenza vaccine vouchers for all the families in the Georgia Head Start Program’s Ninth District. But when few families used the vouchers, she knew she had to bring the vaccines to them. “This is an indigent population that doesn’t always realize the importance of getting vaccinated,” Majmudar said. “They lose their insurance, or they don’t always have the money, so vaccines just fall by the wayside.”Obtaining vouchers and all the necessary supplies from Walgreens, Majmudar has now led immunization clinics all around the state at public schools, health departments, and health fairs. Pharmacists in her state cannot vaccinate patients younger than 13 years. Majmudar staffs her clinics with student pharmacists and student physician assistants from Mercer University. Today, the physician assistant program at Mercer has made the immunization clinics a requirement.“Now, my job is not only educating patients about vaccines,” Majmudar said, “but also students.”Community Outreach Honorable MentionAllison Dering-AndersonView Large Image Figure ViewerDownload (PPT)“I love pharmacy, but I don’t have very many chances to save someone’s life—but [vaccines] are one of those chances,” said Allison Dering-Anderson, PharmD. She spreads the word about vaccines on “Ask Dr. Ally,” a segment on the KFOR radio show “Problems and Solutions” that airs in nine Midwestern cities in seven states. A part of the live call-in show for more than 15 years, Dering-Anderson frequently stresses the importance of influenza vaccines, shingles vaccines, and pertussis vaccines—especially for new grandparents who want to protect their infant grandchildren.“I tell listeners about the threat we had in our house that if grandparents don’t get a whooping cough vaccine, they can’t see the grandchildren,” Dering-Anderson said.“I love pharmacy, but I don’t have very many chances to save someone’s life—but [vaccines] are one of those chances.”Oftentimes callers ask Dering-Anderson about vaccines, but if no one calls in, they are her go-to topic. “I always prep a few topics in the event that the phone doesn’t ring, and vaccines are a passion for me,” she said.For the Clinical Assistant Professor in the College of Pharmacy at University of Nebraska, clear communication is key to improving vaccination uptake. Besides speaking on her twice-monthly radio segment, Dering-Anderson has presented on vaccines at the University of Nebraska’s Science Café.“If we spend our lives using seven-syllable words, nobody wins. Our patients don’t understand, and we lose the opportunity to teach them.”Pharmacy Team Member National AwardeeFor some time, Marianne Reed, store manager at Walgreens in Fayetteville, NC, had been collecting store items to donate to charitable organizations for people who are homeless. Then she realized that the pharmacy could do more for them.Marianne ReedView Large Image Figure ViewerDownload (PPT)“I thought, ‘Why not take it one step further?’ There’s nobody who helps them with their medical needs. So I set up flu clinics where we could vaccinate our homeless, and our pharmacist travels with me,” Reed said. At the clinics, the pharmacist checks blood pressure in addition to administering influenza vaccinations.Coordinating an influenza clinic for people who are homeless is easier said than done. Reed often must host clinics in unsafe areas of town that have the largest concentration of homeless people, so she calls on community partners, such as the agencies she is working with, to provide security for the event. When Reed organizes clinics in a neighborhood to which homeless patients must travel, she calls on a partnering organization for bus vouchers the patients can use. Walgreens provides the influenza vaccinations, and its community partners get the word out to the homeless.“Flu vaccines keep people healthy and keep our homeless out of the ER, which costs taxpayers more than a voucher for a vaccination,” Reed said, “so it’s a win-win situation.” Since 2008, APhA’s Immunization Champion Awards have recognized pharmacists, their team members, clinician colleagues, community partners, and friends who have made extraordinary contributions towards improved vaccination rates in their communities. This year’s awardees and honorable mentions have made great accomplishments in vaccine advocacy, education, community outreach, and vaccine administration. The clinicians and their partners find innovative solutions to bureaucratic problems. They are outspoken about the value of vaccines and of pharmacists as vaccine providers. And they often give of their own time to ensure that vaccines reach everyone who is eligible for them, not just those who can seek them out and pay for them. The following individuals and organizations are the 2014 APhA Immunization Champion awardees and honorable mentions. Individual Practitioner National AwardeesWhen Eric Crumbaugh, PharmD, was a child, his grandfather told him how 5 of his own 10 brothers and sisters had died of measles or whooping cough before they were 5 years old. Crumbaugh’s grandfather went on to work for the Shelby County Department of Health in Tennessee, and Crumbaugh gives him the credit for his initial interest in public health. “His story resonated with me. We don’t see that with children anymore because of school vaccination mandates,” Crumbaugh said. “It would be great if we could do something similar to improve adult immunization rates.”Crumbaugh has done his part to improve adult vaccination rates. As a pharmacist at Kroger, he helped launch the first pharmacist-run international travel vaccine clinic in Arkansas, and he was the first pharmacist in the state certified to administer yellow fever vaccine.Now immunization grant coordinator at the Arkansas Pharmacists Association, Crumbaugh led an initiative with the goal of increasing the number of influenza, pneumococcal, and shingles vaccines given by Arkansas pharmacists by 10% from 2012 to 2013. By the end of the first year of the program, Arkansas pharmacists had increased the number of flu, pneumonia, and shingles immunizations by 80%, 114%, and 298%, respectively. He has led dozens of immunization-related continuing pharmacy education programs and trained hundreds of pharmacists to immunize.Crumbaugh credits his Arkansas colleagues with his success. “The reason we’ve been so successful is that we have great pharmacists here in Arkansas.”Serving Genoa Healthcare’s patients with mental illness all around Minnesota, Julie Gambaiani, PharmD, BCACP, runs a mobile medication therapy management (MTM) program. Vaccines are the first item on the agenda at each MTM session.Julie GambaianiView Large Image Figure ViewerDownload (PPT)“People with mental illness die 25 years earlier than the rest of the population. And they’re not dying of schizophrenia or bipolar,” Gambaiani said. “They die because medically they’re not being taken care of. Preventive care can make a difference.”Gambaiani said that people with mental illness often do not get the same quantity and quality of primary care that people in the general population do. Through her practice, Gambaiani supports Minnesota’s 10 x 10 Initiative to increase the life expectancy of people with mental illness by 10 years in 10 years.“They die because medically they’re not being taken care of. Preventive care can make a difference.”That’s why vaccines are one of her top priorities. The first pharmacist to register to use Minnesota’s immunization database, Gambaiani checks it before each MTM session to see if her patient is due for any vaccines, and she brings the necessary vaccine with her. Gambaiani also empowers her patients to stay informed about their health care by giving them easy access to their immunization records. She travels with her printer wherever she goes to ensure she’s always able to print a copy of her patients’ records for them to keep. When Eric Crumbaugh, PharmD, was a child, his grandfather told him how 5 of his own 10 brothers and sisters had died of measles or whooping cough before they were 5 years old. Crumbaugh’s grandfather went on to work for the Shelby County Department of Health in Tennessee, and Crumbaugh gives him the credit for his initial interest in public health. “His story resonated with me. We don’t see that with children anymore because of school vaccination mandates,” Crumbaugh said. “It would be great if we could do something similar to improve adult immunization rates.” Crumbaugh has done his part to improve adult vaccination rates. As a pharmacist at Kroger, he helped launch the first pharmacist-run international travel vaccine clinic in Arkansas, and he was the first pharmacist in the state certified to administer yellow fever vaccine. Now immunization grant coordinator at the Arkansas Pharmacists Association, Crumbaugh led an initiative with the goal of increasing the number of influenza, pneumococcal, and shingles vaccines given by Arkansas pharmacists by 10% from 2012 to 2013. By the end of the first year of the program, Arkansas pharmacists had increased the number of flu, pneumonia, and shingles immunizations by 80%, 114%, and 298%, respectively. He has led dozens of immunization-related continuing pharmacy education programs and trained hundreds of pharmacists to immunize. Crumbaugh credits his Arkansas colleagues with his success. “The reason we’ve been so successful is that we have great pharmacists here in Arkansas.” Serving Genoa Healthcare’s patients with mental illness all around Minnesota, Julie Gambaiani, PharmD, BCACP, runs a mobile medication therapy management (MTM) program. Vaccines are the first item on the agenda at each MTM session. “People with mental illness die 25 years earlier than the rest of the population. And they’re not dying of schizophrenia or bipolar,” Gambaiani said. “They die because medically they’re not being taken care of. Preventive care can make a difference.” Gambaiani said that people with mental illness often do not get the same quantity and quality of primary care that people in the general population do. Through her practice, Gambaiani supports Minnesota’s 10 x 10 Initiative to increase the life expectancy of people with mental illness by 10 years in 10 years. “They die because medically they’re not being taken care of. Preventive care can make a difference.” That’s why vaccines are one of her top priorities. The first pharmacist to register to use Minnesota’s immunization database, Gambaiani checks it before each MTM session to see if her patient is due for any vaccines, and she brings the necessary vaccine with her. Gambaiani also empowers her patients to stay informed about their health care by giving them easy access to their immunization records. She travels with her printer wherever she goes to ensure she’s always able to print a copy of her patients’ records for them to keep. Individual Practitioner Honorable MentionsWhen seniors on the Navajo reservation in Tsaile, AZ, saw members of their community suffering from shingles, they went to Tsaile Health Center to ask for a vaccine. Lt. Carlisha Gentles, PharmD, BCPS, hated to turn them away, but the Indian Health Service (IHS) clinic didn’t stock the pricey vaccine, and pharmacists couldn’t Lt. Carlisha Gentles vaccinate anyway. Patients’ only option was to visit a community pharmacy 2 to 4 hours away.“This population is underserved in general, but they should have just as many chances at health care and preventive services as anyone outside the reservation does,” Gentles said.Gentles acquired a small amount of the zoster vaccine to conduct a demonstration study. Following the Institute for Healthcare Improvement’s Plan, Do, Study, Act model, Gentles demonstrated to medical staff that a pharmacist-led zoster vaccine program was sustainable. Her efforts led the health center’s medical staff to add the vaccine to the formulary in 2013. That year, she and a pharmacist colleague vaccinated 150 people, while continuing their duties in the extremely understaffe