Abstract
BackgroundInfluenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs.AimTo explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations.Design and settingA mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales.MethodInterviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model.ResultsThe contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk.ConclusionBefore community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome.
Highlights
Influenza is a significant cause of morbidity and excess winter mortality in the UK.[1,2] Those at higher risk, including people with underlying health conditions such as cardiac or respiratory disease, and those aged ≥65 years, are eligible for immunisation, the cost of which is met by the NHS.[3]
Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole
In the UK a pilot was undertaken as early as 2002,11 and non-NHS influenza vaccination services are widely available from community pharmacies.[12]
Summary
Influenza is a significant cause of morbidity and excess winter mortality in the UK.[1,2] Those at higher risk, including people with underlying health conditions such as cardiac or respiratory disease, and those aged ≥65 years, are eligible for immunisation, the cost of which is met by the NHS.[3] The World Health Organization recommends that at least 75% of people ≥65 years should be vaccinated,[4] yet UK vaccination rates are lower than this.[3] Strategies to increase vaccination have included encouraging general practices to increase access, and promoting early morning, evening, and weekend appointments.[5] More recently, community pharmacists have been used as an alternative provider of influenza vaccination and this has been found to increase immunisation rates and meet service user needs.[6,7,8]. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs
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