National Vaccine Advisory Committee Research Articles

Community chain pharmacists’ perceptions of increased technicians’ involvement in the immunization process

BackgroundOver the past 2 decades, pharmacists have positioned immunization services as an important aspect of their expanding role in patient care. ObjectivesTo examine how community chain pharmacists view time spent on immunization, available in-store resources and barriers, and pharmacy technician involvement in the context of their views about the achievement of key National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice in their workplace. MethodsA representative, nationwide survey was administered electronically to chain community pharmacists over a 4-week period. Community pharmacists offering year-round immunization in retail chain, supermarket, and mass-merchant settings, randomly sampled from a database maintained by the American Pharmacists Association. We examined several sets of interrelated relationships regarding pharmacists’ perceived achievement of 3 key NVAC standards (assessment, recommendation and administration), time spent on the overall immunization process, the effectiveness of available in-store resources, immunization impediments, and the endorsement of increased technician involvement in community pharmacy-based immunization service (PBIS) delivery. ResultsA sample of 590 survey responses was obtained from 9717 e-mails delivered, with 489 deemed eligible (5% response rate). Sizeable numbers of pharmacists acknowledged that several activities integral to achieving optimal immunization levels were not being addressed. Although pharmacists accepted that appropriately trained pharmacy technicians should be able to ask (77%) and assess (66%) patients, only 24% agreed that technicians should be able to administer vaccine doses. Pharmacists satisfied with in-store immunization resources and technicians’ involvement were more likely to report achieving the 3 key NVAC standards. Paradoxically, how pharmacists viewed their immunization time expenditures was unrelated to whether they agreed that pharmacy technicians should have an expanded role in asking, assessing, or administering vaccines to their patients. ConclusionOverall, community pharmacies would likely better meet national immunization goals by achieving all 3 key NVAC standards and incorporating expanded roles for appropriately trained and supervised technicians in PBIS.

Optimizing the immunization activities of community chain pharmacists: Insights from a national survey

ObjectivesTo assess (1) the practices, attitudes, and perceptions of immunizing chain community pharmacists regarding implementation of immunization services per the National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice and (2) how community pharmacists view the effectiveness of corporate initiatives toward improving immunization volumes. DesignFollowing extensive formative research and pilot-testing, a cross-sectional survey was administered electronically to chain community pharmacists over a 4-week period. Setting and participantsRespondents were chain community pharmacists engaged in year-round immunization in the United States, randomly sampled from a list of 9717 maintained by the American Pharmacists Association. Outcome measuresPharmacists’ reports of immunization volumes, patterns of time use, perceptions of time spent on the immunization process, immunization attitudes, and confidence in completing NVAC standard components. Pharmacists also evaluated the utility of corporate goals, feedback, and incentives received. ResultsThe survey yielded 590 responses, with 489 meeting the eligibility criteria (5% response rate) and distributed from across the country. In total, 84% of respondents reported giving 26 or more vaccinations/week during the influenza season, whereas only 6% reported as many outside of the influenza season. Pharmacists spent, on average, 29% of their day addressing the immunization process during the influenza season and 12% outside of the influenza season. Only 29% of respondents were confident that their patients’ complete immunization needs were assessed at each patient encounter and only 46% were confident that their patients received strong recommendations regarding their specific immunization needs. Most pharmacists viewed corporate goals and the messages and strategies to achieve them as limited in scope and largely inadequate. ConclusionIn the context of their current role expectations, most community pharmacists who responded were not confident that key NVAC Standards were being implemented to improve patient immunization rates and did not view corporate initiatives as effective toward that effort.

2020 National Vaccine Plan Development: Recommendations From the National Vaccine Advisory Committee.

2020 National Vaccine Plan Development: Recommendations From the National Vaccine Advisory Committee.

Increasing influenza immunization rates among healthcare providers in an ambulatory-based, University Healthcare Setting☆.

Despite its 'best practice' status as an intervention to combat healthcare-related influenza, many healthcare personnel (HCP) do not seek vaccinations themselves. The objective of this study was to achieve the Healthy People [HP] 2020's influenza vaccination goal of 90% among our HCP. The study utilized the model for improvement, consisting of Plan-Do-Study-Act (PDSA) cycles. Each influenza season served as a PDSA cycle until the HP 2020 vaccination goal was achieved. The quality improvement (QI) study was conducted over four influenza seasons (i.e. 2014-15; 2015-16; 2016-17 and 2017-18). The study's setting was an ambulatory-based, university health center within a suburban university located in central New Jersey. Adapting the National Vaccine Advisory Committee's definition of HCP, clinical and non-clinical staff members (n = 110) participated in the QI-study. QI-interventions were centered on staff education/outreach, improved accessibility to influenza vaccines and frequent communication to staff over several PDSA cycles. The QI-interventions significantly increased our overall vaccination coverage on our influenza vaccination status survey from 70.2% (2011-14 influenza seasons; n = 102) to 84.9% (2014-15 influenza season; n = 93) in PDSA 1, and 91.1% (2015-16 influenza season; n = 90) in PDSA cycle 2 (χ2 = 309.53, P < 0.001). Vaccination rates remained above the 90% performance goal during our quality control/assurance measuring periods (i.e. the 2016-18 influenza seasons). This study demonstrates that influenza vaccination coverage can significantly improve among HCP through the application of concurrent and multifaceted QI-interventions.

Development of a US trust measure to assess and monitor parental confidence in the vaccine system

ObjectiveTo develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. MethodsWe used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., “Information Environment”, “Trust”, “Healthcare Provider”, “Attitudes and Beliefs”, and “Social Norms”). Reliability for EVCI was assessed using Cronbach’s alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. ResultsRespondents’ EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. ConclusionsWe developed EVCI to reliably measure parental vaccine confidence, with individuals’ scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.

Flu, Pneumococcal Vaccination Rates on the Rise

Flu, Pneumococcal Vaccination Rates on the Rise

Strengthening the Effectiveness of National, State, and Local Efforts to Improve HPV Vaccination Coverage in the United States: Recommendations From the National Vaccine Advisory Committee.

In February 2018, recognizing the suboptimal rates of human papillomavirus (HPV) vaccination in the United States, the assistant secretary for health of the US Department of Health and Human Services charged the National Vaccine Advisory Committee (NVAC) with providing recommendations on how to strengthen the effectiveness of national, state, and local efforts to improve HPV vaccination coverage rates. In the same month, the NVAC established the HPV Vaccination Implementation Working Group and assigned it to develop these recommendations. The working group sought advice from federal and nonfederal partners. This NVAC report recommends ways to improve HPV vaccination coverage rates by focusing on 4 areas of activity: (1) identifying additional national partners, (2) guiding coalition building for states, (3) engaging integrated health care delivery networks, and (4) addressing provider needs in rural areas.

A Guide to the California Immunization Registry and Its Use to Enhance the Delivery of Immunization Services

Pharmacists in California are assuming a greater role as independent providers of immunizations for children and adults under Senate Bill 493 (SB 493). One of the requirements for pharmacists as independent providers of immunizations in California is that they must report their administered doses to the California immunization registry system (CAIR). The National Vaccine Advisory Committee Standards for Immunization Practice also supports this practice by recommending that all immunizing providers report vaccinations to their local and state immunization information systems (IIS). This document presents background and specific features of CAIR; best practice recommendations for the use of IIS lookup, forecasting, follow-up, and recall; and documentation features to enhance the delivery of immunization services.

Pneumococcal Vaccination Among Medicare Beneficiaries Occurring After the Advisory Committee on Immunization Practices Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged ≥65 Years.

On September 19, 2014, CDC published the Advisory Committee on Immunization Practices (ACIP) recommendation for the routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, to be used in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) (1). This replaced the previous recommendation that adults aged ≥65 years should be vaccinated with a single dose of PPSV23. As a proxy for estimating PCV13 and PPSV23 vaccination coverage among adults aged ≥65 years before and after implementation of these revised recommendations, CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS). Claims from any time during a beneficiary's enrollment in Medicare Parts A (hospital insurance) and B (medical insurance) since reaching age 65 years were assessed among beneficiaries continuously enrolled in Medicare Parts A and B during annual periods from September 19, 2009, through September 18, 2016. By September 18, 2016, 43.2% of Medicare beneficiaries aged ≥65 years had claims for at least 1 dose of PPSV23 (regardless of PCV13 status), 31.5% had claims for at least 1 dose of PCV13 (regardless of PPSV23 status), and 18.3% had claims for at least 1 dose each of PCV13 and PPSV23. Claims for either type of pneumococcal vaccine were highest among beneficiaries who were older, white, or with chronic and immunocompromising medical conditions than among healthy adults. Implementation of the National Vaccine Advisory Committee's standards for adult immunization practice to assess vaccination status at every patient encounter, recommend needed vaccines, and administer vaccination or refer to a vaccinating provider might help increase pneumococcal vaccination coverage and reduce the risk for pneumonia and invasive pneumococcal disease among older adults (2).

Evaluation of the 2010 National Vaccine Plan Mid-course Review: Recommendations From the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on February 7, 2017.

Evaluation of the 2010 National Vaccine Plan Mid-course Review: Recommendations From the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on February 7, 2017.

Overcoming Barriers and Identifying Opportunities for Developing Maternal Immunizations: Recommendations From the National Vaccine Advisory Committee.

Overcoming Barriers and Identifying Opportunities for Developing Maternal Immunizations: Recommendations From the National Vaccine Advisory Committee.

Society of behavioral medicine supports increasing HPV vaccination uptake: an urgent opportunity for cancer prevention.

Human papillomavirus (HPV) vaccine coverage remains low in the USA. The Society for Behavioral Medicine (SBM) supports the goals outlined by Healthy People 2020, the President's Cancer Panel, and the National Vaccine Advisory Committee to increase vaccination coverage among both males and females. SBM makes the following recommendations in support of efforts to reduce structural and other barriers to HPV vaccination services in order to increase rates of series completion. We encourage legislators and other policymakers to improve administration authority, insurance coverage, and reimbursement rates to healthcare providers who make the HPV vaccine available to adolescents; provide instrumental support to fund the development of school curricula on HPV vaccination; and increase public awareness that HPV vaccination can prevent cancer. We urge healthcare providers and healthcare systems to increase the strength, quality, and consistency of HPV vaccination recommendations for all eligible patients; to treat HPV vaccination as a routine preventive service; employ culturally appropriate communication strategies in clinical settings to educate eligible patients, parents, and guardians about the importance, effectiveness, and safety of HPV vaccination; and to strengthen and better coordinate the use of electronic medical records and immunization information systems.

Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States

BackgroundRoutine administration of all age-appropriate doses of vaccines during the same visit is recommended for children by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP). MethodsEvaluate the potentially achievable vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) with simultaneous administration of all recommended childhood vaccines. Compare the potentially achievable vaccination coverage to the reported vaccination coverage for calendar years 2001 through 2013; by state in the United States and by selected socio-demographic factors in 2013. The potentially achievable vaccination coverage was defined as the coverage possible for the recommended 4+DTaP, 4+PCV, and Hib-FS if missed opportunities for simultaneous administration of all age-appropriate doses of vaccines for children had been eliminated. ResultsCompared to the reported vaccination coverage, the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS could have increased significantly (P<0.001), the vaccination coverage would have achieved the 90% target of Healthy People 2020 for the three vaccines beginning in 2005, 2008, and 2011 respectively. In 2013, the potentially achievable vaccination coverage increased significantly across all selected socio-demographic factors, potentially achievable vaccination coverage would have reached the 90% target for more than 51% of the states in the United States. ConclusionsThe findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for achieving the vaccination coverage target of Healthy People 2020. Encouraging providers to deliver all recommended vaccines that are due at each visit by implementing client reminder and recall systems might decrease missed opportunities for simultaneous administration of childhood vaccines.

Overcoming Barriers to Low HPV Vaccine Uptake in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015.

Overcoming Barriers to Low HPV Vaccine Uptake in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015.

A Call for Greater Consideration for the Role of Vaccines in National Strategies to Combat Antibiotic-Resistant Bacteria: Recommendations from the National Vaccine Advisory Committee

A Call for Greater Consideration for the Role of Vaccines in National Strategies to Combat Antibiotic-Resistant Bacteria: Recommendations from the National Vaccine Advisory Committee

Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015 [corrected

Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015 [corrected

Pharmacist-administered immunizations: What does your state allow?

As trusted and highly accessible health care providers, pharmacists are well positioned to increase the public's access to immunizations. The use of pharmacists to administer immunizations has evolved rapidly over the past 2 decades. In 1995, only nine states allowed pharmacists to immunize. Today, pharmacists have authority to administer immunizations in all 50 states, the District of Columbia, and Puerto Rico.1,2 Although the extent of pharmacists' authority varies by state, great progress has been made in modernizing states' scope of practice laws and regulations to allow pharmacists to increase immunization rates across the lifespan, while working in coordination and collaboration with the rest of the immunization neighborhood.

NVAC Statement of Support Regarding Efforts to Better Implement IIS-to-IIS Data Exchange Across Jurisdictions: Approved by the National Vaccine Advisory Committee on February 10, 2015.

NVAC Statement of Support Regarding Efforts to Better Implement IIS-to-IIS Data Exchange Across Jurisdictions: Approved by the National Vaccine Advisory Committee on February 10, 2015.

NVAC: New standard, schedule updates for adult immunizations

Abstract Now that the revised Standards for Adult Immunization Practice from the National Vaccine Advisory Committee (NVAC) are in place for all vaccine providers, what does this mean for pharmacists?

The National Vaccine Advisory Committee: reducing patient and provider barriers to maternal immunizations: approved by the National Vaccine Advisory Committee on June 11, 2014.

The National Vaccine Advisory Committee: reducing patient and provider barriers to maternal immunizations: approved by the National Vaccine Advisory Committee on June 11, 2014.