Nontraditional Settings Research Articles

An Evaluation of the Positive Action Program for Youth Violence Prevention: From Schools to Summer Camps

New Orleans has experienced some of the highest per capita rates of homicide in the nation. In response, the City of New Orleans developed the NOLA FOR LIFE murder reduction strategy, one aspect of which is the implementation of Positive Action, a character building program for youth. The Positive Action program has offered promising results for curbing youth violence when implemented in school-based settings. However, given the city’s mostly charter-based school system, summer camps are among the few entry points available through which to implement city-wide youth initiatives. During the 2016 summer camp session, an evaluation was conducted to determine whether incorporating the Positive Action curriculum into a 6-week summer camp results in youth experiencing positive changes in peer self-esteem, the ability to get along with others, bullying behavior, and normative beliefs about aggression. This evaluation compares youth that received the Positive Action curriculum during summer camp with those that received the traditional summer camp curriculum. A multi-method approach of quantitative pre-and post-surveys of youth and focus group interviews with camp teachers were employed. Results from the quantitative data suggest few statistically significant findings, while qualitative data suggests that Positive Action may be effective at reducing violent norms and behavior. Implications for social workers and the need for adapting school-based violence reduction interventions for non-traditional settings are discussed.

Barbershops as a Point of Care for Black Men with Hypertension

Uncontrolled hypertension is a major problem in the United States; identifying nontraditional settings in which the problem can be addressed may lead

The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health

BackgroundIntegrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization—or organizational unit—within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study’s aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools—the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation.Methods/designThis study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization’s general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach.DiscussionThe study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.

A Survey of Online and Mobile Technology Use at Peer Support Agencies.

Understanding how individuals with mental illness who receive services at peer support agencies use technology can inform the development of online and mobile health interventions tailored for users in these non-traditional mental health settings. The purpose of this study was to assess the use of technology among individuals with mental illness at peer support agencies. A survey delivered within peer support agencies (PSAs) in one state assessed technology use among individuals ages 18 and over with a self-identified mental illness receiving services at these agencies. In total, 195 individuals from 10 PSAs completed the survey. Eighty-two percent of respondents used the internet, with 63% of respondents connected to the internet at the PSAs. Eighty one percent of respondents owned a cell phone, 70% used text messaging, 58% owned smartphones, 61% used mobile applications, and 72% used social media. PSA users under age 55 were significantly more likely to own a smartphone than PSA users age 55 and older. Among internet users, 71% had searched for health information online and 57% had searched for mental health information online. Many individuals who receive services at PSAs have access to online and mobile technologies. These technologies may be leveraged to expand the reach of evidence-based health and mental health programs to individuals in these non-traditional mental health settings. Future research should explore the feasibility of intervention strategies that involve PSAs as a resource for linking people with mental illness to online and mobile support for their health and wellness goals.

The Development of a Role-Emerging Fieldwork Placement in a Homeless Shelter

The purpose of this project was to develop and evaluate student learning outcomes of a role-emerging fieldwork Level II placement in a local homeless shelter. A role-emerging fieldwork placement denotes any placement in which there is not an identified occupational therapy program or no on-site occupational therapy (OT) supervisor. The project ran from January through June 2017 at a local homeless shelter with 1 Masters of Occupational Therapy (MOT) student from a local university completing their first Level II fieldwork rotation from January through March, followed by 2 MOT students completing their second rotation from April through June. Fieldwork supervision was provided by an off-site fieldwork educator to meet the minimum Accreditation Council for Occupational Therapy Education (ACOTE) standard of 8 hours per week of direct supervision. Student experience was evaluated using the Fieldwork Experience Assessment Tool (FEAT) after the first week of the rotation, at midterm, and during the final week. Students reported decreased stigma towards the population, increased skills in occupational therapy practice, and improved confidence in their clinical decision making. Role-emerging fieldwork placements can provide a productive learning opportunity for selected students to explore the occupational therapy role in non-traditional settings. This paper will describe the creation of the role-emerging fieldwork project, development of student-run occupational therapy programming in a homeless shelter, student feedback regarding progress towards learning objectives, and describe student attitudes towards role-emerging fieldwork placements.

Stakeholders’ Practices and Perspectives on Solid Medical Waste Management: A Community Based Study in Accra, Ghana

Solid medical waste (SMW) is hazardous and requires specific treatment prior to final disposal. Limited information addresses the management of SMW in non-traditional settings such as in households, traditional birth attendants’ (TBAs) homes and chemical seller (CS) shops. A descriptive, exploratory study was conducted to identify major disposal practices and perceived hazards associated with SMW and explore their views regarding segregation as a potential management option. Twenty-nine household members, 10 TBAs and 8 CS who volunteered to participate in the study were involved in 6 focus group discussions (FGDs). Additionally, five key informants in private sector waste management companies were interviewed. FGDs were audio recorded, transcribed and translated, manually coded into themes and sub-themes using an iterative approach, and integrated with data from the interviews. In households, medicines were discarded by dosage forms with solid forms discarded in the household bin, while syrups were mostly emptied into drains. TBAs buried material used for delivery in clients’ compounds and CS tended to burn expired medicines or discard them with general waste. Participants perceived the following as hazards associated with SMW: infection transmission, penetrative injury, poisoning and aesthetic nuisance. Despite this awareness, they reported barriers to source segregation as a potential management option. Barriers included implied consumer costs, lack of supportive logistics and operational knowledge, and possible injury. Reported methods of disposing SMW supported earlier studies and could be potentially hazardous if not addressed. Provision of storage facilities, supportive logistics and public sensitization might encourage source segregation as a potential management option for SMW in the community.

The Future of Research on Alcohol-Related Disparities Across U.S. Racial/Ethnic Groups: A Plan of Attack.

Research suggests striking disparities in alcohol use, problems, and treatment across racial/ethnic groups in the United States. However, research on alcohol-related disparities affecting racial/ethnic minorities remains in its developmental stages. The current article aims to support future research in this growing field by highlighting some of the most important findings, questions, and approaches, focusing on psychosocial research. This article advances seven research needs (i.e., questions and topics meriting attention) that we believe are of crucial importance to the field. We draw on the existing literature to illuminate under-explored areas that are highly relevant to health intervention and that complement the field's existing focus. Identified research needs include research that (a) better describes disparities in alcohol-related health conditions and their drivers, (b) identifies appropriate screening and brief intervention methods for racial/ethnic minorities, (c) investigates disparities in access to and use of alcohol treatment and support services, (d) examines the comparative efficacy of existing alcohol interventions and develops tailored interventions, (e) explores the impacts of specific alcohol policies across and within racial/ethnic groups, and (f) describes the full spectrum of alcohol-related harms and how and why these may vary across racial/ethnic groups. We also call for (g) continuing research to monitor disparities over time. This article points to specific strategies for describing, explaining, intervening on, and monitoring some of the most substantial alcohol-related disparities. Conclusions outline methods and processes that may be advantageous in addressing these priorities, including the use of longitudinal designs; consideration of life course changes; attention to nontraditional intervention settings; and inclusion of disadvantaged populations in all aspects of research.

Interactive Web-Based Tool for Nutritional Microbiology in Applied Agriculture Outreach.

The interconnection of microbiology, biology, and agriculture poses unique challenges for dissemination of basic science research data in an applied format. Further, audiences including the general public, stakeholders, agricultural commodity producers, and students to which information is directed often possess various backgrounds and educational training. In response to technological advances, and the benefits of web-based learning tools to deliver complex information, an integrative approach to deliver microbial content information was developed. Through the constructed web-based interface, an interactive format to highlight the microbe of interest consisted of a main image with strategically placed hotspots to illuminate the location/environment/organ where the microbe can be found. As each hotspot is accessed, an additional image and description of the role and function of the microbe at the location is presented. To encourage regular user access with the learning tool, monthly features were created to focus on various concepts in nutritional microbiology. Monthly themes were selected by the educator to cover a specific microbe, environment, and physiological or nutritional function. Facilitation of educator operation of the interface was achieved through development of an easy-to-use dashboard, allowing for uploading of main, monthly, and hotspot images, along with information on the overview of microbe function and with details contained within the hotspot descriptions. Additionally, an archive feature was created to allow access to information that was previously covered within the learning tool. Application of this web-based interface can span across classroom settings, outreach educational events, adult and youth learning within Extension, student recruitment, and many other non-traditional learning settings to impact production agriculture with research-driven microbiological and biological concepts.

Supervision Of Nursing Students In Rural Environments: Engaging Learning By Teaching The Teachers

 The health profession workforce is challenged by the increased numbers of undergraduate students requiring supervised experiences in environments where service delivery is the primary goal. Given the increased need to recruit and retain suitably qualified and educationally prepared staff into these sometimes under resourced locations, guidance of health profession students, in particular students of nursing, in rural areas of Tasmania is a topical issue. This situation was acknowledged in 2010 when the Commonwealth Government’s Department of Health and Ageing sponsored a local project to increase the number of opportunities for students to undertake professional experience within non-traditional and rural healthcare settings. The project goals included identifying and acknowledging those healthcare professionals who supervised learners; providing guidance, mentorship and resources; and building capability and capacity in environments to host students. On project completion, further Commonwealth funding became available through Health Workforce Australia to continue the project aims. Over six years, an educational process focusing on the needs of rural healthcare professionals related to supervision and support of undergraduate nursing students was established. An evaluative approach enabled the use of Weimer’s personal accounts of change methodology to analyse and critique the application of developed learning and teaching resources. Initially resource development focused on current knowledge, skills and understandings of supervision of learners by health professionals in practice. From the findings, the scope of support broadened to include development and delivery of workshops to enable the supervisors of students to develop a pedagogical understanding of learning and teaching in healthcare settings. Evaluation suggested supervisors require guidance and mentorship related to the ‘how’ of learning and teaching. More specifically they wanted synchronous and asynchronous access to consistent and contemporary learning and teaching information in a timely manner. Given their geographic isolation, this educational support was delivered in a variety of innovative ways, including digital resources, online programs, videoconferencing and face-to-face learning opportunities. This paper outlines the processes and outcomes of developing a collaborative approach to increasing the capability and capacity of health professionals, in particular registered nurses, who choose to supervise undergraduate students during their rural workplace-based professional experience. Â

Development of a template to facilitate reflection among student pharmacists.

Reflective practice activities utilizing appropriate tools enhance learning during and after experiential placements. Reflective tools described in the literature, used to support students on traditional placements of a duration of at least two weeks, sit at the unstructured end of a continuum (completely unstructured to just minimal structure). Additionally, non-traditional settings in role-emerging placements are of value as an alternative for experiential education. There were no reflective tools in the literature to provide a means of supporting pharmacy students as novice reflectors in non-traditional settings. To develop one fit-for-purpose tool that students could utilize across their experiences, regardless of type or duration of experiential placement. A multi-phased approach was adopted, including a mix of methodologies: interviews, focus groups, informal feedback from stakeholders, and grading reflective accounts utilizing Mezirow's categories of reflection. A range of stakeholders were involved at each stage to ensure the reflective tool was fit-for-purpose. These included students, placement preceptors, and academic staff acting as graders of student reflective accounts. A total of 24 students participated in focus groups, 13 supervisors/preceptors engaged in interviews and informal feedback, and 853 student reflective accounts were graded, over 3 years. The final tool that has been developed and evaluated in this research supported students to develop to critical reflectors (6% - Phase 2 increased to 62.9% - Phase 3). This novel and innovative approach supports novice reflectors, encourages reflection on action and enhances professional development. It is a structured yet flexible tool, for which there was a gap in the published literature. It can be utilized in varied placements in pharmacy curricula internationally.

A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital

Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening. We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations. From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients. Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n=855) of eligible patients accepted HBV testing. However, only 55.3% (n=415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96-11.38, p=0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort. Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.

Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress

BackgroundPosttraumatic stress disorder (PTSD) is prevalent among military veterans and is associated with significant negative health outcomes. However, stigma and other barriers to care prevent many veterans from pursuing traditional mental health treatment. We developed a group-based Integrative Exercise (IE) program combining aerobic and resistance exercise, which is familiar to veterans, with mindfulness-based practices suited to veterans with PTSD. This study aimed to evaluate the effects of IE on PTSD symptom severity and quality of life, as well as assess the feasibility and acceptability of IE. MethodsVeterans (N = 47) were randomized to either IE or waitlist control (WL). Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks. ResultsCompared with WL, veterans randomized to IE demonstrated a greater reduction in PTSD symptom severity (d = −.90), a greater improvement in psychological quality of life (d = .53) and a smaller relative improvement in physical quality of life (d = .30) Veterans’ ratings of IE indicated high feasibility and acceptability. LimitationsThe sample was relatively small and recruited from one site. The comparison condition was an inactive control. ConclusionsThis initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.

Towards Proxemic Mobile Collocated Interactions

Research on mobile collocated interactions has been exploring situations where collocated users engage in collaborative activities using their personal mobile devices (e.g., smartphones and tablets), thus going from personal/individual toward shared/multiuser experiences and interactions. The proliferation of ever-smaller computers that can be worn on our wrists (e.g., Apple Watch) and other parts of the body (e.g., Google Glass), have expanded the possibilities and increased the complexity of interaction in what we term “mobile collocated” situations. Research on F-formations (or facing formations) has been conducted in traditional settings (e.g., home, office, parties) where the context and the presence of physical elements (e.g., furniture) can strongly influence the way people socially interact with each other. While we may be aware of how people arrange themselves spatially and interact with each other at a dinner table, in a classroom, or at a waiting room in a hospital, there are other less-structured, dynamic, and larger-scale spaces that present different types of challenges and opportunities for technology to enrich how people experience these (semi-) public spaces. In this article, the authors explore proxemic mobile collocated interactions by looking at F-formations in the wild. They discuss recent efforts to observe how people socially interact in dynamic, unstructured, non-traditional settings. The authors also report the results of exploratory F-formation observations conducted in the wild (i.e., tourist attraction).

OP.3C.03] BLOOD PRESSURE SCREENING RESULTS FROM HEALTHY HEART AFRICA

Objective: Hypertension is highly prevalent in Africa but is characterized by poor awareness, treatment, and control rates. Healthy Heart Africa (HHA) is a comprehensive hypertension intervention program designed to improve hypertension awareness, detection, referral, treatment, and retention in care. Here, we present mass blood pressure (BP) screening results from the HHA program. Design and method: HHA was initiated in March 2015 as a partnership between local organizations, government, and industry. Protocols for identifying and managing hypertension in adults were developed through collaboration with the Kenyan Ministry of Health. Six partners developed and implemented novel approaches to educate, screen, and treat adult Kenyans for hypertension. Healthcare providers at participating facilities received HHA hypertension protocols and screened eligible individuals. Elevated BP was defined as > = 140/90 mmHg. Deidentified screening data were extracted from service delivery registers and summarized descriptively. Results: Over 18 months, 2,014,285 Kenyans were screened at participating facilities. Screenings occurred in health clinics (35%), home (15%), work (11%), church (10%), public meetings (7%), others (19%), and not recorded (3%). More women than men were screened (63% vs 36%; 1% gender not recorded). Urban men were more easily reached by screening along daily, busy walking commutes and through nonclinic sites. Of those screened, 21% had elevated BP; prevalence increased with increased age (Figure). More than 40% of individuals aged > = 60 years had elevated BP. More men than women in younger age groups (16–20 and 21–25 years) had elevated BP. Of those screened, 31% had normal BP (<120/80 mmHg), 48% were prehypertensive (120–139/80–89 mmHg), 14% had stage 1 hypertension (140–159/90–99 mmHg), 5% had stage 2 hypertension (160–179/100–110 mmHg), and 2% had severe BP (> = 180/110 mmHg).Conclusions: While these findings are not from a representative sample, data demonstrate high prevalence of elevated BP indicative of hypertension prevalence among Kenyan adults, illustrating the need for screening in the community. Screening in nontraditional settings may be an effective strategy to reach more men who were more difficult to reach than women. Systematic screening is expected to increase hypertension detection, treatment, and ultimately control rates.

Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform.

With the health care delivery system in transition, the way in which oral health care services are delivered in 2040 will inevitably change. To achieve the aims of reduced cost, improved access, and higher quality and to advance population wellness, oral health care will likely become a more integrated part of medical care. An integrated primary care system would better meet the needs of an increasingly diverse and aging U.S. population with uneven access to health care services. By 2040, trends suggest that a smaller proportion of dental hygienists will work in traditional solo dental offices; many more will practice with multidisciplinary health care teams in large-group dental and medical practices and in a variety of non-traditional community settings. This integration will require changes in how dental hygienists are educated. To shape the skill sets, clinical judgment, and knowledge of future practitioners, current dental hygiene curricula must be reexamined, redirected, and enhanced. This article examines some of the factors that are likely to shape the future of dental hygiene practice, considers the strengths and weaknesses of current curricula, and proposes educational changes to prepare dental hygienists for practice in 2040. This article was written as part of the project "Advancing Dental Education in the 21st Century."

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Strengths and Weaknesses of the Current Dental Hygiene Educational System.

The state of the dental hygiene educational system in the United States is evolving. The numbers of programs, extent of curricula, and diversity of students, faculty, and practice settings vary significantly across the country. New trends in workforce utilization and delivery models are challenging current educational foundations and mandating an interprofessional approach to both the education and practice of dental hygienists. This article presents an overview of the current state of dental hygiene education to create a baseline for discussion of desired educational models for 2040. The strengths and weaknesses are defined to motivate change. Limitations of the current two-year associate degree are emphasized, along with the need to add expanded content and development of new skills. The developing non-traditional practice settings bring both a challenge to dental hygiene education and a promise of increasing potential in primary care interprofessional settings for the 21st century. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Population characteristics associated with pharmacy-based influenza vaccination in United States survey data

ObjectivesTo examine the population characteristics associated with the health behavior of receiving an influenza vaccine from a pharmacy-based setting. DesignSecondary analysis of data from states that participated in an optional influenza module in the 2014 Behavioral Risk Factor Surveillance System, a state-based observational survey of U.S. adults. Setting and participantsAnalytic sample of 28,954 respondents from 8 states and Puerto Rico who reported receiving an influenza vaccination in the past year. Main outcome measuresThe main outcome was a self-reported categoric variable indicating the setting of the most recent seasonal influenza vaccination: doctor’s office, pharmacy-based store, or other setting. ResultsMultinomial logistic regression results showed that environmental, predisposing, enabling, and need factors in the Andersen model were salient features associated with odds of using pharmacy-based influenza vaccination settings instead of a doctor’s office. Residents of states that allowed pharmacists as immunizers before 1999 reported greater use of pharmacy-based store settings (odds ratio [OR] 1.31). Compared with young adults, individuals 65 years of age and older were more likely to choose a pharmacy-based store than a doctor’s office (OR 1.41) and less likely to use other community settings (OR 0.45). Compared with non-Hispanic whites, black respondents were less likely to use pharmacy-based store vaccination (OR 0.51), and multiracial and Hispanic respondents were more likely to use other settings (ORs 1.47 and 1.60, respectively). Enabling and need factors were also associated with setting. ConclusionBased on this dataset of selected states from 2014, almost one-fourth of U.S. adults who reported receiving an annual influenza vaccination did so from a pharmacy-based store; 35% reported using other community-based settings that may enlist pharmacists as immunizers. There were striking disparities in use of nontraditional vaccination settings by age and race or ethnicity. Pharmacists and pharmacies should address missed opportunities for vaccination by targeting outreach efforts based on environmental and predisposing characteristics.

Pharmacists' Attitudes and Perceived Barriers to Human Papillomavirus (HPV) Vaccination Services.

Use of non-traditional settings such as community pharmacies has been suggested to increase human papillomavirus (HPV) vaccination uptake and completion rates. The objectives of this study were to explore HPV vaccination services and strategies employed by pharmacies to increase HPV vaccine uptake, pharmacists’ attitudes towards the HPV vaccine, and pharmacists’ perceived barriers to providing HPV vaccination services in community pharmacies. A pre-piloted mail survey was sent to 350 randomly selected community pharmacies in Alabama in 2014. Measures included types of vaccines administered and marketing/recommendation strategies, pharmacists’ attitudes towards the HPV vaccine, and perceived system and parental barriers. Data analysis largely took the form of descriptive statistics. 154 pharmacists completed the survey (response rate = 44%). The majority believed vaccination is the best protection against cervical cancer (85.3%), HPV is a serious threat to health for girls (78.8%) and boys (55.6%), and children should not wait until they are sexually active to be vaccinated (80.1%). Perceived system barriers included insufficient patient demand (56.5%), insurance plans not covering vaccination cost (54.8%), and vaccine expiration before use (54.1%). Respondents also perceived parents to have inadequate education and understanding about HPV infection (86.6%) and vaccine safety (78.7%). Pharmacists have positive perceptions regarding the HPV vaccine. Barriers related to system factors and perceived parental concerns must be overcome to increase pharmacist involvement in HPV vaccinations.

Impact of Pharmacist Immunization Authority on Seasonal Influenza Immunization Rates Across States

PurposeThe 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. MethodsInfluenza immunization rates across states were compared before and after policy changes permitting pharmacists to administer influenza immunizations. The study used Behavioral Risk Factor Surveillance System (BRFSS) survey data on influenza immunization rates between 2003 and 2013. Logistic regression models were constructed and incorporated adjustments for the complex sample design of the BRFSS to predict the likelihood of a person receiving an influenza immunization based on various patient health, demographic, and access to care factors. FindingsOverall, as states moved to allow pharmacists to administer influenza immunizations, the odds that an adult resident received an influenza immunization rose, with the effect increasing over time. The average percentage of people receiving influenza immunizations in states was 35.1%, rising from 32.2% in 2003 to 40.3% in 2013. The policy changes were associated with a long-term increase of 2.2% to 7.6% in the number of adults aged 25 to 59 years receiving an influenza immunization (largest for those aged 35–39 years) and no significant change for those younger or older. ImplicationsThese findings suggest that pharmacies and other nontraditional settings may offer accessible venues for patients when implementing other public health initiatives.