Visibility of Vaccination and How Do We Improve?

What is Pneumonia? Pneumonia is an infection of the lower respiratory tract or alveoli Pneumonia is the most common infectious cause of death in children and adults. The most common causative agent in adult pneumonia is streptococcus pneumoniae

How Much Does Pneumonia Cost? Mortality rate of 30-40% A study among Medicare patients showed healthcare costs the year after a pneumonia hospitalization to be $15,682 higher than control patients without pneumonia Total annual cost of hospital-treated pneumonia in elderly Medicare patients in 2010 was estimated at > 7 billion dollars Study shows medicare patients because as with most studies medicare patients are an ideal target population because of ease of monitoring and record keeping Mortality rate in the elderly may be as high as 60%

What is the True cost? Time in the hospital Cost of medication (out-of-pocket) Burden on family Quality of life: Travel Freedom Health Family

What is the Pneumonia Vaccine? The bacteria streptococcus pneumoniae accounts for up to 75% of cases of pneumonia in otherwise healthy adults Streptococcus pneumoniae has over 90 different serotypes Pneumovax covers 23 of these serotypes that cause the vast majority of infections Prevnar covers 13 of these serotypes and is designed to stimulate less developed immune systems. Prevnar was approved in 2010, prior to this the equivalent vaccine only covered 7 serotypes Serotype: A serologically distinguishable strain of a microorganism 4 doses of prevnar is part of the childhood immunization schedule

How does it work? The pneumonia vaccine, like other vaccines stimulates the body to develop antibodies to a specific microbe The pneumonia vaccines are targeted against the most common types of the most causative agent of pneumonia, streptococcus pneumoniae Neither Pneumovax nor Prevnar prevent against other causative agents of pneumonia such as viruses or fungi Viruses: RSV, influenza Fungi Gram negative: pseudomonas aeroginosa

Risks of the Pneumococcal Vaccine Fortunately there are few adverse reactions with the pneumococcal vaccination such as: -Injection site pain, soreness, and tenderness (60% of patients) -Injection site swelling / induration (20.3%) -Headache (17.6%) -Injection-site erythema (16.4%) -Ashthenia & fatigue (13.2%) -Myalgia (11.9%)

Confusion Over Pneumonia Vaccines

Language from the CDC: 697 words

The Guidelines Clarified Prevnar 13 is a 4 dose child vaccine and Pneumovax is recommended for adults >= 65

Who else would benefit? Adults ages 19-64 with: Immunocompromising conditions or asplenia (anatomical or functional) Ceberobrospinal fluid leaks or cochlear implants Chronic heart disease Chronic lung disease Chronic liver disease Chronic renal failure Alcoholism Diabetes mellitus Smoke cigarettes Reside in nursing homes or long-term care facilities Immunocompromising conditions that are indications for pneumococcal vaccination are: congenital or acquired immunodeficiency (including B- or T-lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy) Anatomical or functional asplenia that are indications for pneumococcal vaccination are: sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, and splenectomy. Administer pneumococcal vaccines at least 2 weeks before immunosuppressive therapy or an elective splenectomy, and as soon as possible to adults who are newly diagnosed with asymptomatic or symptomatic HIV infection Chronic Heart disease: CHF and cardiomyopathies (exclude HTN) Chronic Lung disease: COPD, emphysema, asthma Chronic liver disease: Includes cirrhosis

Where is the Vaccine Available? Physicians office Clinics Pharmacies!!! “Community pharmacies are uniquely positioned to increase immunization rates in the United States. In a 2009 survey, only 20% to 30% of internists and family physicians stocked all vaccines recommended by the Centers for Disease Control and Prevention (CDC), with nearly 80% not planning to increase their offerings and 2% planning to stop carrying them altogether”

Pharmacies…Lot’s of competition A Google search for where to the pneumococcal vaccine. The top hit (which is an ad) is Walgreens

How Can a Pharmacy Stand Out? Signage Handouts Call lists Vaccination clinics Counseling and talking with patients “Pharmacists who talked with patients about their risk for pneumococcal disease were able to increase vaccination rates in their pharmacy greater than those in traditional care settings” Taitel M, Cohen E, Duncan I, Pegus C. Pharmacists as providers: targeting pneumococcal vaccinations to high risk populations. Vaccine. 2011;29(45):8073-8076

So How Do We Make Vaccination More Visible “Drumming up business” Simply talking with patients has been proven by studies to increase vaccination the most -Talking with regular patients -Talking with patients getting other vaccinations -Having call lists of eligible patients to “cold call” about vaccinations -”Advertising on store receipts” -Having vaccination days with an immunizing pharmacist set up near the front of the store (flu clinic) -Having vaccinations in stocks that other pharmacies might not have

Making Vaccination More Visible Talking with regular patients Talking with patients getting other vaccinations Automatically generated call lists of eligible patients for vaccines “Advertising” vaccinations and the pharmacy on store receipts Vaccination days with an immunizing pharmacist located in the front of the store

Where We Give Vaccinations Chain Drug Stores and Clinics Vs. Our Vaccine Locations Chain drug stores generally have a comfortable waiting area, clinic, or counseling area to give the vaccinations. The martins that I have seen give vaccinations around the pharmacy, on the waiting bench, and if empty possibly in the community rooms. A designated area makes patients feel more comfortable and more likely to observe this as a professional service as they would in their doctors office.

What This Means to Us Healthier patients Happier patients Developing a relationship with patients Developing trust for additional immunizations: -Travel immunizations -Zostavax -Yearly Influenza