1. ©2011 Walgreen Co. All rights reserved. Community Pharmacy Impact on Access to Immunizations for Health Professional Shortage Areas Patricia Murphy, MPH Clinical Outcomes and Analytics March 30, 2011

2. 2 ©2011 Walgreen Co. All rights reserved. Background Influenza infects 5 to 20% of the U.S. population 1 –Over 200,000 hospitalizations 1 –$80 billion economic burden 2 Less than 50% of individuals get vaccinated 3 Barriers to vaccination include: 4,5 –Cost –Patient knowledge –Inadequate access to primary care

3. 3 ©2011 Walgreen Co. All rights reserved. Physician Shortages Millions of Americans affected 6 –All income levels and races –Urban and rural Growing problem 7 –Shortage of more than 100,000 physicians expected

4. 4 ©2011 Walgreen Co. All rights reserved. Health Professional Shortage Areas (HPSAs) 8 Areas with inflated population to provider ratios Designated by federal government Three designation types: –Dental –Mental health –Primary medical care

5. 5 ©2011 Walgreen Co. All rights reserved. HPSAs Primary medical care –General/family practice –General internal medicine –OB/GYN –Pediatrics Uses –Assignment of federal physicians –Medicare incentive payments

6. 6 ©2011 Walgreen Co. All rights reserved. Community Pharmacies Well-positioned across U.S. –Within three miles of nearly every American home 9 Extensive network of immunizers Expanded hours No appointment necessary

7. 7 ©2011 Walgreen Co. All rights reserved. Objective To evaluate the capacity of a national retail pharmacy chain to offer and administer influenza immunizations in HPSAs throughout the U.S.

8. 8 ©2011 Walgreen Co. All rights reserved. Methods Retrospective analysis –Number of pharmacies located in HPSAs –HPSA population served –Number of flu shots administered in HPSAs 2009-2010 flu shot season –September 1, 2009 – February 28, 2010

9. 9 ©2011 Walgreen Co. All rights reserved. Methods (continued) Data from all Walgreens locations* in the 50 United States Prescription fills used to identify influenza vaccination H1N1 was excluded Population and provider data was current as of December 2009 *North Dakota does not have a pharmacy.

10. 10 ©2011 Walgreen Co. All rights reserved. Methods: HPSAs Population to provider ratio calculated for each census tract –Ratio of more than 3,500:1 = HPSA designation Providers: physicians and nurse practitioners within a 30-mile radius of each census block Pharmacy and influenza immunization administration locations were mapped to HPSAs

11. 11 ©2011 Walgreen Co. All rights reserved. Methods: Population Served Determined by retail trade area –Geographic area where approximately 70% of customers reside –Landscape barriers –Urban versus suburban populations –Traffic patterns –Drive time –Market competition

12. 12 ©2011 Walgreen Co. All rights reserved. Pharmacies Can Serve More Than 35 Million Americans Residing in HPSAs Served by Walgreens

13. 13 ©2011 Walgreen Co. All rights reserved.

14. 14 ©2011 Walgreen Co. All rights reserved. State Total Population Percent of Population in HPSA Percent Served by Walgreens Percent of Locations in HPSAs Alabama4,743,54075.049.383.9 Mississippi3,006,43073.054.371.2 Louisiana4,498,96864.846.271.3 States with Greatest Percentage of Population in HPSAs

15. 15 ©2011 Walgreen Co. All rights reserved. Can serve 55% of these underserved individuals Additional States with More than 50 Percent of Population in HPSAs Idaho Alaska South Carolina Missouri New Mexico Florida

16. 16 ©2011 Walgreen Co. All rights reserved. Influenza Vaccinations Administered by Walgreens in HPSAs StateTotal FluTotal HPSA% HPSA Alaska4,610 100 Alabama62,03348,58578.3 Mississippi49,48232,43465.5 Utah27,18117,75365.3 Florida615,790400,51265.0 Louisiana66,58041,87762.9 U.S. Total4,647,3961,702,51036.6

17. 17 ©2011 Walgreen Co. All rights reserved.

18. 18 ©2011 Walgreen Co. All rights reserved. Community Pharmacies Increase Access and Convenience Fill in Gaps and Diminish Barriers Increase Vaccination Rates Improve Health and Wellness The Community Pharmacy: Valuable Source for Vaccinations

19. 19 ©2011 Walgreen Co. All rights reserved. Acknowledgements Devonee Harshburger, MS Senior Manager Healthcare Planning and Research Ed Cohen, PharmD Senior Business Manager Immunization Clinical Services

20. 20 ©2011 Walgreen Co. All rights reserved. Thank You! For more information, please contact: Patricia Murphy, MPH Clinical Outcomes and Analytics Walgreen Co. 1415 Lake Cook Rd MSL444 Deerfield, IL 60015 Patricia.Murphy@Walgreens.com

21. 21 ©2011 Walgreen Co. All rights reserved. References 1.Seasonal influenza (flu). Centers for Disease Control and Prevention Web site. http://www.cdc.gov/flu/about/qa/disease.htm. Accessed March 15, 2011. 2.Molinari NA, Ortega-Sanchez IR, Messonnier ML, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine. 2007;25(27):5086-5096. 3.Centers for Disease Control and Prevention (CDC). Interim results: state-specific seasonal influenza vaccination coverage - United States, August 2009-January 2010. MMWR. 2010;59(16):477-484. 4.A report on reaching underserved ethnic and minority populations to improve adolescent and adult immunization rates. National Foundation for Infectious Diseases Web site. http://www.nfid.org/pdf/publications/adoladultwhitepaper.pdf. 2002. Accessed March 15, 2011. http://www.nfid.org/pdf/publications/adoladultwhitepaper.pdf. 2002. 5.Vlahov D, Coady MH, Ompad DC, Galea S. Strategies for improving influenza immunization rates among hard-to- reach populations. J Urban Health. 2007;84(4):615-631. 6.Primary care access: an essential building block of health reform. National Association of Community Health Centers Web site. www.nachc.com/research-data.cfm. Accessed March 15, 2011.www.nachc.com/research-data.cfm 7.The complexities of physician supply and demand: projections through 2025. Association of American Medical Colleges Center for Workforce Studies Web site. http://www.aamc.org/workforce/. Accessed March 15, 2011.http://www.aamc.org/workforce/ 8.Shortage designation: health professional shortage areas (HPSAs). U.S. Department of Health and Human Services Health Resources and Services Administration Web site. http://bhpr.hrsa.gov/shortage/hpsadesignation.htm. Accessed March 15, 2011.http://bhpr.hrsa.gov/shortage/hpsadesignation.htm 9.Ahlquist GD, Javanmardian M, Ashish Kaura M, Bilokrynytskyy I. The pharmacy solution: an expanding role for pharmacies in healthcare delivery. Booz and Co. Web site. http://www.booz.com/media/uploads/The_Pharmacy_Solution.pdf. 2010. Accessed March 15, 2011. http://www.booz.com/media/uploads/The_Pharmacy_Solution.pdf. 2010.