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Integrating Pharmacies into a Public Health Approach to Vaccination

David Blythe, MD, MPH, Maryland Department of Health and Mental HygieneDr. Joshua Sharfstein
Laura Herrera, MD, MPH, Maryland Department of Health and Mental Hygiene
Joshua M. Sharfstein, MD, Secretary, Maryland Department of Health and Mental Hygiene

Pharmacists providing vaccinations can be an important way to reduce barriers and increase access to vaccinations.  For nearly 10 years, Maryland pharmacists have had the authority to administer some vaccinations; in particular, influenza vaccinations and pneumococcal and shingles vaccinations to adults. In response to the 2009 H1N1 pandemic, the authority was expanded so that Maryland pharmacists could administer influenza vaccination to anyone 9 years old and older.

This option has substantially expanded access to vaccination.  Our overall influenza vaccination coverage rates are increasing, and, per national data from the Centers for Disease Control and Prevention (CDC), around one in five of all vaccinated adults in the United States now get their vaccination at a pharmacy.  Pharmacies are the most common place to get influenza vaccination outside of doctors’ offices and other medical facilities.

At the same time, it is critical for information to be accessible in multiple medical settings, and for primary care clinicians to have information about the vaccination status of their patients.

Recognizing the important role that pharmacists can play in providing vaccines safely and conveniently, and mindful of adolescent and adult vaccination rates below the Healthy People 2020 goals, in 2013, the Maryland legislature passed and Governor Martin O’Malley signed legislation expanded the ability of pharmacists to vaccinate.  The measure allows pharmacists that have been trained and certified to vaccinate to administer all CDC recommended vaccinations to adolescents with a prescription and to adults without a prescription but in accordance with a protocol.  It also requires pharmacists to notify an individual’s primary care provider of the vaccination.

In 2009, there were about 500 Maryland pharmacists trained and certified to provide vaccinations.  Today, there are over 3,000 pharmacists from all across the state trained and certified to provide vaccinations.  We expect that number to increase even more throughout the coming years, as the new law went into effect this October.

Recognizing the importance of primary care, one other feature of the new Maryland law is that pharmacists administering vaccinations are required to notify primary clinicians and report those vaccinations to ImmuNet, the Maryland immunization registry.  ImmuNet has the capacity to receive those records directly electronically from pharmacy information systems.  Currently, four large pharmacy chains representing 379 sites throughout the state - and thousands of immunizations annually—are reporting directly electronically from their existing pharmacy information systems into ImmuNet.

Primary care clinicians can then obtain information directly from pharmacies as well as through the registry.

This reporting should ultimately lead to better coordination of care and vaccination services, fewer duplicate vaccinations, and better provision of recommended vaccines.