Implementing pharmacy-located HPV vaccination: findings from pilot projects in five US states
Implementing pharmacy-located HPV vaccination: findings from pilot projects in five US states
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DOI：
10.1080/21645515.2019.1602433
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发表时间：
2019-05-07
影响因子：
4.8
通讯作者：
Brewer, Noel T.
中科院分区：
文献类型：
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作者：
Calo, William A.;Shah, Parth D.;Brewer, Noel T.
药店是人类乳头瘤病毒（HPV）疫苗接种的有前途的替代场所，因为它们的人口覆盖范围，便利性和现有的疫苗输送基础设施。然而，美国的药店很少用于青少年HPV疫苗接种。我们试图通过将过程评估结果映射到关键的实施科学结构（服务渗透率，可接受性，适当性，可行性，保真度，采用性和可持续性）来记录在美国五个州实施药店HPV疫苗接种服务的挑战和机遇。计划在北卡罗来纳州（k = 2家药房）、密歇根州（k = 10）、爱荷华州（k = 2）、肯塔基州（k = 1）和俄勒冈州（未招募药房）开展试点项目，采用不同的程序和招募策略。研究中心开放入组，共12个月。尽管在这些州做出了大量努力，但只有13剂HPV疫苗接种给青少年，3剂接种给符合年龄条件的年轻人。我们确定了这些业绩不佳的两个主要原因。首先，服务渗透率和适当性方面的不良结果表明存在参与障碍：家长需求低和药房工作人员的参与度低。其次，可行性、采用和可持续性方面的不良结果似乎是由于行政障碍造成的：缺乏第三方报销（即，向商业支付者收费，参与儿童疫苗计划），以及有限地融入初级保健系统。总之，五个州的试点项目都在努力管理HPV疫苗。使药店成为青少年HPV疫苗接种的成功场所的机会包括扩大第三方报销范围，以涵盖药剂师管理的所有疫苗，提高公众对药剂师免疫培训的认识，以及改善与初级保健提供者的护理协调。
Pharmacies are promising alternative settings for human papillomavirus (HPV) vaccination because of their population reach, convenience, and existing infrastructure for vaccine delivery. However, pharmacies in the US are rarely used for adolescent HPV vaccination. We sought to document challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states by mapping process evaluation results onto key implementation science constructs: service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability. Pilot projects were planned in North Carolina (k = 2 pharmacies), Michigan (k = 10), Iowa (k = 2), Kentucky (k = 1), and Oregon (no pharmacy recruited) with varying procedures and recruitment strategies. Sites had open enrollment for a combined 12 months. Despite substantial efforts in these states, only 13 HPV vaccine doses were administered to adolescents and three doses to age-eligible young adults. We identified two major reasons for these underperforming results. First, poor outcomes on service penetration and appropriateness pointed to engagement barriers: low parent demand and engagement among pharmacy staff. Second, poor outcomes on feasibility, adoption, and sustainability appeared to result from administrative hurdles: lacking third party reimbursement (i.e., billing commercial payers, participation in Vaccines for Children program) and limited integration into primary care systems. In summary, pilot projects in five states all struggled to administer HPV vaccines. Opportunities for making pharmacies a successful setting for adolescent HPV vaccination include expanding third party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists' immunization training, and improving care coordination with primary care providers.