Addressing COVID 19 Vaccine Hesitancy in Rural Community Pharmacies Reducing Disparities Through an Implementation Science Approach

项目摘要 2019冠状病毒病大流行对农村社区造成了严重影响，这些社区通常是健康 缺乏医疗保健基础设施的专业短缺地区，包括医院1 -3。相比 城市人群，生活在农村地区的个人更不愿意接种疫苗8，9， 合并的健康状况增加了他们患严重COVID-19并发症的风险12， SARS-CoV-2变种的疫苗接种率较低，疫苗接种任务较少33，40。因此，在本发明中， 非常需要采取干预措施，增加农村地区的疫苗接种。作为最容易获得的医疗保健 农村地区的专业人员4，5和最值得信赖的药物信息来源之一16，社区 药剂师完全有能力解决服务不足的农村人口对疫苗的犹豫。 由于疫苗接种的谈话是敏感的，往往带有政治色彩，药剂师需要 实施支助，包括提供培训和持续指导，以提供循证疫苗 犹豫咨询干预18.促进执行，由受过培训的促进者指导和 在专业人员实施新实践时与他们一起解决问题，提高实践的采用率 在23 -26之间。然而，一般而言，实施便利化和虚拟便利化（例如，视频辅导）中 特别是，尚未在社区药房环境中进行系统研究。需要审查 虚拟促进作为增加疫苗犹豫咨询和COVID-19的手段的有效性 由于到农村地区的路途遥远，而且社会距离很远，因此接种疫苗非常重要。 我们的目标是测试虚拟促进是否增加了农村药剂师实施COVID-19疫苗的能力 当与“标准”实施方法（例如，培训和 传播执行支助工具）。利用农村药学实践研究网络 （PBRN）跨越5个东南部国家，我们提出了两个目标。Aim 1涉及30例阶梯楔形试验 农村药店，以测试虚拟便利化是否优于标准方法，以增加：（a） 药剂师实施疫苗犹豫咨询干预的忠诚度和（B） 对接种疫苗犹豫不决的患者同意接种疫苗。使用项目赞助的数据收集系统， 我们将收集关于执行结果的数据，包括忠实性和有效性。在目标2中，我们将 进行成本评估，探讨虚拟便利化的可持续性。我们有独特的优势来测试这些 相互竞争的实施方法，并利用农村社区药剂师参与疫苗 在疫苗接种率低的农村社区提供犹豫咨询。

PROJECT SUMMARY The COVID-19 pandemic has disproportionally impacted rural communities, which are often health professional shortage areas that lack health care infrastructure, including hospitals1-3. When compared to urban populations, individuals living in rural areas are more vaccine hesitant8,9, have a higher prevalence of comorbid health conditions that increase their risk for severe COVID-19 complications12, and are at greater risk from SARS-CoV-2 variants due to lower vaccination rates and fewer vaccination mandates33,40. Thus, interventions to increase vaccine uptake in rural areas are greatly needed. As the most accessible healthcare professional in rural areas4,5 and one of the most trusted sources of medication information16, community pharmacists are well-positioned to address vaccine hesitancy with underserved, rural populations. Because vaccination conversations are sensitive and often politically charged, pharmacists need implementation support, including training and ongoing guidance to deliver evidence-based vaccine hesitancy counseling interventions18. Implementation facilitation, in which trained facilitators coach and troubleshoot problems with professionals as they implement new practices, increases adoption of practices with fidelity23-26. However, implementation facilitation generally, and virtual facilitation (e.g., video coaching) in particular, has not been systematically studied in community pharmacy settings. The need to examine the effectiveness of virtual facilitation as a means to increase vaccine hesitancy counseling and COVID-19 vaccination is of great importance given the large travel distances to rural areas and social distancing. Our goal is to test if virtual facilitation increases rural pharmacists’ ability to implement COVID-19 vaccine hesitancy counseling when compared to a “standard” implementation approach (e.g., training and dissemination of implementation support tools). Using a rural pharmacy practice-based research network (PBRN) that spans 5 southeastern states, we propose two aims. Aim 1 involves a stepped-wedge trial with 30 rural pharmacies to test whether virtual facilitation outperforms the standard approach in increasing: (a) the fidelity with which pharmacists implement the vaccine hesitancy counseling intervention and (b) the number of vaccine hesitant patients who agree to receive the vaccine. Using a project-sponsored data collection system, we will gather data on implementation outcomes, including fidelity and effectiveness. In Aim 2, we will conduct a cost assessment to explore the sustainability of virtual facilitation. We are uniquely positioned to test these competing implementation approaches and leverage rural community pharmacists to engage in vaccine hesitancy counseling in rural communities that have low vaccination rates.