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

解决农村社区药房对 COVID 19 疫苗的犹豫，通过实施科学方法减少差异

• 批准号: 10708869
• 负责人: GEOFFREY M CURRAN
• 金额: $ 64.68万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708869
• 关键词: Address; Adoption; Agreement; Ally; Automobile Driving; Budgets; COVID-19 complications; COVID-19 impact; COVID-19 pandemic; COVID-19 susceptibility; COVID-19 vaccination; COVID-19 vaccine; Cessation of life; Charge; Communities; Community Pharmacy; Complex; Cost Analysis; Counseling; Country; Data; Data Collection; Dissemination and Implementation; Effectiveness; Effectiveness of Interventions; Evidence based practice; Feedback; Goals; Health; Health Professional; Healthcare; High Prevalence; Hospitals; Hour; Human Papilloma Virus Vaccination; Human Papillomavirus; Individual; Infrastructure; Intervention; Modeling; Monitor; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Politics; Positioning Attribute; Primary Care; Research; Resources; Risk; Rural; Rural Community; Rural Population; SARS-CoV-2 variant; Safety; Sampling; Services; Social Distance; Source; System; Telephone; Testing; Time; Training; Travel; Trust; Update; Urban Population; Vaccination; Vaccines; Walking; comorbidity; cost effective; disparity reduction; effectiveness evaluation; evidence base; flu; health care availability; health professional shortage areas; implementation facilitation; implementation fidelity; implementation outcomes; implementation science; improved; pandemic disease; practice-based research network; primary care provider; primary outcome; rural area; rural counties; rural patients; rural underserved; secondary outcome; severe COVID-19; support tools; vaccine acceptance; vaccine hesitancy; video coaching; virtual

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.

项目摘要 共同-19大流行对农村社区的影响不成比例，这通常是健康 缺乏医疗基础设施的专业短缺地区，包括医院1-3。与 城市人口，居住在农村地区的人更加疫苗犹豫8,9，患病率更高 合并症的健康状况增加了严重COVID-19并发症的风险12，并且风险更大 来自SARS-COV-2的变体，由于疫苗率较低和疫苗较少的规定33,40。那， 非常需要采取干预措施以增加粗糙区域的疫苗摄取。作为最容易获得的医疗保健 在粗糙地区的专业人士4,5和最受信任的药物信息来源之一，社区16 药剂师的位置良好，可以解决疫苗犹豫不决的农村人群。 由于疫苗接种对话很敏感，而且通常在政治上充电，因此药剂师需要 实施支持，包括培训和正在进行的指导以提供循证疫苗 犹豫咨询干预措施18。实施设施，训练有素的促进者教练和 在实施新实践时，对专业人员的问题进行故障排除，增加了实践的采用 与Fidelity23-26。但是，实施设施一般以及虚拟设施（例如，视频教练） 特别是在社区药房环境中尚未系统地研究。需要检查 虚拟设施的有效性作为增加疫苗犹豫咨询和COVID-19的手段 鉴于与崎rough的地区和社会疏远的距离很大，疫苗接种非常重要。 我们的目标是测试虚拟设施是否增加了粗糙的药剂师实施Covid-19疫苗的能力 与“标准”实施方法相比，犹豫咨询（例如，培训和 传播实施支持工具）。使用基于药房实践的粗糙研究网络 （PBRN）跨越了5个东南州，我们提出了两个目标。 AIM 1涉及30个阶梯式审判 粗糙的药房测试虚拟设施是否在增加的标准方法上表现出：（a） 药剂师实施疫苗犹豫咨询干预措施的保真度和（b） 同意接受疫苗的疫苗犹豫患者。使用项目赞助的数据收集系统， 我们将收集有关实施成果的数据，包括忠诚和有效性。在AIM 2中，我们将进行 成本评估以探索虚拟设施的可持续性。我们在测试这些方面是独一无二的 竞争实施方法并利用农村社区药剂师进行疫苗 疫苗率低的农村社区的犹豫咨询。

项目成果

Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial.

• DOI: 10.1186/s13012-023-01327-7
• 发表时间: 2023-12-18
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Curran, Geoffrey;Mosley, Cynthia;Gamble, Abigail;Painter, Jacob;Ounpraseuth, Songthip;Brewer, Noel T.;Teeter, Ben;Smith, Megan;Halladay, Jacquie;Hughes, Tamera;Shepherd, J. Greene;Hastings, Tessa;Simpson, Kit;Carpenter, Delesha
• 通讯作者: Carpenter, Delesha