Improving Immunization Information System Implementation in Community Pharmacies

项目摘要 强有力的医疗保健提供者的建议是患者接受的最有影响力的因素。 预防针然而，随着接种疫苗的供应商数量的增加， 国家免疫信息系统（IIS）中的免疫记录支离破碎，这是一个严重的问题， 供应商和国家层面。在这两点上，通过IIS提供的完整免疫记录是必要的。 临床护理，以确定适当的疫苗接种，病人可能需要，并确保个人不 疫苗接种过量或不足，以及人口水平，以监测疫苗接种率和促进疫情爆发 应对措施和召回。为了有效地使用免疫信息系统， 疫苗1）使用IIS评估免疫状态，2）报告每次接种疫苗的时间， 病人在IIS以前的研究表明，当使用IIS时，疫苗接种率显着增加， 免疫服务提供者。缺乏药房参与IIS已被确定为一个严重的问题， 全国只有35%的药剂师将接种疫苗的信息输入IIS， 在接种疫苗之前检查IIS。这对常规疫苗接种很重要， 在大流行应对工作中，包括分发COVID-19疫苗以及 在大流行期间无法进行管理。根据确定的决定因素制定多方面战略 需要将IIS纳入药房工作流程，包括评估免疫状态， 需要的疫苗，并记录接种的疫苗。这项研究的目的是使用一个 执行情况摸底框架，以确定决定因素和完善战略，以改善信息系统 在社区药房环境中实施，然后将使用 执行成果。这将有助于实现长期目标，改善国际信息系统的使用， 在农村社区药房的免疫状况和推荐的疫苗，从而提高 疫苗接种覆盖率、应对努力以及安全有效地提供免疫接种。的 具体目标是：1）确定社区药房特定的决定因素，以整合IIS报告 2）定制IIS知情药房免疫流程 采用以人为本的设计方法的实施策略，以及3）评估选定的 在社区药房设置的实施策略。拟议的研究将使用解释性的 序贯混合方法研究设计，以确定和完善特定药店的实施 加强国际投资系统一体化的战略。这项研究的结果将作为一个大的阶梯的基础， 在南卡罗来纳州农村和其他东南部州的药房中进行的楔形群随机试验， 评估多个相关结果，如忠诚度，有效性（免疫接种），可持续性， 和执行费用。

PROJECT SUMMARY Strong health care provider recommendations are the single most influential factor in patient acceptance of vaccination. However, as the number of providers administering vaccines increases, there is a concern of fragmented immunization records in state Immunization Information Systems (IISs), a serious issue at both the provider and state levels. Complete immunization records provided through IISs are necessary at both the point of clinical care, to determine appropriate vaccinations the patient may need and ensure that individuals are not over or under-vaccinated, as well as the population level, to monitor vaccination rates and facilitate outbreak response efforts and recalls. To effectively use IISs, it is critical that each immunization provider administering vaccines 1) assesses immunization status using the IIS and 2) reports each time a vaccine is administered to a patient in the IIS. Previous research has shown significant increases in vaccination rates when IIS is used by immunization providers. Lack of pharmacy participation in IISs has been identified as a serious concern, with only 35% of pharmacists nationwide entering administered vaccination information into an IIS, and even fewer checking the IIS before administering a vaccine. This is important for routine vaccinations and becomes critical in pandemic response efforts, including distribution of COVID-19 vaccines as well as catch up vaccinations that were unable to be administered during the pandemic. Multi-faceted strategies mapped to identified determinants are needed to incorporate IIS into pharmacy workflow including assessing immunization status, recommending needed vaccines, and documenting administered vaccines. The objective of this study is to use an Implementation Mapping framework to identify determinants of and refine strategies to improve IIS implementation in the community pharmacy setting, which will then be evaluated using the Taxonomy of Implementation Outcomes. This will help to achieve the long-term goal, to improve the use of IISs to assess immunization status and recommend vaccines in the rural community pharmacy setting, thereby improving vaccination coverage, response efforts, and making the provision of immunizations safe and efficient. The specific aims are to 1) identify community pharmacy specific determinants to integration of IIS reporting and assessment into pharmacy workflow, 2) tailor IIS Informed Pharmacy Immunization Process implementation strategies using a human-centered design approach, and 3) evaluate selected implementation strategies in a community pharmacy setting. The proposed study will use an explanatory sequential mixed-methods research design to identify and refine pharmacy-specific implementation strategies to improve integration of IISs. Results from this study will serve as the foundation for a large stepped wedge cluster randomized trial among pharmacies in rural South Carolina and other southeastern states, assessing multiple relevant outcomes such as fidelity, effectiveness (immunizations administered), sustainability, and implementation costs.