Improving Immunization Information System Implementation in Community Pharmacies

项目总结 强烈的医疗保健提供者推荐是影响患者接受 接种疫苗。然而，随着管理疫苗的提供者数量的增加，人们对 国家免疫信息系统(IISS)中零散的免疫记录是国家免疫信息系统(IISS)的一个严重问题 提供者和州政府级别。通过IISS提供的完整免疫记录在这两个点都是必要的 临床护理，以确定患者可能需要的适当疫苗接种，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 应对努力和召回。为了有效地使用IISS，至关重要的是每个免疫提供者都要管理 疫苗1)使用IIS评估免疫状态，以及2)每次疫苗接种到 IIS的病人。先前的研究表明，当人们使用IIS时，疫苗接种率显著增加 免疫接种提供者。IISS缺乏药房参与已被认为是一个严重的问题， 全国只有35%的药剂师将接种疫苗的信息输入到IIS中，甚至更少 在接种疫苗前检查IIS。这对常规疫苗接种很重要，也变得至关重要。 在大流行应对工作中，包括分发新冠肺炎疫苗以及补种疫苗 在大流行期间无法进行管理。映射到确定的决定因素的多方面战略 需要将IIS整合到药房工作流程中，包括评估免疫状态、建议 所需疫苗，并记录接种的疫苗。这项研究的目的是使用一种 实施映射框架，以确定决定因素并改进战略以改进IIS 在社区药房环境中的实施，然后将使用 实施成果。这将有助于实现长期目标，改进IISS的使用情况进行评估 在农村社区药房环境中提供免疫状况和推荐疫苗，从而改善 疫苗接种覆盖率、应对努力，以及提供安全有效的免疫接种。这个 具体目标是1)确定社区药房整合IIS报告的特定决定因素 和评估纳入药房工作流程，2)量身定制IIS知情药房免疫流程 使用以人为中心的设计方法的实施策略，以及3)评估选定的 社区药房环境中的实施策略。拟议的研究将使用一种解释性的 顺序混合方法研究设计，以确定和改进药房特定的实施 改善IISS一体化的战略。这项研究的结果将作为一个大的台阶的基础 在南卡罗来纳州农村和其他东南部州的药店中进行的楔形群随机试验， 评估多个相关结果，如保真度、有效性(实施的免疫接种)、可持续性、 和实施成本。

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.