Pro-Active Pharmacy-Based Vaccination Study: A Multi-State Intervention

描述(申请人提供)：肺炎和流感是美国第六大死因。65岁以下高危人群的肺炎球菌免疫接种率极低，一般估计不到20%。在传统疫苗管理人员中调查了用于增加疫苗接种覆盖率的各种类型的干预措施。到目前为止，几乎没有人注意到以药房为基础的疫苗接种服务的潜在影响。这项研究的主要目标是设计、实施和评估一种能显著增加肺炎球菌疫苗接种覆盖率的主动疫苗接种服务，即：简单实施、提供者和客户可接受、适用于不同的药房实践环境、可持续和可持续。按照社区预防服务工作队的建议，采用多因素干预措施，以优化疫苗接种覆盖面。这是一项针对阿拉巴马州、田纳西州和威斯康星州相匹配的干预县的社区药店及其患者的多组分干预的准实验设计。干预措施包括以系统、提供者和患者/社区为导向的战略，以增加肺炎球菌疫苗接种覆盖率。需要检验的四个关键结果是干预效果(假设1)、干预过程(假设2)、参与率(假设3)和制度化(假设4)。将使用电话调查形式在药房一级收集数据，并使用基于网络的调查形式在工作人员一级收集数据。将使用重复措施来评估干预前、干预期间和干预后对疫苗接种服务的看法。这项拟议的研究将做出几项贡献。首先，它将调查社区药房环境中以前没有做过的干预效果。其次，它解决了干预研究中的几个知识空白，包括干预保真度、参与和非参与地点之间的差异，以及最后是干预期后以药房为基础的疫苗接种服务的可持续性。更多地了解影响这些关键结果的因素将有助于政策制定者和医疗从业者计划促进这一重要实践的传播。

DESCRIPTION (provided by applicant): Pneumonia and influenza are the sixth leading cause of death in the United States. The pneumococcal immunization rate for adults with high risk conditions who are under 65 years of age is extremely low, generally estimated to be less than 20%. Various types of interventions used to increase vaccination coverage have been investigated among traditional vaccine administrators. So far, little attention has been given to the potential impact of pharmacy-based vaccination services. The primary goal of this study is to design, implement, and evaluate a pro-active vaccination service that significantly increases pneumococcal vaccination coverage and that is: simple to implement, acceptable to providers and clients, applicable to diverse pharmacy practice environments, sustainable and sustained. A multi-component intervention, as recommended by the Task Force on Community Preventive Services, is used in order to optimize vaccination coverage. A quasi-experimental design of a multi-component intervention that targets community pharmacies and their patients in matched intervention and control counties in Alabama; Tennessee, and Wisconsin. The intervention includes system-, provider- and patient/community-oriented strategies for increasing Pneumococcal vaccination coverage. Four key outcomes to be examined are the intervention effects (Hypothesis 1), intervention process (Hypothesis 2),.rates of participation (Hypothesis 3), and institutionalization (Hypothesis 4). Data will be gathered both at the pharmacy-level, using a telephone- survey format and at the staff-level, using a web-based survey format. Repeat measures will be used to assess the perceptions of vaccination services before, during, and after the interventions. This proposed study will make several contributions. First, it will investigate the intervention effects in community pharmacy settings that previously have not been done. Second, it addresses several knowledge gaps in intervention studies including intervention fidelity, the differences between participating and nonparticipating sites, and lastly the sustainability of pharmacy-based vaccination services beyond the intervention period. Increased understanding of factors influencing these key outcomes will help policy-makers and healthcare practitioners plan to facilitate the diffusion of this important practice.