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

项目总结 新冠肺炎疫情对农村社区造成了不成比例的影响，这些社区通常是健康的 缺乏卫生保健基础设施的专业人员短缺地区，包括医院1-3。与之相比 城市人口中，生活在农村地区的个人对疫苗更犹豫8，9，有更高的流行率 并存的健康状况增加了他们患严重新冠肺炎并发症的风险12，而且处于更大的风险 来自SARS-CoV-2变种，因为接种率较低，要求接种的疫苗较少33，40。因此， 迫切需要采取干预措施，提高农村地区的疫苗接种率。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 药剂师在解决服务不足的农村人口对疫苗的犹豫不决方面处于有利地位。 由于疫苗接种的对话是敏感的，而且往往带有政治色彩，药剂师需要 实施支助，包括提供循证疫苗的培训和持续指导 犹豫不决心理咨询干预18。实施促进，由训练有素的促进员指导和 在专业人员实施新实践时与他们一起解决问题，增加实践的采用率 保真度为23-26。然而，一般的实施促进和虚拟促进(例如，视频指导) 特别是，在社区药房环境中还没有得到系统的研究。有必要研究 虚拟促进作为增加疫苗迟疑咨询和新冠肺炎的有效手段 鉴于前往农村地区的路程很远，而且社会距离遥远，接种疫苗非常重要。 我们的目标是测试虚拟便利化是否增加了农村药剂师实施新冠肺炎疫苗的能力 犹豫不决咨询与“标准”实施方法相比(例如，培训和 传播执行支助工具)。使用基于农村药房实践的研究网络 (PBRN)跨越东南部5个州，我们提出了两个目标。目标1涉及一项阶梯式楔形试验，共有30人 乡村药房测试虚拟便利化在增加以下方面是否优于标准方法： 药剂师实施疫苗犹豫不决咨询干预的忠诚度和(B) 同意接种疫苗的犹豫不决的患者。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，包括保真度和有效性。在目标2中，我们将进行 一项成本评估，以探索虚拟促进的可持续性。我们处于独特的地位，可以测试这些 相互竞争的实施方法，并利用农村社区药剂师从事疫苗接种 在接种率低的农村社区进行犹豫不决的咨询。

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.