Pub Date : 2019-10-20DOI: 10.1177/1715163519879179
Joseph Fonseca, Jane Pearson Sharpe, S. Houle, N. Waite
Background Improving vaccination coverage remains a global priority for reducing the health burden and social impact linked to at least 29 infectious diseases for which there are effective vaccines. While childhood vaccinations remain essential, an aging population means that the need for life-course vaccination programs that target adults is increasing. Pharmacists are particularly well suited to overcoming many of the challenges associated with vaccinating adult populations, hence the ongoing development of legislation for pharmacists as immunizers (PAIs) in Canada and abroad. This article provides an overview of the current Canadian landscape for pharmacists administering vaccines, highlights similarities and differences in legislation and regulation and discusses both challenges and opportunities for pharmacists who provide vaccination services. PAIs in Canada have expanded since 2007, when BC became the first province to allow pharmacist-administered vaccinations. Since that time, Canada’s decentralized pharmacy regulatory environment—where decision making takes place largely on a provincial/territorial (P/T) level—has resulted in P/T differences in how quickly and to what extent PAI authority has been implemented. The result is a heterogenous PAI landscape across Canadian jurisdictions, with several interacting variables determining which, if any, vaccines a pharmacist can administer, to whom and under what funding model.
{"title":"Time for harmonization: Pharmacists as immunizers across Canadian jurisdictions","authors":"Joseph Fonseca, Jane Pearson Sharpe, S. Houle, N. Waite","doi":"10.1177/1715163519879179","DOIUrl":"https://doi.org/10.1177/1715163519879179","url":null,"abstract":"Background Improving vaccination coverage remains a global priority for reducing the health burden and social impact linked to at least 29 infectious diseases for which there are effective vaccines. While childhood vaccinations remain essential, an aging population means that the need for life-course vaccination programs that target adults is increasing. Pharmacists are particularly well suited to overcoming many of the challenges associated with vaccinating adult populations, hence the ongoing development of legislation for pharmacists as immunizers (PAIs) in Canada and abroad. This article provides an overview of the current Canadian landscape for pharmacists administering vaccines, highlights similarities and differences in legislation and regulation and discusses both challenges and opportunities for pharmacists who provide vaccination services. PAIs in Canada have expanded since 2007, when BC became the first province to allow pharmacist-administered vaccinations. Since that time, Canada’s decentralized pharmacy regulatory environment—where decision making takes place largely on a provincial/territorial (P/T) level—has resulted in P/T differences in how quickly and to what extent PAI authority has been implemented. The result is a heterogenous PAI landscape across Canadian jurisdictions, with several interacting variables determining which, if any, vaccines a pharmacist can administer, to whom and under what funding model.","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"395 - 400"},"PeriodicalIF":1.5,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519879179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41336569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-18DOI: 10.1177/1715163519877897
Carlene Oleksyn
In Canada, the National Advisory Committee on Immunization (NACI) makes recommendations for vaccination. However, vaccines that are publicly funded vary by province and territory, largely based on cost effectiveness and budget capacity, rather than clinical indication and vaccine effectiveness. Using their full scope of practice, pharmacists have a unique opportunity to offer recommended protection against vaccine-preventable diseases to patients.
{"title":"The role of pharmacists in providing recommended vaccines","authors":"Carlene Oleksyn","doi":"10.1177/1715163519877897","DOIUrl":"https://doi.org/10.1177/1715163519877897","url":null,"abstract":"In Canada, the National Advisory Committee on Immunization (NACI) makes recommendations for vaccination. However, vaccines that are publicly funded vary by province and territory, largely based on cost effectiveness and budget capacity, rather than clinical indication and vaccine effectiveness. Using their full scope of practice, pharmacists have a unique opportunity to offer recommended protection against vaccine-preventable diseases to patients.","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"406 - 410"},"PeriodicalIF":1.5,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519877897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43250634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.1177/1715163519877898
Carolyn Whiskin, N. Cutcliffe
1. Adults over 65 years of age 2. High-risk individuals with immunocompromising conditions, including those related to disease (such as cancer, human immunodeficiency virus [HIV] or sickle cell anemia), surgical procedures (such as tissue transplants or splenectomy) and immunosuppressive medications (biologic or nonbiologic therapies) 3. At-risk individuals who are immunocompetent but have 1 or more comorbid medical conditions, such as chronic heart disease, chronic obstructive pulmonary disease (COPD) or other chronic lung disease and diabetes
{"title":"Opportunities for pharmacists in vaccinating higher-risk populations","authors":"Carolyn Whiskin, N. Cutcliffe","doi":"10.1177/1715163519877898","DOIUrl":"https://doi.org/10.1177/1715163519877898","url":null,"abstract":"1. Adults over 65 years of age 2. High-risk individuals with immunocompromising conditions, including those related to disease (such as cancer, human immunodeficiency virus [HIV] or sickle cell anemia), surgical procedures (such as tissue transplants or splenectomy) and immunosuppressive medications (biologic or nonbiologic therapies) 3. At-risk individuals who are immunocompetent but have 1 or more comorbid medical conditions, such as chronic heart disease, chronic obstructive pulmonary disease (COPD) or other chronic lung disease and diabetes","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"418 - 423"},"PeriodicalIF":1.5,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519877898","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43021206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.1177/1715163519878473
J. Isenor, S. Bowles
The Canadian National Advisory Committee on Immunization (NACI) makes recommendations for the use of vaccines. Individual provinces and territories determine which vaccines will be funded and the schedules that are appropriate, based on their resources (e.g., funds, immunization providers, etc.). Routine vaccinations recommended for previously vaccinated adults and those who are unimmunized or underimmunized are found in Table 1. This article will focus on influenza, tetanus, diphtheria, acellular pertussis (Tdap) and tetanus and diphtheria (Td) vaccines for routine vaccination, as well as measles, mumps and rubella (MMR), meningococcal and polio vaccines for adults requiring catch-up, with emphasis on pharmacy-based vaccination. Other articles in this special section on pharmacists as immunizers give information on pneumococcal, human papillomavirus (HPV), varicella and zoster vaccines. Canadian pharmacists are highly accessible health care professionals. Approximately 60% of Ontarians reside within walking distance of a pharmacy and 91% within a 5 km drive, and similar results have been observed in Nova Scotia. This degree of accessibility and the resulting frequency of pharmacy visits (up to 14 times per year) provides pharmacists with multiple opportunities to assess for, recommend and administer routine vaccines for adults. However, there is considerable variation across provinces/territories regarding specific vaccines included within pharmacists’ scope of practice. Over 20 years ago, the American Pharmacists Association developed guidelines for pharmacy-based vaccination advocacy that are directly applicable to Canadian pharmacists today. Pharmacists were encouraged to engage their patients as educators (recommending vaccines), facilitators (hosting other immunizers in a pharmacy/clinic) or as immunizers. Evidence supports pharmacists in each of these roles to improve vaccination coverage among adult patients. Nowadays, vaccination is generally considered a standard of practice for pharmacists. In addition, community-based pharmacists are in an excellent position to determine if their adult patients are up to date on recommended vaccines. Medication reviews offer the opportunity to create an “inferred diagnosis” from current drug therapies, which can then be used to identify the need for education and/or specific vaccine recommendations. This might include influenza vaccine for patients receiving insulin, diabetic supplies or respiratory medications used to treat asthma or chronic obstructive pulmonary disease (COPD). Table 1 NACI-recommended routine vaccinations for previously immunized adults and for adults who are unimmunized or underimmunized
{"title":"Opportunities for pharmacists to recommend and administer routine vaccines","authors":"J. Isenor, S. Bowles","doi":"10.1177/1715163519878473","DOIUrl":"https://doi.org/10.1177/1715163519878473","url":null,"abstract":"The Canadian National Advisory Committee on Immunization (NACI) makes recommendations for the use of vaccines. Individual provinces and territories determine which vaccines will be funded and the schedules that are appropriate, based on their resources (e.g., funds, immunization providers, etc.). Routine vaccinations recommended for previously vaccinated adults and those who are unimmunized or underimmunized are found in Table 1. This article will focus on influenza, tetanus, diphtheria, acellular pertussis (Tdap) and tetanus and diphtheria (Td) vaccines for routine vaccination, as well as measles, mumps and rubella (MMR), meningococcal and polio vaccines for adults requiring catch-up, with emphasis on pharmacy-based vaccination. Other articles in this special section on pharmacists as immunizers give information on pneumococcal, human papillomavirus (HPV), varicella and zoster vaccines. Canadian pharmacists are highly accessible health care professionals. Approximately 60% of Ontarians reside within walking distance of a pharmacy and 91% within a 5 km drive, and similar results have been observed in Nova Scotia. This degree of accessibility and the resulting frequency of pharmacy visits (up to 14 times per year) provides pharmacists with multiple opportunities to assess for, recommend and administer routine vaccines for adults. However, there is considerable variation across provinces/territories regarding specific vaccines included within pharmacists’ scope of practice. Over 20 years ago, the American Pharmacists Association developed guidelines for pharmacy-based vaccination advocacy that are directly applicable to Canadian pharmacists today. Pharmacists were encouraged to engage their patients as educators (recommending vaccines), facilitators (hosting other immunizers in a pharmacy/clinic) or as immunizers. Evidence supports pharmacists in each of these roles to improve vaccination coverage among adult patients. Nowadays, vaccination is generally considered a standard of practice for pharmacists. In addition, community-based pharmacists are in an excellent position to determine if their adult patients are up to date on recommended vaccines. Medication reviews offer the opportunity to create an “inferred diagnosis” from current drug therapies, which can then be used to identify the need for education and/or specific vaccine recommendations. This might include influenza vaccine for patients receiving insulin, diabetic supplies or respiratory medications used to treat asthma or chronic obstructive pulmonary disease (COPD). Table 1 NACI-recommended routine vaccinations for previously immunized adults and for adults who are unimmunized or underimmunized","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"401 - 405"},"PeriodicalIF":1.5,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519878473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46408762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-14DOI: 10.1177/1715163519878659
J. Kung, J. Lipowski, R. Tsuyuki
Over the past few years, we have been discussing the impact of CPJ on pharmacy practice. To recap, we view impact as how the material published in the journal affects practice (i.e., the patient care you deliver). Traditional measures of impact focus on citations (the number of times articles are cited by other authors)—we don’t think this is as relevant as changing your practice, which won’t be reflected by citations. As such, I am pleased to introduce Janice Kung, a health sciences librarian and new member of CPJ’s Editorial Board, and Jessica Lipowski, our publishing editor at SAGE Publications, who will be regularly reporting on the real impact of the journal.
{"title":"The impact of CPJ on practice: An update","authors":"J. Kung, J. Lipowski, R. Tsuyuki","doi":"10.1177/1715163519878659","DOIUrl":"https://doi.org/10.1177/1715163519878659","url":null,"abstract":"Over the past few years, we have been discussing the impact of CPJ on pharmacy practice. To recap, we view impact as how the material published in the journal affects practice (i.e., the patient care you deliver). Traditional measures of impact focus on citations (the number of times articles are cited by other authors)—we don’t think this is as relevant as changing your practice, which won’t be reflected by citations. As such, I am pleased to introduce Janice Kung, a health sciences librarian and new member of CPJ’s Editorial Board, and Jessica Lipowski, our publishing editor at SAGE Publications, who will be regularly reporting on the real impact of the journal.","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"357 - 361"},"PeriodicalIF":1.5,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519878659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46343487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-11DOI: 10.1177/1715163519877906
S. Houle
{"title":"Making it happen: Strategies to incorporate vaccinations into community pharmacy practice","authors":"S. Houle","doi":"10.1177/1715163519877906","DOIUrl":"https://doi.org/10.1177/1715163519877906","url":null,"abstract":"","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"427 - 429"},"PeriodicalIF":1.5,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519877906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43304252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-11DOI: 10.1177/1715163519877896
C. Hughes
Introduction Across Canada, pharmacists are increasingly involved in providing vaccinations. The accessibility of pharmacists provides opportunity to improve adult vaccination rates for influenza and other routinely recommended vaccines. Since pregnant women are an important segment of the population that may require vaccines, pharmacists should be aware of vaccine recommendations as well as contraindications in pregnancy. Physiologic changes that occur during pregnancy, such as alterations in the balance of type 1 and 2 T-helper cells, increase the susceptibility of pregnant women to illness. Vaccination in pregnancy provides protection not only for the woman but also for the fetus and infant in the first few vulnerable months of life (i.e., before infant vaccines can be given) and thus addresses a previous gap in vaccination coverage. However, misperceptions around the safety of vaccines have been shown to influence patient decisions to refuse vaccinations during pregnancy. Other commonly reported patient barriers include not receiving a provider recommendation for the vaccine and pregnant women perceiving they are not at risk for contracting the disease. This article highlights vaccines that are recommended in all pregnant women, as well as vaccines that should be avoided. The significant role and responsibility of pharmacists in proactively promoting maternal vaccination are also underscored (summarized in Box 1).
{"title":"Pharmacists and vaccination in pregnancy","authors":"C. Hughes","doi":"10.1177/1715163519877896","DOIUrl":"https://doi.org/10.1177/1715163519877896","url":null,"abstract":"Introduction Across Canada, pharmacists are increasingly involved in providing vaccinations. The accessibility of pharmacists provides opportunity to improve adult vaccination rates for influenza and other routinely recommended vaccines. Since pregnant women are an important segment of the population that may require vaccines, pharmacists should be aware of vaccine recommendations as well as contraindications in pregnancy. Physiologic changes that occur during pregnancy, such as alterations in the balance of type 1 and 2 T-helper cells, increase the susceptibility of pregnant women to illness. Vaccination in pregnancy provides protection not only for the woman but also for the fetus and infant in the first few vulnerable months of life (i.e., before infant vaccines can be given) and thus addresses a previous gap in vaccination coverage. However, misperceptions around the safety of vaccines have been shown to influence patient decisions to refuse vaccinations during pregnancy. Other commonly reported patient barriers include not receiving a provider recommendation for the vaccine and pregnant women perceiving they are not at risk for contracting the disease. This article highlights vaccines that are recommended in all pregnant women, as well as vaccines that should be avoided. The significant role and responsibility of pharmacists in proactively promoting maternal vaccination are also underscored (summarized in Box 1).","PeriodicalId":46612,"journal":{"name":"Canadian Pharmacists Journal","volume":"152 1","pages":"424 - 426"},"PeriodicalIF":1.5,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1715163519877896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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