Enhancing Adult Immunization In Minnesota Pharmacy Settings National Immunization Conference Presenter: Annie Fedorowicz, MPH September 29, 2014

Immunization in Pharmacies Practice of Pharmacy Act (Minn. Stat. §151, subd. 27, Article 5) • Pharmacists allowed to administer vaccines under: – Vaccine protocols (MN version of standing orders) – Patient-specific orders (prescriptions)

• Vaccine type & age designations: – Seasonal influenza vaccine to individuals 10 & up ‒ All recommended vaccines to adults 18 & up

In 2014: • 1,274 licensed pharmacies • 564 pharmacies in MIIC • 5 MnVFC pharmacies

2014 Practice of Pharmacy Act Changes Worked in collaboration with the MN Board of Pharmacy & pharmacy partners to amend the Practice of Pharmacy Act by: • Expanding the definition of who can sign vaccine protocols for pharmacists • Providing guidance on the criteria to include in vaccine protocols • Clarifying that pharmacists should complete an immunization training course that aligns with best practice standards

• Assuring that submitting immunizations to the Minnesota Immunization Information Connection (MIIC) is an acceptable method to fulfill reporting requirements

• Ensuring pharmacists comply with the Advisory Committee on Immunization Practices (ACIP) immunization best practice standards

MN Prevention & Public Health Funds (PPHF) Project Goals • Enhance adult immunization in: – Pharmacy settings – Workplace settings – Community health centers – Health care facilities (hospitals & nursing homes)

• Long-term outcome: – MN sees higher adult immunization coverage rates

Needs Assessment Summary Issues Identified • Pharmacists are: – Busy – Hard to reach

• Educational needs: – Vaccine administration – Storage & handling of vaccines

– MIIC utilization  MN’s Immunization Information System (IIS)

Pharmacists were unfamiliar or had not heard of MIIC

Pharmacy Advisory Group Purpose: Advise the MDH Immunization Program on how to better collaborate with pharmacists to provide immunization best practices resources. • Members represented key pharmacy stakeholder groups: – Board of Pharmacy – Pharmacist professional associations

– Community-based pharmacists – Health system pharmacists – University of MN College of Pharmacy – MDH Office of Emergency Preparedness – MN Retailers Association (represented chain & drugstore pharmacies)

Project Goals 1. Support proposed pharmacy legislation changes 2. Create pharmacy-specific educational resources to promote immunization best practices 3. Increase utilization of MIIC

4. Understand billing & reimbursement barriers

Web page & Factsheet

Available at: http://www.health.state.mn.us/divs/idepc/immunize/registry/pharmacies.html

MIIC & Pharmacies MIIC can make it easy for pharmacies to ensure patients are up-to-date on their immunizations & that patient immunization records are complete & accurate.

• Pharmacists can use MIIC to: ‒ Submit immunizations given ‒ View immunization histories ‒ Recommend appropriate vaccines based on the patient’s age & immunization history  Forecaster (clinical decision support) tool

‒ Print an official copy of a patient’s immunization history

Pharmacies using MIIC Organizations in MIIC, July 2003- July 2014 1000 Primary Care Clinic

Number of Active Organizations

900 School/School-Based Clinic

800 700

Childcare, Headstart, Preschool

600 Pharmacy

500 400

Nursing Home, Long Term Care, Home Care

300

Specialty Provider

200 100

Hospital

0 2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

MIIC in Pharmacy Settings Film • Purpose: – Communicate that MIIC is an easy tool that can be used in current pharmacy practice to better coordinate patient immunization care

• Target audience: – Pharmacists

The Film & the Adult Standards • Film promotes the Standards for Adult Immunization Practice: – MIIC can be used to assess patients’ immunization needs  Can be incorporated into existing pharmacy practice  Assessment using MIIC is key to sharing a strong recommendation & administering vaccines or referring patients to other immunizing providers

‒ Pharmacies encouraged to document immunizations administered in MIIC

Creating the film Partnerships developed through the Pharmacy Advisory Group were key! • Conducted key informant interviews with community & health system pharmacists

• Developed a script – Used scripted scenarios to derive themes & develop interview questions

• Hired a film director • Recruited volunteer actors & found filming locations at no cost • Developed a film promotion plan

Film Viewing

Film Promotion Plan • Plan to make the film available: – MDH YouTube channel  Embedded in MIIC & Pharmacies Web page  Cross-linked to Immunization Delivery in Pharmacy Settings Web page

– Integrate into pharmacy trainings provided by MIIC Regional Coordinators – Promote to pharmacy partners that provide MIIC training to students & pharmacists

Lessons Learned • Establish an advisory group to guide your work – Low cost – Leverage members’ networks in planning, developing & disseminating useful resources

• Communicate how the IIS can enhance pharmacy immunization practice – Easily fits into existing pharmacy practice – Easy tool to use  Does not disrupt workflow

– Submitting immunizations given to MIIC fulfills MN reporting requirements – Using MIIC to make appropriate immunization recommendations creates a trusted relationship between pharmacists & patients

Acknowledgements • MDH Leadership – Kris Ehresmann

• CDC – Sam Graitcer

– Margo Roddy

• Film Director

– Denise Dunn

– Scott Jenson

• MDH Film Project Team

• Pharmacy Partners

– Andrea Ahneman

– Kathryn Schultz

– Angie Discher

– Michelle Johnson

– Annie Fedorowicz

– Ann Philbrick

– Chris Van Bergen

– Pharmacy Advisory Group members

– Lisa Harris

Questions or Comments? • Presenter contact information: – Annie Fedorowicz, MPH Adult Immunization Outreach Specialist Email: [email protected] Office phone: 651-201-3525