The Expanding Role of Community Pharmacists in Identification of At-Risk Patients and Provision of Pneumococcal Vaccinations Ed Cohen, PharmD Immunization Clinical Services March 30, 2011

Background Patients at risk for pneumonia1,2 Ages 65 and older Ages 64 and under with select chronic conditions: Asthma Diabetes Heart disease

Background (continued) Invasive pneumococcal disease3-5 $3.7 billion: annual direct medical costs $1.8 billion: annual indirect costs Incidence: 40/100,000 for those at-risk Mortality rate: 1 in 20

Background (continued) Immunization rates remain low6,7 68%: age 65 and older 18%: all high-risk adults Pharmacists can play a significant role Identify patients at-risk Provide pneumococcal vaccinations (PPVs)

Walgreens Immunization Program Over 26,000 certified immunizers Nearly 8,000 points of care Influenza vaccines available all day Pharmacists identify and counsel patients at-risk for pneumonia

Objective Evaluate the impact of Walgreens pharmacists identifying and counseling at-risk patients on the importance of PPV

Methods Retrospective analysis assessing number of PPVs administered to at-risk patients receiving influenza vaccinations 2010-2011 flu shot season Data from all Walgreens pharmacies in the U.S.

Methods (continued) Identified all patients with a pharmacy fill for an influenza vaccination from 8/1/2010-11/14/2010 Limited to patients with two or more prescription fills between 11/15/2009 and 11/14/2010 Excluded those patients with PPV prior to their flu shot

Methods (continued) Identified those patients 65 years of age and older with prescription fills for chronic condition Checked for presence or absence of PPV Comparison rate obtained from benchmark medical and pharmacy claims database covering members over a two-year period: ~425,000 members older than 64 years of age ~370,000 members 64 years of age and younger with a chronic condition Benchmark averaged 2008 & 2009 immunization rates from August thru November Benchmark Chronic conditions include: Cardiovascular Disease Chronic pulmonary Disease Diabetes Hematological Disorders Immuno compromised Liver disease

Results Walgreens Benchmark (August – November, 2008 & 2009) 2,095,748 Walgreens patients received influenza immunizations during the study period 1,374,380 were considered at-risk 65,608 (4.77%) received a PPV Benchmark (August – November, 2008 & 2009) 1,204,104 benchmark members were at-risk 34,917 (2.90%) received a PPV

Flu Shot Recipients and Pneumonia Risk 34% 66%

At-Risk Patients Receiving PPV The difference is an increase of 64.5% over benchmark (P < 0.0001)

Conclusion Pharmacists provided a higher rate of PPVs than benchmark Pharmacists are successful at: Identifying at-risk patients Providing additional immunization services Pharmacists are a trusted resource for immunization services

Conclusion (continued) Pharmacists can collaborate with other heath professionals to increase immunization rates Community pharmacists can provide relevant health and wellness recommendations and counseling to at-risk patients

Limitations Results are likely underestimated Pharmacist privilege to administer pneumonia vaccines is limited to select states and ages Pneumonia vaccination is typically a “one-time only” procedure

Acknowledgements Michael Taitel, PhD Director of Health Outcomes and Analytics Cheryl Pegus, MD, MPH Chief Medical Officer Zhongwen Huang, MS Senior Outcomes Analyst Patricia Murphy, MPH Senior Outcomes Analyst

References 1. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 1997;46(RR-8):1-24. 2. Advisory Committee on Immunization Practices provisional recommendations for use of pneumococcal vaccines. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/vaccines/recs/provisional/downloads/pneumo-oct-2008-508.pdf. 2008. Accessed March 13, 2011. 3. Weycker D, Strutton D, Edelsberg J, Sato R, Jackson LA. Clinical and economic burden of pneumococcal disease in older U.S. adults. Vaccine. 2010;28(31):4955-4960. 4. Vaccines and immunizations. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/vaccines/. Accessed March 13, 2011. 5. Nuorti, P. New ACIP recommendations for use of pneumococcal polysaccharide vaccine in adults. Centers for Disease Control and Prevention Web site. www.cdc.gov/vaccines/ed/ciinc/downloads/Mar_09/PPSV_ACIP_Update.ppt. Accessed March 13, 2011. 6. Behavioral Risk Factor Surveillance System Survey Data. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/brfss/. Accessed March 13, 2011. 7. National Health Interview Survey. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/nhis.htm. Accessed March 13, 2011.