1. Is Pharmacy Participation in State Policy Networks Related to Flexibility of Laws Governing Pharmacist Administration of Vaccines? Jeanine Mount, PhD, RPh School of Pharmacy Univ. of Wisconsin-Madison and Salisa Westrick, PhD Harrison School of Pharmacy Auburn University Supported by the U.S. Centers for Disease Control and Prevention

2. Growth in number of states allowing pharmacists to administer vaccines 1.Savino, L. B. (1998, July). Your pharmacy and immunizations. America’s Pharmacist, 120(7), 49-53. 2.States that allow pharmacists to administer immunizations (fact sheet). American Pharmacists Association Web Site. Available at: www.aphanet.org/pharmcare/immunofact.html.www.aphanet.org/pharmcare/immunofact.html 1 2 2 2 2

3. Some things we know – and where we need to know more Basic premise: State-level factors are key to pharmacy-based immunization delivery What we know…What we don’t know… Laws governing pharmacy-based immunization vary widely across the states How these laws vary (or with what effects) Leadership groups in pharmacy – State boards and associations – can have important influences How active State boards and associations are in State vaccine planning/programming arenas Whether variability in laws is systematically related to activity of pharmacy leadership groups

4. Objectives for today 1.Describe content and variability in state laws governing pharmacist administration of vaccines 2.Describe level of participation by (a) State Boards of Pharmacy and (b) State Pharmacy Associations in state-level vaccine planning/programming 3.Discuss relationships involving 1) and 2).

5. Methods  National cross-sectional study  Review of state laws/records during 2004  Key informant interviews Phone interviews with 3 key informants from each state: Board of Pharmacy, State Pharmacy Association and state agency overseeing immunization-related planning/programming Interviews content analyzed Each Board and each Association classified as having "active" or "reactive” orientation  Board orientation, Association orientation and flexibility of pharmacist immunization laws described and their relationships analyzed

6. Mechanisms Authorizing Immunization Delivery Collaborative Practice Agreement or Protocol: “blanket” authorization Prescription order: patient-specific authorization Number of States (%) YesNo Agreement or Protocol (flexible) 32 (80%) 8 (20%) Prescription Order (restrictive) 28 (70%)12 (30%)

7. Scope of Permitted Activities Restricting patients &/or activities lessens flexibility Number of States (%) YesNo Any age restriction 16 (40%)24 (60%) Any vaccine type restriction 6 (15&)34 (85%)

8. Other Requirements Number of States (%) YesNo Training Requirement 24 (60%)16 (40%) Board of Pharmacy Involvement 13 (32.5%)27 (67.5%) States may establish other requirements for vaccine administration by pharmacists, reducing flexibility

9. Variability in State law flexibility

10. Board & Association Activity Levels High Activity Proactive, promoting expansion of pharmacy roles Moderate Activity Regular administrative involvement and “insider” activity Low Activity Reactive, responding to external proposals & initiatives None/No Activity No receptivity reported; deterring change

11. Board of Pharmacy Activity n = 38 States

12. Level of Board Activity and Flexibility of Immunization Law Level of Activity

13. State Association Activity n = 34 States

14. Level of Association Activity and Flexibility of Immunization Law Level of Board Activity

15. Conclusions 1.State policies vary widely in their overall flexibility. 2.Boards of Pharmacy tend to be less activity than State Associations in state-level immunization- related activities. 3.Flexibility of State laws permitting immunization delivery by pharmacists relates more strongly to orientation/activity of the State Association than to that of the Board of Pharmacy. 4.Greater involvement of State pharmacy groups could facilitate crafting of more flexible laws to improve immunization rates.