1. Jeanine K. Mount1 Salisa Westrick2 Suntaree Watcharadamrongkun1
Community Pharmacy Readiness to Provide In-House Immunization Delivery Service
Jeanine K. Mount1
Salisa Westrick2
Suntaree Watcharadamrongkun1
1-University of Wisconsin-Madison
2-Auburn University
This research was supported by grant R06-CCR from the Centers for Disease Control and Prevention (CDC).

2. Objectives
Describe the level of pharmacy readiness to provide in-house immunization delivery services.
Identify the level of discontinuation of in-house immunization delivery service.
Compare the level of pharmacy readiness among 17 states.

3. Background
Pharmacies and pharmacists are in an excellent position to help increase immunization rates among high risk populations.
Pharmacies may vary in terms of their readiness to provide immunization delivery services.
Little evidence exists on how many pharmacies and pharmacists are involved in immunization delivery services.
Better knowledge of pharmacy readiness may help policymakers design effective strategies to expand pharmacy involvement in this important service.

4. Methods Community pharmacy was the unit of analysis.
Information was gathered from key informants of community pharmacies in 17 states.
The 17 states were selected to maximize the variability in immunization law and geographical locations.
For each state, a random sample of 150 community pharmacies was drawn, resulting in a total sample of 2,558 pharmacies.

5. Methods
A computer-assisted telephone interview (CATI) system was used to gather data.
A pre-notification letter was sent to all potential participants prior to making telephone contact.
Data were collected during July 2005 – February 2006.
A total of 1,707 eligible pharmacies participated; response rate was 69.1%.
Nonresponse bias was investigated: hard-to-contact cases differed from relatively easy to contact cases in terms of their involvement in in-house services.1
1Further details about the study methods can be found in Westrick, SC & Mount, JK (In press).. Effects of repeated callbacks on response rate and nonresponse bias: Results from a 17-state pharmacy survey. Research in Social & Administrative Pharmacy.

6. Stages of readiness to provide in-house immunization services
Precontemplation: Not interested in providing an in-house service
Contemplation: Interested in providing an in-house service but had no clear plan
Planning: Planned to provide an in-house service in the near future
Maintenance: Provided in-house services during the data collection period
Discontinuation: No longer provided an in-house service
Unclear: Respondents were not aware of any plans or refused to answer this question.
Modified from Prochaska, J.O., Redding, C. A., & Evers, K. E., Health behavior and health education: Theory, research, and practice. 2 ed. The transtheoretical model and stages of change., ed. K. Glanz, Lewis, F. M., & Rimer, B. K. 1996, San Francisco: Jossey-Bass.

7. Table1:
Stage of readiness to provide in-house immunization services among 1,707 participating community pharmacies and extrapolation of results to the 17-state pharmacy population
Readiness Stage
Sample (n)
Population (N) %
Precontemplation
646
7725
38.1%
Contemplation
245
3720
18.4%
Planning
211
2235
11.0%
Maintenance
296
2777
13.7%
Discontinuation
157
1572
7.8%
Unclear
152
2231
Total
1707
20260
100%

8. Figure 1: Stage of readiness to provide in-house immunization services in the 17 states

9. Figure 2: Stage of readiness to provide in-house immunization services

10. Results
Of the 1707 pharmacies, 38.1% had no intention to implement immunization services while 18.4% were interested but had no plan.
Only 11.0% had a plan to implement in-house immunization services in the near future.
Results show that 13.7% of participating pharmacies were immunization service providers.
About 7.8% had provided immunization services in the past but no longer provided the services.
Readiness stages varied from one state to another. However, the majority of states were still in the precontemplation and contemplation stages.

11. Discussion
Pharmacy-based in-house immunization services are in an early stage of the diffusion process.
Discontinuation rate was high considering the current diffusion stage.
To increase the level of pharmacy involvement, various strategies should be tailored to fit a specific readiness stage. Examples:
Increase level of interest among those in precontemplation stage.
Help pharmacies in the contemplation stage formulate a concrete plan to offer immunization services.
Address specific questions/concerns of those in planning stage.
Recognize the efforts of pharmacies that currently provide immunization services.
Prevent the abandonment of those in the maintenance stage.

12. Conclusion
Pharmacies were in different stages of readiness to provide immunization delivery services.
Patterns of readiness varied from one state to another.
In most states, the majority of pharmacies have not yet begun in-house immunization services.

13. Figure 3: Stage of readiness to provide in-house immunization services

14. Figure 4: Stage of readiness to provide in-house immunization services

15. Figure 5: Stage of readiness to provide in-house immunization services