1. 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

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

3. 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

4. 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)

5. 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

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

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

8. Methods (continued)
Identified all patients with a pharmacy fill for an influenza vaccination from 8/1/ /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

9. 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

10. 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

11. Flu Shot Recipients and Pneumonia Risk
34%
66%

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

13. 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

14. 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

15. 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

16. 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

17. References
1. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 1997;46(RR-8): Advisory Committee on Immunization Practices provisional recommendations for use of pneumococcal vaccines. Centers for Disease Control and Prevention Web site Accessed March 13, 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): Vaccines and immunizations. Centers for Disease Control and Prevention Web site. Accessed March 13, Nuorti, P. New ACIP recommendations for use of pneumococcal polysaccharide vaccine in adults. Centers for Disease Control and Prevention Web site. Accessed March 13, Behavioral Risk Factor Surveillance System Survey Data. Centers for Disease Control and Prevention Web site. Accessed March 13, National Health Interview Survey. Centers for Disease Control and Prevention Web site. Accessed March 13, 2011.