The Role of the Pharmacist in Pneumococcal Vaccination

Transcription

1 The Role of the Pharmacist in Pneumococcal Vaccination The Role of the Pharmacist in Pneumococcal Vaccination Miranda Wilhelm, PharmD Clinical Associate Professor Department of Pharmacy Practice Southern Illinois University Edwardsville School of Pharmacy Edwardsville, Illinois Faculty and Staff Disclosures Miranda Wilhelm, PharmD, has the following relevant financial relationships with commercial interests to disclose: Speakers Bureau Merck Vaccines Pharmacy Times Continuing Education Planning Staff: Dave Heckard; Maryjo Dixon, RPh; Dipti Desai, PharmD, RPh; Jyoti Arya, PharmD, RPh; Donna Fausak; and Susan Pordon have no financial relationships with commercial interests to disclose. An anonymous peer reviewer has been used as part of content validation and conflict resolution. The peer reviewer has no relevant financial relationships with commercial interests to disclose. The content of this symposium may include information regarding the use of products that may be inconsistent with, or outside the approved labeling for, these products in the United States. Pharmacists should note that the use of these products outside current approved labeling is considered experimental and are advised to consult the prescribing information for these products. This activity is funded by an educational grant from Merck Sharp & Dohme Corp. Learning Objectives At the completion of this activity, participants will be able to: Examine the incidence and negative impact of pneumococcal disease, particularly on high-risk group patients Explain the composition, indications, dosage, administration, and potential adverse effects associated with available pneumococcal disease vaccines Explore various methods that pharmacists can implement to increase vaccination rates for pneumococcal disease, especially among high-risk groups Annual Burden of Pneumococcal Disease 900,000 Cases Pneumonia 12,000 Cases Bacteremia 3000 Cases Meningitis Pneumococcal Disease Fast Facts. CDC website. Accessed 8/9/17. Pneumococcal Disease Call to Action: A Task Force Report. National Foundation for Infectious Diseases website. resources/pneumococcalcta/older.pdf. Accessed 8/8/17. 1

2 Annual Burden of Pneumococcal Disease Annual Burden of Pneumococcal Disease Pneumococcal Infection Overall Mortality Rate Mortality Rate Age 65 Years Pneumonia 5% to 7% 10.6% Bacteremia (sepsis) 20% 60% Meningitis 30% 80% Disease Invasive Pneumococcal Disease, All Ages 15,635 14,665 14,595 14,714 10,962 10,641 MMWR Tables. CDC Wonder Website. Available at: Accessed 8/9/17. Pneumococcal Disease Surveillance and Reporting. CDC website. Accessed 9/1/17. Pneumococcal Disease Surveillance and Reporting. CDC website. Accessed 9/1/17. Economic Burden of Pneumococcal Disease Direct medical costs totaled $3.5 billion Adults 65 years and older costs totaled $1.8 billion Pneumococcal Disease Surveillance and Reporting. Accessed 9/1/17. Huang SS, et al. Vaccine. 2011;29(18): Pneumococcal Disease Call to Action: A Task Force Report. National Foundation for Infectious Diseases website. 2

3 Vaccination Rates Category Percent years, High Risk (HR), total years, HR, Caucasian years, HR, African American years, HR, Hispanic years, HR, Asian years, total years, Caucasian years, African American years, Hispanic years, Asian 49.0 Goal for People 2020 = 60% Goal for People 2020 = 90% Percent Vaccination Pneumococcal Vaccination Rates in US Adults 65 Years Caucasian African American Hispanic Asian People 2020 Goal National Average MMWR. May 5, 2017 / 66(11);1 28. Immunization and Infectious Diseases. People website. and infectious diseases/objectives. Accessed 8/9/17. MMWR. May 5, 2017 / 66(11);1 28. Immunization and Infectious Diseases. People website. and infectious diseases/objectives. Accessed 8/9/17. CDC Schedule for Adults (19 Years +) CDC Schedule for Adults (19 Years +) Based on Medical Condition Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, CDC website. combined schedule.pdf. Accessed 8/9/17. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, CDC website. combined schedule.pdf. Accessed 8/9/17. Use of PCV13 and PPSV23 in High-Risk Adults Years Cerebrospinal fluid leaks Cochlear implants Functional or anatomic asplenia Immunocompromised Congenital or acquired immunodeficiency HIV Chronic renal failure Nephrotic syndrome Leukemia Lymphoma Hodgkin disease Generalized malignancy Iatrogenic immunosuppression Solid organ transplant Multiple myeloma Use of PCV13 and PPSV23 in Patients 65 Years Pneumococcal Vaccination Recommendations for Children and Adults by Age and/or Risk Factor. Immunization Action Coalition website. Item #P2019 (11/15). Accessed 8/8/17. Pneumococcal Disease: Hard to say it; easy to get vaccinated. National Foundation for Infectious Diseases website. resources/pneumo/adult pneumo guide hcp.pdf. Accessed 9/1/17. MMWR. September 4, 2015; 64(34):

4 0.5 ml dose IM (deltoid) PCV13 Pneumococcal Vaccines PPSV ml dose IM (deltoid) or SC Barriers to Pneumococcal Vaccination Lack of attention to pneumococcal prevention among health care professionals Competing priorities during patient visits Lack of public awareness about pneumococcal disease and available prevention Complicated schedule ADEs injection site reactions (pain, redness, tenderness, muscle pain), fatigue, headache ADEs injection site reactions (pain, soreness, tenderness, redness), headache Pneumovax 23 [package insert]. Whitehouse Station, NJ: Merck & Co., Inc; 5/2015; Prevnar 13 [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; Role of the Pharmacist Role of the Pharmacist Increase education and awareness about vaccine-preventable diseases Educate patients that pneumococcal pneumonia Display education materials (eg, posters, brochures) in patient waiting area Provide education through pharmacy website, newsletters, on-hold/voic scripts Use a strong recommendation, As your pharmacist, I recommend you receive this vaccine today Offer vaccination to African American and Hispanic patients Offer vaccination to patients being/recently discharged from the hospital Offer vaccination to patients receiving influenza vaccine Offer vaccination to all patients turning 65 years Offer to provide pneumococcal education programs to local support and/or senior groups Identify high-risk patients DOB Medication profile Medical conditions Insurance coverage Social history Immunization Screening Questionnaire System solutions Implement standing orders Review state s Immunization Information System (IIS or immunization registry) Pharmacists Can Do It! Conclusion Pharmacists as Providers: Targeting Pneumococcal Vaccinations to High-Risk Populations Combined PPSV vaccination with influenza 1.3 million at-risk patients vaccinated for influenza by a pharmacist 65,598 also received PPSV Vaccination rate of 4.88% (stat sig vs standard care vaccination rate of 2.90%) Patients years had the highest vaccination rate at 6.60% Pneumococcal disease includes pneumonia, bacteremia (sepsis), and meningitis Invasive pneumococcal disease (sepsis and meningitis) has a high mortality rate Ethnic disparities exist with pneumococcal vaccination rates Pharmacists can impact vaccination rates by identifying high-risk patients for vaccine-preventable diseases Taitel M, et al. Vaccine. 2011;19;29(45): doi: /j.vaccine

5 Additional Resources Immunization Action Coalition Advisory Committee on Immunization Practices (ACIP) National Foundation for Infectious Diseases Pneumococcal Vaccination Resources National Foundation for Infectious Diseases Pneumococcal Task Force Report 5