The College of Pharmacy at UTHSC is changing the dialogue pharmacists have with patients who are at a high risk for pneumococcal disease. Through a grant from Merck & Co., principal investigator Justin Gatwood, PhD, MPH, and co-investigators Kenneth Hohmeier, PharmD, Tracy Hagemann, PharmD, Chelsea Renfro, PharmD, and Chi-Yang Chiu, PhD, a statistician from the College of Medicine, have implemented an innovative model for training pharmacy students and practicing community pharmacists to use proven communication techniques to overcome vaccine hesitancy.
Pharmacists have made a large impact on reducing vaccine-preventable diseases. However, not all patients are willing to be vaccinated, even with a pharmacist’s recommendation. These vaccine “hesitant” patients represent a major obstacle to public health, and traditional communication techniques based primarily in educating the patient may be insufficient. Rather, more directed communication styles that aim to influence behavior change may be necessary. “When it comes to convincing or influencing patients, our students are not as comfortable in this area and we have seen this even among practicing pharmacists,” Dr. Gatwood said. “So we want to approach the training both in our students and in those out in practice, because we estimate that even those who are out in practice are still burdened by not having great strengths in influencing people to change their health behavior, especially in the area of disease prevention, such as with vaccination.”
Currently, student pharmacists are required to complete the APhA’s Pharmacy-Based Immunization Delivery certificate program which requires pre-course work, a pre-session assessment, participation in an eight-hour live seminar, and the successful administration of two intramuscular injections and one subcutaneous injection. Students are also required in their curriculum to administer 10 immunizations per year during their second and third year of pharmacy school.
Although students are trained in administering immunizations, there is not as much instruction on how to influence and encourage patients in vaccination initiation and completion. The overarching theme for the project, which began in the winter of 2018, will be in improving the pharmacist’s assertiveness to have effective conversations with their patients so that they are better able to communicate the benefits of recommended vaccinations, with the end goal of the patient receiving the vaccine. The Merck & Co. project will be focused on the pneumococcal two-shot vaccine series.
In recent years, there has been a dramatic shift in the services patients receive from their community pharmacists. Laws have modernized so that community pharmacies can administer immunizations, while also expanding the type of immunizations offered and who could receive them.
“We are seeing a clear trend toward patients receiving more vaccinations at community pharmacies than at their physician office,” Dr. Gatwood said. “It’s much easier to access your community pharmacist and they are just as available to give a vaccination as your physician, but you may not necessarily see your physician that often. We see more and more medication use and patients seeing pharmacists more often. It just makes more sense for patients to receive their vaccinations there, than it does to make a special trip to their physician office.”
Statistics show more than 90 percent of Americans live within two miles of a pharmacy. Because of this accessibility, patients are interacting with their community pharmacist more often. Numbers show time and time again that pharmacists can have a big influence in improving health care outcomes.
The training program will have two phases. It will not only focus on student communication assertiveness, but will partner with local Walgreens in the Memphis area to train practicing pharmacists using the same techniques to develop better communication workflow with patients. The first phase will entail at home self-study through a structured curriculum for improving communication skills and vaccination knowledge.
“We are designing the training program to be condition agnostic so that it can be applied across different vaccinations,” Dr. Gatwood said. “The focus really is trying to improve the assertiveness of the recommendation that our pharmacists are giving and that can be done for any number of vaccinations.”
The second phase will be training in the new $39.7 million Center for Healthcare Improvement and Patient Simulation (CHIPS), where pharmacists and student pharmacists can practice improvisation techniques and communication skills with standardized patients. Their interactions will be observed and debriefs will be held to discuss how they handled patient objections and hesitancy to receiving the recommended vaccinations.
“We hope this will demonstrate the value of the CHIPS center in trying to improve the interpersonal skills of pharmacists,” Dr. Gatwood said. “We think it’s a valuable asset we have in CHIPS, and this will be a first demonstration on how we can use simulation to improve specific skills sets in both student pharmacists and practicing pharmacists. We hope this will demonstrate value, and from that, we can expand the concept to include other vaccinations and really focus UTHSC as a leader in building the communication skills surrounding vaccination across the country, and we can include this concept in future training that all pharmacists will go through.”
At the conclusion of both training phases, there will be a six-month follow-up period looking at how students and pharmacists felt applying the training techniques in real-world practice and assessing data on the differences in pneumococcal vaccination rates before and after the program.
“Vaccination is a leading opportunity for pharmacists to impact public health,” Dr. Gatwood said. “With the availability of consumer misinformation about vaccinations and mistrust in the industry, we want to equip pharmacists to better address that poor information and help people understand the true benefit behind receiving recommended vaccinations, so it leads to reduced rate of disease and better quality of life.”
Note: This story is from the most recent issue of Pharmacy Magazine.