Closing adult vaccination gaps through a pharmacist-directed transitions of care service in a safety-net hospital.

BACKGROUND

Adult vaccination gaps remain common, especially among populations with health and socioeconomic disparities. Although pharmacist-led vaccination initiatives have been studied in community settings, less is known about incorporating vaccine assessment and intervention in inpatient settings. This study evaluated the impact of a pharmacist-led inpatient vaccination initiative nested within a transitions of care (PharmTOC) consult service.

OBJECTIVES

The primary objective was to assess the impact of an inpatient pharmacist-directed immunization initiative. Secondary objectives were to identify barriers to vaccination, including social determinants of health (SDoH) and reasons for vaccine hesitancy to determine predictors of vaccine noncompliance.

METHODS

This study included adult patients referred to the PharmTOC service. A vaccine review was incorporated into the service workflow to identify patients indicated for influenza, pneumococcal, and COVID-19 vaccinations. SDoH were collected on all patients and non-up-to-date patients were interviewed to obtain information on vaccine hesitancy. Interventions were made to providers of patients with vaccination gaps. Descriptive statistics were used to characterize the sample. Multivariable logistic regression identified variables associated with vaccination status.

RESULTS

A total of 147 patients were evaluated, of whom only 17.0% were up-to-date on eligible vaccinations. Among 118 patients offered vaccination, 79 (66.9%) accepted at least one recommended vaccine, including 68 (57.6%) who accepted all recommendations. Of those who assented, 46 (58.2%) patients received at least one vaccine during hospitalization. Lack of confidence in vaccines was the most common reason for vaccine noncompliance. Pharmacist education was associated with modest reductions in documented vaccine hesitancy. Male gender and younger age were independently associated with vaccine noncompliance.

CONCLUSIONS

Most patients had at least one identified vaccination gap. Approximately two-thirds of eligible patients accepted at least one recommended vaccine and over half of these patients were vaccinated before discharge. Incorporating vaccination screening into a pharmacist-directed service may help address preventative care needs.