Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review.

CONTEXT: Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities. OBJECTIVE: The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies. METHODS: We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion. RESULTS: A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them. CONCLUSION: Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.

Community Pharmacists and Influenza Vaccination: Opportunities and Challenges From a Public Health Perspective.

Context: In Quebec, Bill 31, adopted on March 18, 2020, extended vaccination to pharmacists. Despite many advantages, this new practice comes with public health issues reinforced in the context of COVID-19. Therefore, it is essential to understand the opportunities and challenges of the participation of community pharmacists in influenza vaccination, from a public health perspective by (i) describing the year of 2020-2021 influenza vaccination offer, (ii) its opportunities and challenges, and (iii) its impact on the accessibility of this service newly offered by pharmacists to the most vulnerable people. Methods: This research is a case study from one of the most affected areas by COVID-19 in Canada: Laval. Our method combines documentary analysis and semi-structured interviews with health professionals and public health actors (n = 23). Researchers used a thematic analysis to analyze these results. Results: Most partners (pharmacists, public health administrators) underlined multiple opportunities of this new practice, ie, pharmacists who can vaccinate, particularly for chronically ill patients. However, structural and strategical challenges remain. More specifically, vaccination seemed to only rely on a "first come, first served" basis, which questions public health objectives of vaccination, such as equitable access. Conclusion: The introduction of new actors, such as pharmacists, represents a major opportunity to improve vaccination coverage and reduce the burden of COVID-19 on the health system. However, this delegation of a public health activity to the private sector undoubtedly requires closer coordination with public health institutions.

Assessment of community pharmacists' engagement in pharmacy-delivered influenza vaccination: a mixed-methods study.

OBJECTIVES: This study aimed to identify factors contributing to pharmacists' engagement in vaccination services during the first influenza vaccination campaign in 2019-2020 for the Canadian province of Quebec, led by community pharmacists. METHODS: A mixed-methods study was conducted using a sequential exploratory design. Semi-structured interviews were administered to pharmacists and key informants (n = 23) and data were analysed according to the Consolidated Framework for Implementation Research in community pharmacy. The findings were then used to construct a survey of community pharmacists' engagement in vaccination, which was tested in a Quebec urban community. The study participation rate was 34.6% (n = 29). KEY FINDINGS: Pharmacists expressed positive attitudes towards the implementation of vaccination services, following legislative reform. Factors such as previous involvement in vaccination campaigns and the number of pharmacists on duty were positively associated with engagement in influenza vaccination, whereas staff shortages and logistical problems were a barrier to engagement. Qualitative findings provided in-depth understanding of the value of interprofessional collaboration between pharmacists and nurses. CONCLUSIONS: Vaccination in pharmacies is currently more reflective of individual choice than an indication of collective change in the profession. Logistical factors are key to enhancing the uptake of vaccination in community pharmacies throughout Quebec. External support from professional associations and interprofessional collaboration should be enhanced to promote the implementation of vaccination services in pharmacies.

Severe Benzodiazepine Use Disorder in a 16-Year-Old Adolescent: A Rapid and Safe Inpatient Taper.

We describe the case of a 16-year-old boy with a 1-year history of severe benzodiazepine misuse. After being denied access to several treatment programs and hospital centers that felt unprepared to manage benzodiazepine use disorder and withdrawal in an adolescent, the patient was admitted to a tertiary pediatric unit for rapid inpatient tapering and detoxification. The patient was hospitalized for 13 days and received decreasing doses of diazepam under close monitoring of withdrawal symptoms. The taper was well tolerated, and the patient was transferred to a youth residential substance use treatment center, where he completed a successful 2-month placement. This case highlights the lack of adolescent-friendly facilities allowing safe tapering of rapid-acting benzodiazepines in North America. Given high rates of benzodiazepine misuse among youth and the risks associated with benzodiazepine misuse and withdrawal, there is a critical need for more research, provider training, and dedicated resources in this area.