RESUMO
BACKGROUND: Administration of the recombinant zoster vaccine (RZV) in an ambulatory clinic visit is not covered by Medicare, and the pharmacy at Tufts Medical Center (TMC) had not previously offered immunizations, leaving clinicians to instruct their patients to receive RZV at outside pharmacies without close follow-up. OBJECTIVE: Improve immunization access by standardizing administration of RZV for eligible patients at TMC. PRACTICE DESCRIPTION: TMC is an academic medical center that serves a vast patient population. The adult primary care clinic offers services for approximately 40,000 patients. Atrium 3 Pharmacy is a 340B hospital-based outpatient pharmacy located in TMC. PRACTICE INNOVATION: Patient referrals for RZV administration were sent from the adult primary care clinic to a designated certified pharmacy technician (CPhT) working within the outpatient pharmacy. The CPhT contacted patients for cost disclosure and scheduling vaccination appointments. EVALUATION METHODS: After the CPhT processed the referrals and scheduled the patient, they were then immunized at the herpes zoster clinic by a pharmacist and asked to complete a survey to assess their experience. RESULTS: Over a 3-month pilot period from January 1, 2022, to March 15, 2022, there were 151 patient referrals placed from the adult primary care clinic. A total of 50 patients received their first RZV dose and 10 patients received their second RZV dose for an overall total of 60 RZV doses. Survey results showed that 96% of patients answered that their overall satisfaction improved, with 57% of patients selecting that they strongly agree and 39% of patients selecting that they agree. CONCLUSION: An outpatient pharmacy-based herpes zoster vaccine immunization program was successfully established. Most patients found the expansion of services in the outpatient pharmacy satisfactory.
RESUMO
The efficacy of pre-exposure prophylaxis (PrEP) to prevent HIV has been firmly established; however, the success of PrEP largely depends on access to care as well as high levels of medication adherence. One of the key areas of focus for the National HIV/AIDS Strategy for 2020 in the United States calls for full access to comprehensive PrEP services where appropriate and desired, with support for medication adherence. Despite advances and advocacy for PrEP since approval for adults in 2012, large rates of prescribing disparity exist among gender and race/ethnicity. In 2016, only 3.7% of all PrEP users were women and only 11.2% were black. As one of the most widely accessible health care resources, pharmacists are well positioned to improve patient understanding, promote medication adherence, provide key risk reduction counseling, and enhance PrEP efficacy. Pharmacists' knowledge and accessibility in nearly every urban and rural community can be leveraged as part of a comprehensive HIV prevention strategy to expand access to care and improve population health. As trusted health care professionals, pharmacists develop a strong rapport with patients and may be the key to address current disparities in PrEP prescribing patterns as well as serve as an essential liaison between patients and other members of the multi-disciplinary care team. The purpose of this review is to summarize available data on pharmacist involvement in various models of care providing PrEP services and to identify opportunities to maximize and expand the role of the pharmacist to improve access to PrEP.
