30 - Impact of Pharmacist Assertiveness Training in Recommending Pneumococcal Vaccination among High-Risk Adults

Background: Community pharmacies have become vital access points to provide a range of vaccines to adults, including pneumococcal; however, despite growth in vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below goals set by Health People 2020. A lack of patient awareness is a leading reason for low vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults.

Methods: A multi-phase, pharmacy-based intervention was launched in west and middle Tennessee locations of a nationwide community pharmacy chain focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of three arms based on training intensity: 1) no training; 2) online training only; and 3) online and live simulation training. The program focused on providing assertive recommendations and managing potential hesitancy guided by multiple health communication theories and community-based hesitancy data provided to each pharmacy by the study team. Primary endpoints included changes in pneumococcal vaccinations (counts over 6-month periods [July-December] in 2018 and 2019) and provider vaccine-related self-efficacy and were evaluated by generalized linear models.

Results: A total of 100 pharmacies were enrolled and 50 pharmacists completed their assigned training element. Completing the full training program (i.e., online and live) led to improvements in pharmacist self-efficacy related to being influential in vaccine-related decisions and not being helpless in managing resistance (both p< 0.05). Overall counts of all pneumococcal vaccines were lower (-11.3%) across all stores in the period following training; however, a small increase (2.1%, P=0.084) was observed in the stores that underwent the full training, versus decreases of 22.0% and 9.4% in control and online-only training comparisons, respectively.

Conclusion: Results suggest that provider vaccine self-efficacy can be improved through an evidence-based communication training program but substantial improvements in specific vaccinations may need to leverage a more holistic focus on all recommended adult vaccines.