(262) Implementation of a Comprehensive Pharmacy-Driven Immunization Program in a Pediatric Cystic Fibrosis Clinic

Background: Routine immunization of people with cystic fibrosis (PwCF) is recommended by the Cystic Fibrosis Foundation (CFF) care guidelines as well as international care guidelines[1-5]. The adult care guidelines recommend that immunizations be provided to PwCF regardless of age or gender as part of routine health maintenance[1]. Integrated pharmacy CF team members have many roles and responsibilities[6]. However, managing a comprehensive pharmacy-driven immunization program in CF clinic setting is novel. In October 2021, the Primary Children's CF Center implemented a comprehensive pharmacy-driven immunization program to provide all immunizations to PwCF in the states serviced by the center. The purpose of this study is to show how the implementation of a comprehensive pharmacy-driven immunization program can have an impact on immunization rates in PwCF.

Methods: This study was IRB-approved by Intermountain Healthcare. The primary outcome measure was the percentage of PwCF who received the pneumococcal polysaccharide 23-valent (PPSV23) and human papillomavirus (HPV) immunizations pre/post the implementation of the comprehensive pharmacy-driven immunization program. Secondary outcome measures include the the total number of immunizations provided, and the number of each immunization provided. The statistical test used for the primary outcome measure was Mann-Whitney-U test.

Results: A total of 228 immunizations were provided to PwCF via the pharmacy-driven immunization protocol October 1, 2021 to March 31, 2022 (See table 1). For the primary outcome measure, the baseline immunization rates for PPSV23 and complete HPV immunized were 28% (57/204) and 42% (29/66) respectively. After implementation of the program, 101 additional PwCF (≥2 years) were immunized with PPSV23 thus improving the rate to 77% (158/204), p< 0.00001. 17 additional PwCF (≥11 years) were completely HPV immunized after initiation of program improving the rate to 70% (46/66), p=0.01.

Conclusions: Routine immunizations are recommended for all PwCF. The implementation of a comprehensive pharmacy-driven immunization program is a new role that a CF pharmacy team may provide. After the implementation of the program in October 2021, a significant improvement from baseline in the PPSV23 and complete HPV immunization rates was made, and all immunizations were provided.

Acknowledgements: Kurt Price, RPh, Bowman's
Kellie Collunga, MA
This project received the 2022 Utah Silver Syringe Community Partner Award

References: [1] Yankaskas JR, Marshall BC, Sufian B, et al. Cystic fibrosis adult care: consensus conference report. Chest. 2004; 125:1S-39S.
[2] Borowitz D, Robinson KA, Rosenfeld M, et al. Cystic Fibrosis Foundation evidence-based guidelines for the management of infants with cystic fibrosis. J Pediatr. 2009 December ; 155(6 Suppl): S73–S93.
[3] Lahiri T, Hempstead SE, Brady C, et al. Clinical practice guidelines from the Cystic Fibrosis Foundation for preschoolers with cystic fibrosis. Pediatrics. 2016;137(4):e20151784.
[4] Malfroot A, Adam G, Ciofu O, et al. Immunisation in the current management of cystic fibrosis patients. J Cystic Fibros. 2005; 4:77-87.
[5] Cystic Fibrosis Australia. Cystic Fibrosis Standards of Care, Australia. 2008.
[6] Zobell JT, Moss J, Heuser S, et al. Understanding the expanding role of pharmacy services in outpatient cystic fibrosis care. Pediatr Pulmonol. 2021 Jun;56(6):1378-1385.