Barriers to Implementing a Pharmacist-Run Immunization Service, as Perceived by community Pharmacists in a Middle Eastern Country: A cross sectional web-based survey

Abstract

Background: Several barriers to instigating a pharmacist-run immunization program existed. This survey aims to identify the barriers perceived by Lebanese community pharmacists (CPs) to implementing such a program and the association of these barriers with their willingness to provide immunization services.Methods:A cross-sectional study using an online survey was conducted over the period of time extending between the 1st of November and the end of December 2020 among Lebanese community pharmacists. The questionnaire included information on their socio-demographic characteristics, willingness to vaccinate and the perceived barriers to the run of immunization service. Statistical analyses were performed using SPSS version 24.0. Two logistic regression were conducted, one to identify factors associated with pharmacists high perception of barriers and another one to determine the predictors of the pharmacist’s willingness to vaccinate.Results:Out of the 412 surveyed community pharmacists, 67.48% of them were willing to expand their practice scope to include immunization. The main perceived barriers were the conflict with other professionals, liability, and reimbursements concerns, time for professional development and lack of knowledge of adverse events after immunization. Our results showed that females were more likely to perceive barriers than males (aOR=2.460, 95% CI (1.876:6.909)). However, pharmacists reporting previous experience in immunization (aOR=0.250, 95% CI (0.170:0.586)), working in urban area (aOR=0.451, 95% CI (0.199:0.926)) and having extensive working hours (aOR=0.244, 95% CI (0.05:1.2)) were less likely to perceive barriers. Female pharmacists were less willing to vaccinate (aOR=0.211, 95% CI (0.116:0.383)). However, having less than 40 years old (aOR=2.518, 95% CI (1.236:5.130)), having large experience ((aOR=1.78, 95% CI (1.087 to 2.993)) or previous experience in immunization (aOR=1.702, 95% CI (1.092 to 3.141)), being pharmacy owner (aOR=1.504, 95% CI (1.098:2.103)) and working more than 24 hours per week (aOR=2.622, 95% CI (1.447:4.752) were positively associated to the willingness to vaccinate. Pharmacists who perceived reimbursement (aOR=0.449 with 95% CI (0.264-0.765)), lack of pharmacy space (aOR=0.410 with 95% CI (0.158-1.060)), sharp safety (aOR=0.298 with 95% CI (0.146-0.609)) and insufficient staff (aOR=0.388 with 95% CI (0.190-0.794)) as barriers were less likely to implement pharmacy-run immunization.Conclusion:Addressing the identified barriers driving pharmacist’s lower willingness to vaccinate would be required to fully harness the potential of pharmacists as vaccinators.

Emerging Roles of Community Pharmacist in Public Health: A Review on ASIA

“…67.48% of the 412 community pharmacists surveyed stated that they would be willing to widen their scope of practice to include vaccines. Conflicts with other professionals, concerns about liability and reimbursements, a lack of time for professional growth, and a lack of knowledge regarding adverse reactions to immunizations were the most often mentioned obstacles [37].…”

“…Be it global, national, state, regional, and institutional, the pharmacists have a responsibility to promote public health [66]. In this article review, several interventions have highlighted the emerging roles of community pharmacists on public health especially on smoking cessation [7][8][9][10][11][12][13][14], weight management [15][16][17][18]68], COVID-19 [58][59][60][61], chronic disease management [19][20][21][22][23][24][25]62], drug misuse prevention and management [26][27][28][29][30][31], and immunization and vaccination [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46].…”

“…On the aspect of community pharmacy-delivered immunization, screening and vaccination services, most believe that community pharmacists carry a variety of public health tasks [36] of which vaccination and immunization should take part. Worries of other professionals facilitating this role include worries about liability and reimbursements, lack of time for professional development, and ignorance of adverse reactions to vaccinations as main hurdles [37]. Thus, the need of this intervention has been collectedly been emphasized on to boost immunization rates, strengthen vaccination programs as it is relatively more accessible for community pharmacist who has sufficient knowledge of and may easily distribute necessary medicines and aides [33,[44][45].…”