VitalSignsNB: Expanding the Immunization Role of New Brunswick’s Pharmacists
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Introduction
VitalSignsNB is the health-based research stream in the Pathways to Professions (P2P) experiential learning program at the New Brunswick Institute for Research, Data and Training (NB-IRDT). P2P brings together students from different educational backgrounds to work on NB-relevant research projects in a multitude of fields. Over 13 weeks, students participate in a variety of training and mentoring sessions on research and employment skills, in addition to engaging in their assigned research topics.
Our team, led by Dr. Chris Folkins, consists of three undergraduate students and one graduate student at the University of New Brunswick, all pursuing degrees in health-related fields. Throughout our time with P2P, we investigated how the expansion of publicly funded vaccinations administered by pharmacy professionals would impact healthcare costs, health outcomes, and access to care in New Brunswick.
Legislation permits pharmacists and, as of 2021, registered pharmacy technicians to administer a wide range of immunizations to the public. Many vaccines in NB are publicly funded when administered by a physician or nurse practitioner; however, most of these vaccines are not free to patients through pharmacy professionals (only influenza and COVID-19 vaccines are publicly funded at pharmacies). This creates a scenario in which patients wishing to take advantage of the accessibility offered at pharmacies must pay for vaccines out-of-pocket – even when they are available through a physician at no cost. NB is missing the opportunity to take advantage of pharmacy professionals’ full scope of practice and is forming a barrier to accessible health services, particularly for residents with no primary care provider.
This summer, we used administrative data from the NB Physician Billing database at NB-IRDT to forecast pharmacy-administered vaccine counts and costs for two additional vaccines into the year 2023. The pneumococcal polysaccharide (Pneu23) vaccine, protecting against pneumonia, and tetanus-diphtheria/tetanus-diphtheria-acellular pertussis (Td/Tdap) boosters, protecting against tetanus, diphtheria, and whooping cough, were selected for analysis owing to the ease of assessment for vaccine eligibility in a community pharmacy setting and large size of the eligible populations.
Relevant literature states that introducing pharmacy professionals as immunizers increases vaccination rates by 12.3%, meaning NB would be spending an additional $68,500 dollars on vaccine acquisition and service fees. However, it is expected that when pharmacies take on 61.1% of immunizations, this leads to cost savings associated with increased physician time saved, in addition to the savings associated with a greater proportion of the population protected against serious illness. We investigated cost savings among increased patients rostered by physicians, reduced pneumonia hospitalizations, productivity losses avoided due to time taken off work to be vaccinated, and time taken off work due to illness. Combining these results led to an annual provincial healthcare saving of over $1.5 million dollars as a result of 2,114 physician hours saved, which translates to a potential 2,676 new patients rostered, 1.56 avoided pneumonia hospitalizations, and over 11,000 working hours saved.
Taking advantage of pharmacy professionals’ broad scope of practice by expanding the number of publicly funded immunizations available in NB’s pharmacies can better meet the needs of the healthcare system and benefit residents of the province directly. Thanks to the accessibility of NB’s 233 community pharmacies, the expansion of publicly funded vaccinations could lead to higher immunization rates, especially among rural regions of the province with lower vaccine uptake and less access to primary care. Future students in the P2P program will have the opportunity to continue this work by exploring additional opportunities for cost savings and improved health care in NB that may be realized through increased investment in pharmacy services.