Counseling Your Patients About Vaccines Follow these steps to bUilding an imm unization-advocacy program. by John D. Grabenstein, MS
P
hannacists have a clear but seldom practiced role in encouraging their patients to be adequately immunized. l -4 Vaccines are dnlgs used to prevent infections, rather than to treat them. Vaccines are drugs; therefore it is natural for phannacists to be involved in their rational use. It is doubly important for phannacists to 'be vaccine advocates because disease prevention and health promotion are integral parts of phannaceutical care. 5 This article discusses how a pharmacist can easily take his or her first steps to understand and advocate vaccines, the preventive medicines. First, be on the lookout for the patients most likely to need additional immunizations. As a phannacist, you meet them every day. When YOll talk to patients with heart disease, diabetes, or asthma and other chronic lung diseases, think about whether they are protected against influenza and pneumococcal pneumonia. All persons more than 64 years old also need these two vaccines, even if they are otherwise healthy. Some 30%-40% of preschool children are not adequately immunized against measles, mumps, rubella (MMR); diphtheria, tetanus, pertussis (DTP); or poliovirus.
Counseling Vulnerable Adults ,..... .
Begin by counseling a patient with heart or lung disease or diabetes with whom you have good rap~'.....) port. This might be a patient taking digoxin, warfarin, theophylline, albuterol, insulin, glipizide, or a similar medication. 3 Tell your patient that infectious-disease experts at the u.S. Public Health Service and the Centers for Disease Control (CDC) in Atlanta recommend he or she get pneumococcal vaccine to guard against a disease that causes 40,000 or more deaths each year in the United States. 6 Just one dose of
Aj
AMERICAN PHARMACY
pneumococcal vaccine will fully protect most people at risk. From October through March, also recommend annual influenza vaccination to these same people, to help prevent a disease that causes an additional 10,000 to 40,000 deaths per year.6 These vaccines can be obtained from most public health clinics and from many private physicians. Infonn the patient that both vaccines are very effective (about 70%) and any side effects that might occur are generally mild and short lived. Infonnation about most vaccines appears in standard phannacy reference books. About 50%-75% of patients will take your advice and be vaccinated.3 Even if they don't, the vast majority of these patients appreciate their pharmacist'S concern for keeping them healthy. After building confidence by working with ;;,) J patients you feel comfortable with, continue motivating additional patients more than 64 years old and those with diabetes or heart or lung disease to be immunized against influenza and pneumonia. "' ,J
To make your vaccine-advocacy program more systematic, slip written notices about infection risk and vaccine availability into the bags with appropriate prescriptions. This is especially appropriate during National Adult Immunization Week each October. You can also offer to store their family's immunization records along with their prescription records. Call your local health department to find out -:J,,) J which, when, and where adult and pediatric vaccines are offered in your area and any associated costs. Share this information with your patients via flyers , posters, or newsletters. Also ask how you can be involved in any special vaccine programs they are conducting. -.;,..J
August 1992/ 658
Vol. NS32, No.8
Counseling Parents About Children's Vulnerability
drug officer at Health Care Studies Activity, Fort Sam Houston, Tex.
Grade-school admission requirements result in more than 98% of America's children being properly immunized at age 6. However, 30%-40% of preschoolers aged 2-6 years lack at least one of the vaccines they need to avoid a preventable infection. The problem is even greater among inner-city and minority children and those in families in the lower socioeconomic strata. 7
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the US. Department of the Army or the Department of Defense.
r;
To improve pediatric immunization, start by , '\ encouraging parents to stay up to date with cur.lJ:..) rent immunization recommendations. Post a copy of the current immunization schedules; they can be obtained from your health department or the September 1991 issue of American Pharmacy. 4
-,1
Ask a few parents with whom you already have J good rapport about the immunization status of their children. Show them the recommended schedule and ask if they have had any problems meeting it. If any children's vaccinations are behind schedule, simply advise the parents to make appointments with their pediatricians or health clinic to schedule the needed ones as soon as possible. Have the location, hours, and costs of vaccination at local public health clinics available to use in answering questions.
IJ
Expanding Advocacy Programs With more experience in recommending vaccines to vulnerable patients, a pharmacist can advocate additional vaccinizations: 4,6 • Tetanus-diphtheria (Td) toxoids-needed by all adults at 10-year intervals. • Hepatitis B vaccine-needed by all health care workers exposed to blood products, homosexually active men, intravenous drug users, and other high-risk groups (routine hepatitis B vaccination of all infants has been recommended by an advisory panel to CDC). • MMR vaccine-two doses needed by all persons born since January 1, 1957. • Haemophilus in/luenzae type b (Hib), influenza, meningococcal, and pneumococcal vaccines-needed by patients who do not have a functioning spleen. Immunization recommendations change periodically and pharmacists should be sure to use current guidelines in their advocacy programs. 4 The pharmacy literature, druginformation centers, CDC, and local health departments are good resources for staying up to date and learning even more about this subject. ,. l
:!::) J
References 1. Grabenstein JO. Immunizations and pharmacy leadership. Am J Hosp Pharm. 1990;47:1127-8. 2. Grabenstein JO. Pharmacists and immunizations: advocating preventive medicine. Am Pharm. 1988;28:25-33 . 3. Grabenstein JO, Hayton BO. Pharmacoepidemiologic program for identifying patients in need of vaccination. Am J Hasp Pharm. 1990;47: 1774-81. 4. Grabenstein JO, Casto OT. Recommending vaccines for your patients' individual needs. Am Pharm. 1991;31:666-77. 5. Hepler CO. The future of pharmacy: pharmaceutical care. Am Pharm. 1990;30:583-9. 6. Williams WW, Hickson MA, Kane MA, et al. Immunization policies and vaccine coverage among adults: the risk for missed opportunities. Ann Intern Med. 1988;108:616-25. 7. Hinman AR. What will it take to fully protect all American children with vaccines. Am J Dis Child. 1991;145:559-62.
Gave us our past . . . It can give us our future
Help protect America's soil and water today.
We owe it to our children. Find out what you can do. Call I-800-THE SOIL. United States Department of Agriculture
Soil Conservation Service
Major John D. Grabenstein, MS, US. Army, is investigational Vol. NS32, No. 8 August 1992/659
AMERICANPHARMACY
P
hannacists have a clear but seldom practiced role in encouraging their patients to be adequately immunized. l -4 Vaccines are dnlgs used to prevent infections, rather than to treat them. Vaccines are drugs; therefore it is natural for phannacists to be involved in their rational use. It is doubly important for phannacists to 'be vaccine advocates because disease prevention and health promotion are integral parts of phannaceutical care. 5 This article discusses how a pharmacist can easily take his or her first steps to understand and advocate vaccines, the preventive medicines. First, be on the lookout for the patients most likely to need additional immunizations. As a phannacist, you meet them every day. When YOll talk to patients with heart disease, diabetes, or asthma and other chronic lung diseases, think about whether they are protected against influenza and pneumococcal pneumonia. All persons more than 64 years old also need these two vaccines, even if they are otherwise healthy. Some 30%-40% of preschool children are not adequately immunized against measles, mumps, rubella (MMR); diphtheria, tetanus, pertussis (DTP); or poliovirus.
Counseling Vulnerable Adults ,..... .
Begin by counseling a patient with heart or lung disease or diabetes with whom you have good rap~'.....) port. This might be a patient taking digoxin, warfarin, theophylline, albuterol, insulin, glipizide, or a similar medication. 3 Tell your patient that infectious-disease experts at the u.S. Public Health Service and the Centers for Disease Control (CDC) in Atlanta recommend he or she get pneumococcal vaccine to guard against a disease that causes 40,000 or more deaths each year in the United States. 6 Just one dose of
Aj
AMERICAN PHARMACY
pneumococcal vaccine will fully protect most people at risk. From October through March, also recommend annual influenza vaccination to these same people, to help prevent a disease that causes an additional 10,000 to 40,000 deaths per year.6 These vaccines can be obtained from most public health clinics and from many private physicians. Infonn the patient that both vaccines are very effective (about 70%) and any side effects that might occur are generally mild and short lived. Infonnation about most vaccines appears in standard phannacy reference books. About 50%-75% of patients will take your advice and be vaccinated.3 Even if they don't, the vast majority of these patients appreciate their pharmacist'S concern for keeping them healthy. After building confidence by working with ;;,) J patients you feel comfortable with, continue motivating additional patients more than 64 years old and those with diabetes or heart or lung disease to be immunized against influenza and pneumonia. "' ,J
To make your vaccine-advocacy program more systematic, slip written notices about infection risk and vaccine availability into the bags with appropriate prescriptions. This is especially appropriate during National Adult Immunization Week each October. You can also offer to store their family's immunization records along with their prescription records. Call your local health department to find out -:J,,) J which, when, and where adult and pediatric vaccines are offered in your area and any associated costs. Share this information with your patients via flyers , posters, or newsletters. Also ask how you can be involved in any special vaccine programs they are conducting. -.;,..J
August 1992/ 658
Vol. NS32, No.8
Counseling Parents About Children's Vulnerability
drug officer at Health Care Studies Activity, Fort Sam Houston, Tex.
Grade-school admission requirements result in more than 98% of America's children being properly immunized at age 6. However, 30%-40% of preschoolers aged 2-6 years lack at least one of the vaccines they need to avoid a preventable infection. The problem is even greater among inner-city and minority children and those in families in the lower socioeconomic strata. 7
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the US. Department of the Army or the Department of Defense.
r;
To improve pediatric immunization, start by , '\ encouraging parents to stay up to date with cur.lJ:..) rent immunization recommendations. Post a copy of the current immunization schedules; they can be obtained from your health department or the September 1991 issue of American Pharmacy. 4
-,1
Ask a few parents with whom you already have J good rapport about the immunization status of their children. Show them the recommended schedule and ask if they have had any problems meeting it. If any children's vaccinations are behind schedule, simply advise the parents to make appointments with their pediatricians or health clinic to schedule the needed ones as soon as possible. Have the location, hours, and costs of vaccination at local public health clinics available to use in answering questions.
IJ
Expanding Advocacy Programs With more experience in recommending vaccines to vulnerable patients, a pharmacist can advocate additional vaccinizations: 4,6 • Tetanus-diphtheria (Td) toxoids-needed by all adults at 10-year intervals. • Hepatitis B vaccine-needed by all health care workers exposed to blood products, homosexually active men, intravenous drug users, and other high-risk groups (routine hepatitis B vaccination of all infants has been recommended by an advisory panel to CDC). • MMR vaccine-two doses needed by all persons born since January 1, 1957. • Haemophilus in/luenzae type b (Hib), influenza, meningococcal, and pneumococcal vaccines-needed by patients who do not have a functioning spleen. Immunization recommendations change periodically and pharmacists should be sure to use current guidelines in their advocacy programs. 4 The pharmacy literature, druginformation centers, CDC, and local health departments are good resources for staying up to date and learning even more about this subject. ,. l
:!::) J
References 1. Grabenstein JO. Immunizations and pharmacy leadership. Am J Hosp Pharm. 1990;47:1127-8. 2. Grabenstein JO. Pharmacists and immunizations: advocating preventive medicine. Am Pharm. 1988;28:25-33 . 3. Grabenstein JO, Hayton BO. Pharmacoepidemiologic program for identifying patients in need of vaccination. Am J Hasp Pharm. 1990;47: 1774-81. 4. Grabenstein JO, Casto OT. Recommending vaccines for your patients' individual needs. Am Pharm. 1991;31:666-77. 5. Hepler CO. The future of pharmacy: pharmaceutical care. Am Pharm. 1990;30:583-9. 6. Williams WW, Hickson MA, Kane MA, et al. Immunization policies and vaccine coverage among adults: the risk for missed opportunities. Ann Intern Med. 1988;108:616-25. 7. Hinman AR. What will it take to fully protect all American children with vaccines. Am J Dis Child. 1991;145:559-62.
Gave us our past . . . It can give us our future
Help protect America's soil and water today.
We owe it to our children. Find out what you can do. Call I-800-THE SOIL. United States Department of Agriculture
Soil Conservation Service
Major John D. Grabenstein, MS, US. Army, is investigational Vol. NS32, No. 8 August 1992/659
AMERICANPHARMACY
