In 2017, almost 4000 Canadians died from opioid-related causes. Coadministration of opioids and benzodiazepines is a risk factor for overdose. Few studies have evaluated leveraging pharmacists to address opioid-benzodiazepine coprescribing. Our aim was to develop and test a role for pharmacists as opioid stewards, to reduce opioid and benzodiazepine doses in coprescribed patients. We conducted Plan-Do-Study-Act cycles between November 2017 and May 2018 across two primary care centre clinics. A third clinic acted as a control. Our intervention included a pharmacist: (1) identifying patients through medical record queries; (2) developing care plans; (3) discussing recommendations with physicians and (4) discussing implementing recommendations. We refined the intervention according to patient and physician feedback. At the intervention clinics, the number of patients with pharmacist developed care plans increased from less than 20% at baseline to over 60% postintervention. There was also a fourfold increase in the number of patients with an active opioid taper. At the control clinic, the number of patients with pharmacist developed care plans remained relatively stable at less than 20%. The number of patients with active opioid tapers remained zero. At the intervention clinics, mean daily opioid dose decreased 11% from 50.5 milligrams morphine equivalent (MME) to 44.7 MME. At the control clinic, it increased 15% from 62.3 MME to 71.4 MME. The number of patients with a benzodiazepine taper remained relatively stable at both the intervention and control clinics at less than 20%. At the intervention clinics, mean daily benzodiazepine dose decreased 8% from 9.9 milligrams diazepam equivalent (MDE) to 9.3 MDE. At the control clinic, it decreased 4% from 10.8 MDE to 10.4 MDE. A proactive, pharmacist-led intervention for coprescribed patients increased opioid tapers and decreased opioid and benzodiazepine doses. Future work will help us understand whether sustaining the intervention ultimately reduces rates of opioid-benzodiazepine coprescribing.

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Background Canada’s pneumococcal immunization goal for adults 65 years and older aims to achieve 80% coverage, yet uptake is only 58% in this population. Barriers include lack of awareness and lack of recommendations by healthcare providers. A pneumococcal immunization campaign was designed to address barriers and increase vaccine uptake from independent community pharmacies. Methods A “Did You Pneu?” pneumococcal immunization campaign was developed by a pharmacist at the head office of an independent community pharmacy banner. The campaign consisted of pharmacist educational materials, in-pharmacy marketing materials, and pharmacy operational supports (Figure 1). In November 2018, a month-long in-pharmacy campaign was carried out across the banner. Feedback collected from pharmacists via telephone interviews was used to inform updates to campaign materials for the November 2019 campaign. A convenience sample of ten independent community pharmacies located across Ontario was selected for a retrospective observational analysis of pneumococcal vaccine purchases from January 2017 to December 2019. Figure 1. “Did You Pneu?” campaign toolkit showing pharmacist educational materials, in-pharmacy marketing materials, and pharmacy operational supports developed and distributed across a banner of independent community pharmacies as part of an adult pneumococcal immunization campaign. Results Analysis of ten independent community pharmacies revealed an increase in the total number of pneumococcal vaccines purchased in November in years a campaign took place compared to baseline. The total number of pneumococcal vaccines purchased in November increased 23% during the first campaign and another 213% during the second campaign (13 vs. 16 vs. 50 vaccines purchased in November 2017, 2018, and 2019, respectively). Increased vaccine uptake was also observed in months subsequent to the in-pharmacy campaign. Analysis of ten independent community pharmacies revealed a 47% increase in the mean number of pneumococcal vaccines purchased per month by the banner (8.8 mean number of pneumococcal vaccines purchased per month twelve months pre-implementation vs. 12.9 twelve months post-implementation). Conclusion A comprehensive pneumococcal adult immunization campaign implemented across a banner of independent community pharmacies led to immediate and sustained increases in vaccine uptake. As pharmacists have a role in promoting adult pneumococcal immunizations, advocacy efforts should be undertaken to include pharmacists in publicly funded immunization programs. Disclosures Tiana Tilli, PharmD, RPh, ACPR, Pfizer Canada Inc. (Grant/Research Support, Speaker’s Bureau)