Impact of a pharmacist-led intervention on post-splenectomy vaccination adherence among trauma patients

Abstract

Background Patients who undergo splenectomy are at increased risk of infection caused by encapsulated bacteria. The Advisory Committee on Immunization Practices recommends a series of vaccinations for asplenic patients, the first of which are generally completed prior to hospital discharge in the setting of trauma. However, studies suggest that trauma patients receive booster vaccinations at a suboptimal rate. The aim of this study was to evaluate the impact of an inpatient, pharmacist-led post-splenectomy counseling service on patient understanding and patient-reported revaccination follow-up rate. Methods Patients who underwent splenectomy due to trauma between October 2017 and February 2019 were surveyed via telephone questionnaire at least eight weeks after initial vaccination. Responses were compared to historical data which was collected prior to the service implementation. The primary outcome was patient reported follow-up vaccination rate. Secondary outcomes included patient awareness of vaccine requirements and need for rehospitalization. Results A total of 67 patients met inclusion criteria, of whom 31 (46%) were successfully contacted by phone. After implementation of the post-splenectomy counseling service, 14 patients (45.2%) reported receiving second doses of pneumococcal and meningococcal vaccines, compared to 6 patients (6.3%) in the pre-implementation cohort ( p = 0.000001). Twenty-eight patients (90%) of the patients in the post-implementation cohort acknowledged awareness of the need for additional vaccines, whereas 44 (46%) of patients in the pre-implementation cohort acknowledged awareness ( p = 0.000043). Conclusion A post-splenectomy counseling service led to improved rates of patient reported adherence to booster vaccines, as well as increased awareness for need to revaccinate.

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis

“…Table 1 describes the characteristics of the included four RCTs studies (Heaton et al, 2022 ; Klassing et al, 2018 ; Ozdemir et al, 2023 ; Stolpe & Choudhry, 2019 ) and 15 non-RCTs studies (Abu-rish et al, 2021 ; Are et al, 2022 ; Bacci et al, 2019 ; Bayraktar-Ekincioglu et al, 2022 ; Cebollero et al, 2020 ; Deslandes et al, 2020 ; Fathima et al, 2021 ; Gatwood et al, 2022 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Howe et al, 2022 ; Page et al, 2020 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ; Villaverde Piñeiro et al, 2022 ). Two RCTs (Klassing et al, 2018 ; Stolpe & Choudhry, 2019 ) which were both conducted in the USA, evaluated the impact of technology-based systems that facilitated the advocacy strategies of pharmacists in identifying patients for vaccine recommendations.…”

“…Comparison: Usual care Pneumococcal Number of vaccine recipients 4 months ≥19 68/351 Serious risk Rihtarchik et al, 2018 United States Non-RCT a Hospital Advocator , i Monitoring system j Pharmacy driven electronic tracking system that allows pharmacists to document and use tracking tools within the EMR to ensure appropriate vaccinations were administered to asplenic patient. Comparison: Usual care Pneumococcal Meningococcal Haemophilus influenza type B Number of vaccine doses administered 2 years ≥18 119/242 Moderate risk Scherrer et al, 2020 United States Non-RCT a Hospital Advocator f,i Monitoring system l Pharmacists provide post-splenectomy counselling that describes the recommended vaccinations and their importance in disease prevention.Patients are provided with handouts contains information on vaccines. Comparison: Usual care Pneumococcal Meningococcal ACWY Meningococcal serogroup B Number of vaccine doses administered 6 months ≥18 31/95 Moderate risk Stolpe & Choudhry, 2019 United States RCT Community c Immuniser Monitoring system j A vaccination prompt system was used to inform patients, that they are scheduled to receive and offered either pneumococcal vaccine, herpes zoster vaccine, or both.…”

“…One study (Howe et al, 2022 ) assessed the impact of providing funding to community pharmacies to encourage vaccination uptake. Seven studies (Abu-rish et al, 2021 ; Bayraktar-Ekincioglu et al, 2022 ; Cebollero et al, 2020 ; Fathima et al, 2021 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Scherrer et al, 2020 ) evaluated the implementation of a quality improvement programme by pharmacists to improve immunisation rates. In these studies, a comparison was made of 20 different comparator interventions against pharmacist-led interventions.…”

“…Pharmacist-led approaches included pharmacists reviewing vaccination history and recommending vaccines to potential recipients or to the doctors in-charge (recruitment) (8 studies, 40%) (Abu-rish et al, 2021 ; Bayraktar-Ekincioglu et al, 2022 ; Cebollero et al, 2020 ; Fathima et al, 2021 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ), patient education (7 studies, 35%) (Abu-rish et al, 2021 ; Bayraktar-Ekincioglu et al, 2022 ; Cebollero et al, 2020 ; Fathima et al, 2021 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Scherrer et al, 2020 ), training (2 studies, 10%) (Cebollero et al, 2020 ; Goode et al, 2023 ), organising campaigns (2 studies, 10%) (Cebollero et al, 2020 ; Goode et al, 2023 ), and stocking up on vaccines (1 study, 5%) (Cebollero et al, 2020 ). Most of these studies were from the USA (7 studies, 63.6%) (Bacci et al, 2019 ; Cebollero et al, 2020 ; Gatwood et al, 2022 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ) and one study each from Turkey (9.1%) (Bayraktar-Ekincioglu et al, 2022 ), New Zealand (9.1%) (Howe et al, 2022 ), Jordan (9.1%) (Abu-rish et al, 2021 ) and Australia (9.1%) (Fathima et al, 2021 ). These studies were primarily conducted in community settings: four community pharmacies (36.3%) (Bacci et al, 2019 ; Fathima et al, 2021 ; Gatwood et al, 2022 ; Howe et al, 2022 ), three primary healthcare clinics (27.2%) (Cebollero et al, 2020 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ), one community centre (9.1%) (Goldsworthy et al, 2022 ), and three hospitals (27.2%) (Abu-rish et al, 2021 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ).…”

“…Most of these studies were from the USA (7 studies, 63.6%) (Bacci et al, 2019 ; Cebollero et al, 2020 ; Gatwood et al, 2022 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ) and one study each from Turkey (9.1%) (Bayraktar-Ekincioglu et al, 2022 ), New Zealand (9.1%) (Howe et al, 2022 ), Jordan (9.1%) (Abu-rish et al, 2021 ) and Australia (9.1%) (Fathima et al, 2021 ). These studies were primarily conducted in community settings: four community pharmacies (36.3%) (Bacci et al, 2019 ; Fathima et al, 2021 ; Gatwood et al, 2022 ; Howe et al, 2022 ), three primary healthcare clinics (27.2%) (Cebollero et al, 2020 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ), one community centre (9.1%) (Goldsworthy et al, 2022 ), and three hospitals (27.2%) (Abu-rish et al, 2021 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ).…”