Pharmacist insights into adolescent human papillomavirus vaccination provision in the United States

Figures & data

Table 1. Characteristics of U.S. pharmacists* and pharmacies providing vaccination in eight states.

	Total (n = 40)
	n (%)
Pharmacist
Age (years)^†
25–34	16 (40)
35–44	13 (33)
≥ 45	11 (28)
Race
White	30 (75)
Asian	6 (15)
Black	2 (5)
Multiracial	2 (5)
Sex
Female	22 (55)
Male	18 (45)
Highest Degree Earned^†
PharmD	28 (70)
BSPharm or BS	11 (28)
MS – Pharmacy Administration	1 (3)
Vaccinations Offered to Adolescents
Influenza	40 (100)
TDAP	32 (80)
MenACWY	24 (60)
HPV	18 (45)
Pneumococcal	14 (35)
Hepatitis B	14 (35)
Hepatitis A	11 (28)
Tetanus and diphtheria	7 (18)
Type of pharmacy practice^†
Chain	31 (78)
Independent	5 (13)
Grocery	2 (5)
Big box retailer	2 (5)
Pharmacy
Number of pharmacists currently administering vaccines^†
2–3	31 (78)
4–5	7 (18)
≥ 6	2 (5)
Number of years pharmacy has provided adolescent vaccination^†
1–3	8 (20)
4–6	18 (45)
≥ 7	9 (23)
Don’t know	5 (13)
Methods used to administer vaccines^‡
Walk-In	40 (100)
Off-site	31 (78)
Appointments during business hours	21 (53)
Mass clinics	15 (38)
Appointments during advertised date	12 (30)
Type of payment accepted by pharmacy^‡
Out of pocket/Self Pay	40 (100)
Private Insurance	40 (100)
Medicare	40 (100)
Medicaid	39 (98)
Tricare	26 (65)
Children’s Health Insurance Program	24 (60)
English-speaking patient population^†
<80 %	3 (8)
80–94 %	8 (20)
≥95 %	29 (73)
Vaccination capacity
Could vaccinate more people	30 (75)
Pharmacy at capacity	8 (20)
Pharmacy over capacity	2 (5)

* Includes 18 pharmacists who did provide HPV vaccination to adolescents aged 9–18 years, and 22 pharmacists who did not provide HPV vaccines but provided Tdap or tetanus and diphtheria, and/or meningitis (MenACWY) vaccines

^† Totals may exceed 100% due to rounding

^‡ Totals may exceed 100%, multiple answers possible

Abbreviations: Human papillomavirus (HPV), United States (U.S.), Doctor of Pharmacy (PharmD), Bachelor of Science in Pharmacy (BSPharm), Bachelor of Science (BS), TDAP = tetanus, diphtheria and pertussis; TD = tetanus and diphtheria; HPV = human papillomavirus; MenACWY = meningococcal vaccine American Pharmacists Association (APhA), Basic Life Support (BLS), Occupational Safety and Health Administration (OSHA), Continuing Pharmacy Education (CPE)

Table 2. Semi-quantitative data on U.S. pharmacist insights into HPV vaccination in eight states among HPV vaccine providers (n = 18).

	n (%)
Challenges to providing HPV vaccines to adolescents*
Parental consent	5 (28)
Tracking and recall of patients	3 (17)
Education/promotion of vaccination	3 (17)
Stigma about vaccination among parents of adolescents	3 (17)
Cost of vaccination	2 (11)
Potential adverse reactions	2 (11)
State laws	1 (6)
Don’t know	1 (6)
None	3 (17)
Strategies to overcome challenges of providing HPV vaccination ^†
Providing education or support to patient and patient’s guardian	4 (22)
Reminder system for patients of upcoming doses	1 (6)
Facilitators towards success of HPV vaccination program in pharmacy*
Clear guidelines from pharmacy/corporate management	4 (22)
State legislative authority to provide vaccination	3 (17)
Promotion outside pharmacy	3 (17)
Education or promotion within pharmacy	3 (17)
Reimbursement of adolescent vaccines	2 (11)
Designated space for vaccination	1 (6)
Student vaccination	1 (6)
Having vaccines in stock	1 (6)
Not applicable^‡	4 (22)
Don’t know	3 (17)
Comfort level administering HPV vaccines to adolescents^§
Very comfortable	14 (78)
Somewhat comfortable	3 (17)
Somewhat uncomfortable	1 (6)

* Totals may exceed 100%, multiple answers possible

^† Only 27% (n = 5) of pharmacists reported ways to overcome challenges

^‡ Pharmacists described their HPV vaccination program as unsuccessful

^§ Pharmacists were given the following options: very comfortable, somewhat comfortable, neutral, somewhat uncomfortable, and very uncomfortable

Abbreviations: Human papillomavirus (HPV), United States (U.S.)

Figure 1. U.S. pharmacist insights into advantages and disadvantages of human papillomavirus (HPV) vaccination in eight states.

Table3. Vaccination operations and communication procedures of U. S. pharmacies in eight states.

	Total (n = 40)
	n (%)
Methods of obtaining new vaccine recommendations*
Pharmacy management or corporate notification	29 (73)
CDC/ACIP recommendations	8 (20)
Local/state government alerts	6 (15)
Practice or professional society newsletter	4 (10)
Other^†	4 (10)
Requires patients to present with prescription for HPV vaccination ^‡
Yes	2 (5)
No	18 (47)
Depends on vaccine	3 (8)
Required if outside of age range per state protocol	13 (34)
All except flu vaccine	3 (8)
Pharmacy requires minor permission or parental consent or both to immunize adolescents
Yes, parental consent only	27 (68)
Yes, both	11 (28)
Yes, minor assent only	1 (3)
Don’t know	1 (3)
Methods utilized to obtain parental consent*
Written consent document	37 (97)
Verbal consent to pharmacist	3 (8)
Electronic consent form	1 (3)
Requires pharmacists be under collaborative practice agreement with clinical prescriber^§
Yes	38 (97)
Depends on vaccine	1 (3)
Pharmacy provides patients with vaccination record to give to their provider	36 (90)
Methods used to report vaccination records to primary care providers*
Fax	31 (78)
Electronic medical records	7 (18)
Handled by corporate office of pharmacy	2 (5)
Paper documentation given to patient	1 (3)
None	2 (5)
Utilizes state immunization information system
Yes	13 (33)
No	19 (48)
Don’t know	8 (20)
Procedures used for patient reminders of multiple-dose vaccines*
Telephone reminders	22 (55)
Mail reminders	3 (8)
Email reminder	1 (3)
Other	5 (13)
None	5 (13)
Don’t know	10 (25)

* Totals may exceed 100%, multiple answers possible

^† Email, chart, phone application, district supervisor updates pharmacists every few weeks by tracking patient eligibility

^‡ Two responses missing or not applicable (n = 38)

^§ One missing response (n = 39)

Abbreviations: Human papillomavirus (HPV), United States (U.S.), Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP)

Figure 2. U.S pharmacy procedures for tracking number of doses of multiple-dose vaccines stratified by current HPV vaccination provision status.

Table

Immunization		Age Range
Influenza	□
Pneumococcal	□
Tdap (adolescent/adult tetanus, diphtheria & pertussis)	□
Td (tetanus, diphtheria)	□
Hepatitis A	□
Hepatitis B	□
HPV (Human Papillomavirus)	□
MCV4 (meningococcal)	□
Zoster (shingles)	□
Travel vaccines (Yellow fever, Japanese Encephalitis, polio, typhoid, and rabies)	□

Table

Immunization
Influenza	□
Pneumococcal	□
Tdap (adolescent/adult tetanus, diphtheria & pertussis)	□
Td (tetanus, diphtheria)	□
Hepatitis A	□
Hepatitis B	□
HPV (Human Papillomavirus)	□
MCV4 (meningococcal)	□
Zoster (shingles)	□
Travel vaccines (Yellow fever, Japanese Encephalitis, polio, typhoid, and rabies)	□

Table

Immunization
Influenza	□
Pneumococcal	□
Tdap (adolescent/adult tetanus, diphtheria & pertussis)	□
Td (tetanus, diphtheria)	□
Hepatitis A	□
Hepatitis B	□
HPV (Human Papillomavirus)	□
MCV4 (meningococcal)	□
Zoster (shingles)	□
Travel vaccines (Yellow fever, Japanese Encephalitis, polio, typhoid, and rabies)	□

Table

Immunization
Influenza	□
Pneumococcal	□
Tdap (adolescent/adult tetanus, diphtheria & pertussis)	□
Td (tetanus, diphtheria)	□
Hepatitis A	□
Hepatitis B	□
HPV (Human Papillomavirus)	□
MCV4 (meningococcal)	□
Zoster (shingles)	□
Travel vaccines (Yellow fever, Japanese Encephalitis, polio, typhoid, and rabies)	□