Academic journal article Canadian Journal of Public Health

Community Pharmacists' Knowledge, Beliefs and Attitudes towards Immunization in Quebec

Academic journal article Canadian Journal of Public Health

Community Pharmacists' Knowledge, Beliefs and Attitudes towards Immunization in Quebec

Article excerpt

Immunization is one of the most useful and effective tools of modern medicine.1 Its successes range from the worldwide eradication of smallpox to the drastic decrease of Haemophilus influenzae type b invasive infections in developed countries.

Many vaccine-preventable diseases still cause major morbidity and mortality in Canada. Influenza and pneumonia are the eighth overall cause of mortality in the country, accounting for 5,826 deaths in 2009.2 One of the keys to immunization's success is a high immunization rate. Some pathogens, such as measles and pertussis, require immunization rates as high as 95% to prevent serious outbreaks.3 Influenza requires lower immunization rates (80%) to establish herd immunity.4

Immunization rates in Quebec are suboptimal, especially among adults. During the 2011-2012 influenza season, 57% of the population aged 60 years and over received the influenza vaccine.5 Thirty percent of people aged from 18 to 59 with chronic illnesses received the influenza vaccine during the same period. In the same groups, even lower immunization rates, 54% and 22% respectively, were reported for pneumococcal vaccines.

Several reasons contribute to low vaccination rates in developed countries. Misperception of one's vulnerability or of the disease's severity, lack of time or interest, doubts about immunization and fear of adverse effects were cited in a Quebec survey.5 The accessibility and convenience of the immunization setting are important issues, especially for medically underserved populations.6 Lack of knowledge and guidance on the part of health professionals is another explanation for poor vaccine uptake in adults.5,7

To widen vaccines' availability and facilitate their uptake, several associations and government agencies, such as the Infectious Diseases Society of America and the Centers for Disease Control and Prevention, recommend that vaccines be available in pharmacies and that pharmacists administer them.8,9 Such a public health strategy broadens the providers' base and benefits hard-to-reach populations because of the large number of pharmacies.10

Pharmacists are among the most trusted and accessible health care professionals.11 In the US, pharmacists are authorized to immunize in every state, though each state may restrict the administration to certain populations and vaccines.12 In Canada, pharmacists are allowed to immunize in six provinces (Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia and Ontario) following completion of training programs that are regulated by each province.13

In 2008-2009, a large survey of Quebec's community pharmacies' immunization services was conducted by the National Public Health Institute of Quebec (INSPQ).14 It showed that 90% of the community pharmacies sold vaccines, and 27% offered vaccine administration (delivered by a nurse). Many pharmacies (44%) were considering offering vaccine administration within the next five years. Half the pharmacists surveyed answered that they would be interested in providing immunization themselves, pending a legislative change.

The INSPQ survey underlined the lack of data concerning pharmacists' knowledge, beliefs and attitudes about immunization in a Canadian context. The objectives of the current study are to fill this gap in knowledge and determine what barriers to pharmacist-led immunization are perceived by Quebec's pharmacists.

METHODS

This study was a descriptive survey of pharmacists working in a community setting in Quebec. The questionnaire was created using the website www.surveymonkey.com. To preserve confidentiality, the answers could not be linked to a particular pharmacist. A copy of the full questionnaire can be found in Appendix A.

Community pharmacists were contacted by phone from January 17 to 25, 2013. Community pharmacies were randomly chosen from a list of Quebec's pharmacies, stratified by chains and banners. In Quebec, those terms refer to commercial groups of independently owned pharmacies with more (chain) or less (banner) obligations toward the group. …

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