(1151) The Impact of Decision Support Prompts on Pharmacy-based Herpes Zoster Vaccine Recommendations and Vaccines Administered

Objectives: Low vaccination rates and vaccine hesitancy remain major threats to public health. Strong healthcare provider recommendations play a pivotal role in driving patient acceptance of vaccinations. Pharmacists, particularly those in rural, primary care shortage areas, are ideally positioned to make strong recommendations in support of their patients and public health. However, barriers have been identified, including lack of time and access to complete immunization histories, that limit pharmacists’ ability to recommend vaccines. Strategies are needed to support consistent pharmacy-based recommendations of needed vaccines. Therefore, the objective of this study was to measure the impact of a decision support prompt on herpes zoster vaccine recommendations and vaccines administered.

Methods: This study was conducted in South Carolina using a quasi-experimental design including 91 community pharmacies. Pharmacies were assigned to one of three groups. The first group, education plus prompt, was comprised of 26 pharmacies that received education in addition to the pharmacy software prompt. Education was comprised of training on the prompt itself, as well as shingles education material to be provided to patients. This was delivered in the format of webinars with Q&A opportunities followed by individual coaching calls as needed. The second group, prompt only, included 33 pharmacies that received the prompt only, and the third group, control, included 32 pharmacies that received neither education nor prompt and served as the control group. A decision support prompt identifying patients eligible for a herpes zoster vaccine was delivered to intervention group pharmacies via pharmacy management software at the point of care. The number of recommendations made and the result of recommendations were collected via a brief questionnaire within the prompt. The number of vaccines administered was collected monthly for 11 months pre- and post-prompt initiation for all three groups. In the analysis phase, the data was analyzed using descriptive statistics, chi-square, ANOVA, and paired t-tests.

Results: A total of 150,828 recommendations were made across the intervention groups, 96,456 in the education plus prompt group and 54,372 in the prompt only group. The top three results of vaccine recommendations by the intervention groups were the patient completed shingles discussion (59.8%), patient caregiver not present (15.6%), and the patient was already vaccinated (7.3%). During the 11 months pre- and post-intervention, the mean change of vaccines administered increased significantly from pre- to post-intervention in the education plus prompt group (16.72%, p= < 0.0001) and the prompt only group (12.76%, p= 0.0267), and decreased significantly in the control group (-10.90%, p= 0.0135). Significant differences were found when comparing the mean vaccines administered between groups (p < 0.001). Specifically, post-hoc tests indicated a significant difference at the 0.05 level between the control and education plus prompts groups, control and the prompts only groups, but not between the education plus prompts and prompts only groups.

Conclusions: Identifying strategies to engage community pharmacies in providing consistent vaccine recommendations is an essential step toward addressing vaccine hesitancy and improving adult vaccination coverage. The results demonstrate the positive impact of pharmacy management software decision support prompts, as evidenced by the significant increase in vaccine administration rates in the intervention groups compared to the control group. While not statistically significant, coupling of the decision support prompts with education may lead to an increase in vaccinations over prompts alone. This study offers valuable insights into the impact of enhancing vaccine recommendations within community pharmacies using innovative pharmacy software interventions, ultimately contributing to improved healthcare decision-making and better public health outcomes. Future studies should further explore the impact of decision support prompts on additional vaccines and in other settings.