(1144) Factors Associated with the Implementation of Pediatric Immunization Services: A Survey of Community Pharmacies in Alabama

Objectives: Pediatric immunization is an effective means of protecting children against potentially fatal vaccine-preventable diseases. Achieving optimal immunization rates among this population is essential to prevent infectious disease outbreaks and protect against serious sequelae from infection. To combat a decline in pediatric immunization rates in Alabama and other states during the COVID-19 pandemic, the US Department of Health and Human Services, through amendments to the Public Readiness and Emergency Act, granted licensed pharmacists in all 50 states the authority to request and administer US FDA-approved vaccines recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) for individuals aged 3 to 18 years until December 31, 2024. Little is known regarding the types of pediatric vaccines being offered and factors facilitating the implementation of pediatric immunization services in community pharmacies. The study objectives were to: 1) assess the types of pediatric vaccines offered in community pharmacies, 2) compare participant/pharmacy characteristics and pharmacists’ perceptions of barriers and their roles between those who provided pediatric vaccination services and those who did not, and 3) assess factors associated with the provision of pediatric immunization services, when controlling for participant/pharmacy characteristics.

Methods: A cross-sectional study was employed, involving a self-administered paper/online survey of 1,172 Alabama community pharmacies from February to April 2023. Up to 5 postal contacts were made, and a $25 Amazon gift card was offered upon completing the survey. The questionnaire included measures such as whether ACIP-recommended vaccines were offered to children aged 10 or younger in 2022 (response options: yes/no); the types of pediatric vaccines administered (response options: yes/no); participants' perceptions of their roles in pediatric immunization (response categories ranging from strongly agree (1) to strongly disagree (5)); and the perceived barriers to providing pediatric immunization (response categories ranging from not a barrier (1) to a major barrier (4)). Exploratory factor analyses (EFA) of the pharmacists' perceived barrier items identified 4 components: Pediatric Vaccination Knowledge, Pediatric Vaccination Proficiency and Attitude, Implementation Logistics, and Child Vaccine Apprehension while the EFA of the perceived role resulted in only one component. All data analyses were conducted using IBM SPSS Statistics 29, with a predetermined alpha level of 0.05.

Results: Out of the 244 responses received, four responses were excluded due to less than 61% completeness, resulting in a final response rate of 20.5%. At a confidence level of 95%, the estimated margin of error was 6.33%. In terms of potential nonresponse bias, early and late respondents’ characteristics were compared; no differences were found. The percentage of pharmacies providing pediatric immunization services was 50.8%. Among the pediatric vaccines offered, Influenza vaccine (91.0%) and Poliovirus inactivated vaccine (4.9%) was the most and the least common, respectively. All scales had acceptable Cronbach’s Alpha coefficient of > 0.70. When comparing pharmacies providing pediatric immunization services to those that did not, significant differences emerged in various variables, including pharmacy type/setting, pharmacist age, average daily prescription volume, average pharmacy practice full-time equivalents as well as the implementation logistics barrier, and pharmacists' perceived role. The multivariable logistic regression analysis further indicated that implementation logistics barrier (p = 0.01) is significantly associated with pharmacies offering pediatric vaccination services after controlling for pharmacy and participant characteristics, including pharmacy type/setting. Specifically, an increase in a unit of implementation logistics barrier is associated with a 45% decrease in the odds of pediatric immunization offering.

Conclusions: The findings show that implementation logistics barrier is the primary factor to consider when devising strategies to promote pediatric vaccination services in community pharmacies. Policymakers and healthcare stakeholders can use these insights to develop targeted interventions to increase the availability of pediatric vaccination services in pharmacies.