Assessing Barriers and Increasing Use of Immunization Information Systems in Pharmacies: A Randomized Controlled Trial

Abstract

The role of pharmacists as immunization providers is increasingly common. However, as the number of providers administering vaccines increases, there is a concern of fragmented immunization records in state and regional immunization information systems (IIS). In order for IIS to have complete records, it is critical that each provider administering vaccines participate and update the IIS each time a vaccine is administered to a patient. In Alabama, participation in the IIS is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded in the state IIS. Limited pharmacy participation may have contributed to these incomplete IIS records. The purpose of this study was to identify barriers to utilization of IIS within a pharmacy context and tailor the information learned about barriers into a novel IIS training program. The research design was a mixed methods approach to qualitatively identify contextual barriers and facilitators to IIS utilization and quantitatively assess effectiveness of the training program on pharmacists’ knowledge, attitudes, intention, enrollment in the IIS, and actual participation in the IIS. The specific aims were to 1) identify barriers and best practices of IIS implementation through qualitative interviews of Alabama pharmacists as well as IIS representatives and participating pharmacists in states identified as having high IIS participation rates, 2) use a participatory design approach to develop an IIS training program, and 3) assess the impact of the IIS training program among community pharmacies’ IIS participation rates. Analysis of qualitative interviews identified multiple factors influencing implementation of IIS in the community pharmacy setting, aligning well with CFIR domains. Results of the randomized controlled trial phase showed a significant effect of the intervention on participants’ awareness, knowledge, and attitudes toward innovation characteristics. The intervention was shown to significantly affect enrollment in IIS. However this effect was not seen when examining participation in the IIS. This pharmacist-centered training program focused on practical strategies to integrate IIS into pharmacy workflow. While this program contains some information specific to the Alabama IIS, it could be adapted and disseminated to other states, incorporating strategies to improve sustainment of the intervention effect over time.