title: National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study.
abstract: BACKGROUND
  Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs.
  
  
  OBJECTIVE
  To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations.
  
  
  METHODS
  A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales.
  
  
  METHODS
  Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013-2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model.
  
  
  RESULTS
  The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs' views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk.
  
  
  CONCLUSIONS
  Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP-pharmacy relationships, and improving public awareness must be overcome.
authors.affiliation: Public Health Wales NHS Trust, Temple of Peace and Health, Cardiff.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evans
authors.affiliation: Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Wood
authors.affiliation: Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff.
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
mesh_terms: D003157:Community Pharmacy Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D007252:Influenza Vaccines / Q000191:economics; D007251:Influenza, Human / Q000517:prevention & control*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D015397:Program Evaluation; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines
keywords: community pharmacy services; general practice; immunisation; pharmacy