title: Cross-Sectional Survey of Perceived Barriers Among Community Pharmacists Who Do Not Immunize, in Wayne County, Michigan.
abstract: BACKGROUND
  The goal of the study was to identify perceived barriers to implementation of vaccination services encountered by independent and small-chain community pharmacies in an urban setting.
  
  
  METHODS
  Pharmacists in independent and small-chain pharmacies located in 29 Michigan ZIP codes were visited and asked to complete a 5- to 10-min semi-structured interview.
  
  
  RESULTS
  A total of 93 independent and 12 small-chain pharmacies participated (n = 105; 61%). The pharmacies filled an average of 700 prescriptions each week with 1.1 pharmacist full-time equivalents and 57 h of technician time. The most common services that participating pharmacies provided were dispensing outpatient medication (99%), medication therapy management (MTM, 65.7%), disease management or coaching (54.3%), point-of-care testing (34.3%), and dispensing medications to inpatient facilities (16.2%). Only seven pharmacies (6.7%) administered vaccinations. When pharmacists were asked to identify what it would take to start to administer vaccines, the most common responses were increased demand from patients (37.1%), adequate time (19%), appropriate space (17.1%), appropriate amount of staff (14.3%), change in attitudes or beliefs of the owner or pharmacists at that pharmacy (13.3%), increased profit related to vaccines (11.4%), and increased awareness among patients about the importance of vaccines (11.4%). The majority of pharmacies (65.3%) reported that only one factor would need to change to start to administer vaccines.
  
  
  CONCLUSIONS
  Independent and small-chain community pharmacies in an urban, primarily low-income area identified several barriers that have prevented implementation of vaccination services. However, the majority of pharmacies reported that only one factor would need to change in order to begin to administer vaccines. Interventional efforts necessary to address commonly cited barriers may include providing education to pharmacists about the need for community pharmacy-based immunization programs in addition to services provided by physician offices, as well as the importance of proactively providing immunization-related recommendations to patients.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA. skelling@med.umich.edu.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kelling
authors.affiliation: University of Toledo, Toledo, OH, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Pattin
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Abdulbaset
authors.initials: A
authors.lastname: Salim
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kilgore
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Erickson
keywords: Community pharmacy; Immunization; Primary prevention; Urban