title: Impact of pharmacists as immunizers on vaccination rates: A systematic review and meta-analysis.
abstract: Underutilization of vaccination programs remains a significant public health concern. Pharmacists serve as educators, facilitators, and in some jurisdictions, as administrators of vaccines. Though pharmacists have been involved with immunizations in various ways for many years, there has yet to be a systematic review assessing the impact of pharmacists as immunizers in these three roles.
  
  
  
  To complete a systematic review of the literature on the impact of pharmacists as educators, facilitators, and administrators of vaccines on immunization rates.
  
  
  
  We identified 2825 articles searching the following databases from inception until October 2015: PubMed, EMBASE, Cochrane Libraries, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Google Scholar. Grey literature was identified through use of the Canadian Agency for Drugs and Technology in Health "Grey Matters" search tool. Content from relevant journals and references of included studies were also searched. Inclusion criteria were clinical or epidemiologic studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms.
  
  
  
  Thirty-six studies were included in the review, 22 assessed the role of pharmacists as educators and/or facilitators and 14 assessed their role as administrators of vaccines. All studies reviewed found an increase in vaccine coverage when pharmacists were involved in the immunization process, regardless of role (educator, facilitator, administrator) or vaccine administered (e.g., influenza, pneumococcal), when compared to vaccine provision by traditional providers without pharmacist involvement. Limitations of the results include the large number of non-randomized trials and the heterogeneity between study designs.
  
  
  
  Pharmacist involvement in immunization, whether as educators, facilitators, or administrators of vaccines, resulted in increased uptake of immunizations. PROSPERO Registration: CRD42013005067.
authors.affiliation: College of Pharmacy, 5968 College St, PO Box 15000, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada; Canadian Center for Vaccinology, 5850/5980 University Ave, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada; Faculty of Medicine, 1459 Oxford St, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada. Electronic address: Jennifer.Isenor@Dal.ca.
authors.forename: J E
authors.initials: JE
authors.lastname: Isenor
authors.affiliation: College of Pharmacy, 5968 College St, PO Box 15000, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: N T
authors.initials: NT
authors.lastname: Edwards
authors.affiliation: College of Pharmacy, 5968 College St, PO Box 15000, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: T A
authors.initials: TA
authors.lastname: Alia
authors.affiliation: Canadian Center for Vaccinology, 5850/5980 University Ave, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada; Faculty of Medicine, 1459 Oxford St, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Slayter
authors.affiliation: Canadian Center for Vaccinology, 5850/5980 University Ave, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada; School of Nursing, 1 West Street, St. Francis Xavier University, Antigonish, Nova Scotia, B2G 2W5, Canada.
authors.forename: D M
authors.initials: DM
authors.lastname: MacDougall
authors.affiliation: Canadian Center for Vaccinology, 5850/5980 University Ave, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada; Faculty of Medicine, 1459 Oxford St, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada; Department of Medicine, 1276 South Park St, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, B3H 2Y9, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: McNeil
authors.affiliation: College of Pharmacy, 5968 College St, PO Box 15000, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada; Canadian Center for Vaccinology, 5850/5980 University Ave, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada; Faculty of Medicine, 1459 Oxford St, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada; Department of Pharmacy, 1796 Summer St, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, B3H 3A6, Canada; Centre for Health Care for the Elderly, 5955 Veterans Memorial Lane, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, B3H 2E1, Canada.
authors.forename: S K
authors.initials: SK
authors.lastname: Bowles
mesh_terms: D006801:Humans; D002170:Canada / Q000453:epidemiology; D006562:Herpes Zoster / Q000453:epidemiology / Q000517:prevention & control; D017589:Immunization Programs / Q000458:organization & administration; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control; D065228:Non-Randomized Controlled Trials as Topic; D010353:Patient Education as Topic; D010595:Pharmacists / Q000592:standards / Q000706:statistics & numerical data; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D011634:Public Health / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D014611:Vaccination / Q000706:statistics & numerical data; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D014612:Vaccines
keywords: Immunizer; Pharmacist; Vaccination