title: Impact of pharmacists as immunizers on influenza vaccination coverage in the community-setting in Nova Scotia, Canada: 2013-2015.
abstract: BACKGROUND
  Annual immunization is the most effective way to prevent influenza and its associated complications. However, optimal immunization rates are not being met in Nova Scotia, Canada. Additional providers, such as pharmacists, may improve access and convenience to receive vaccines. Pharmacists began immunizing patients 5 years of age and older within the publicly funded universal influenza vaccination program during the 2013-2014 influenza season. The objective of this study was to evaluate influenza immunization coverage rates before and after pharmacists in Nova Scotia gained authority to immunize as part of the publicly funded universal influenza vaccination program.
  
  
  METHODS
  Influenza immunization data was obtained from the Department of Health and Wellness from 2010 to 2015. Data included billing data from physicians and pharmacists, and local public health data. Vaccination coverage was calculated as proportion of vaccinations received in comparison to the total population.
  
  
  RESULTS
  Prior to pharmacists immunizing, overall vaccination coverage for Nova Scotia residents 6 months of age and older was 35.8 % in 2012-2013, increasing to 41.8 % coverage in 2013-2014 the year pharmacists began immunizing. A decrease of 1.9 to 39.9 % was observed in 2014-2015. In patients 65 years of age and older living in the community, coverage has increased from 61.8 % in 2012-2013 to 71.6 % in 2013-2014, and again to 73.3 % in 2014-2015 with the addition of pharmacists immunizing. Prior to pharmacists immunizing the highest coverage noted for this portion of the population was 61.8 %.
  
  
  CONCLUSIONS
  The addition of pharmacists as immunizers within a publicly funded universal influenza vaccination program was found to increase overall vaccination coverage in the first year and to maintain higher coverage rates in the second year than those observed before pharmacists began immunizing. Increases in coverage in both years were observed in the elderly. Future research will be required to determine the ongoing impact of the addition of pharmacists as immunizers and other strategies to improve vaccination coverage.
authors: College of Pharmacy, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada ; Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; Faculty of Medicine, Dalhousie University, 1459 Oxford St, Halifax, Nova Scotia B3H 4R2 Canada.
authors: Jennifer E
authors: JE
authors: Isenor
authors: College of Pharmacy, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada.
authors: Jessica L
authors: JL
authors: Killen
authors: Nova Scotia Department of Health and Wellness, PO Box 488, Halifax, Nova Scotia B3J 2R8 Canada.
authors: Beverly A
authors: BA
authors: Billard
authors: Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; Faculty of Medicine, Dalhousie University, 1459 Oxford St, Halifax, Nova Scotia B3H 4R2 Canada.
authors: Shelly A
authors: SA
authors: McNeil
authors: Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; School of Nursing, St. Francis Xavier University, PO Box 5000, Antigonish, Nova Scotia B2G 2W5 Canada.
authors: Donna
authors: D
authors: MacDougall
authors: Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; School of Nursing, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada.
authors: Beth A
authors: BA
authors: Halperin
authors: Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia B3K 6R8 Canada.
authors: Kathryn L
authors: KL
authors: Slayter
authors: College of Pharmacy, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada ; Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8 Canada ; Faculty of Medicine, Dalhousie University, 1459 Oxford St, Halifax, Nova Scotia B3H 4R2 Canada ; Department of Pharmacy, 1796 Summer St, Nova Scotia Health Authority- Central Zone, Halifax, Nova Scotia B3H 3A6 Canada.
authors: Susan K
authors: SK
authors: Bowles
keywords: Canada; Immunization; Influenza vaccination; Pharmaceutical services; Pharmacist; Vaccine coverage