Pharmacists contemplate role behind the syringe

Could help stem flu in elderly

If ever there was a state that might benefit from a comprehensive vaccination program, it’s Mississippi.

Mississippi lags far behind the rest of the nation when it comes to administering flu and pneumococcal vaccines to the elderly. Only 12% of at-risk adults, those over age 65, get vaccinated against the flu in Mississippi, compared with about 50% of elderly patients nationwide.

To help improve that vaccination rate, the state of Mississippi in September 1996 gave pharmacists the authority to administer flu and pneumococcal vaccines, following completion of a weekend training course in the fine points of immunology. And "points" is the right word. To gain certification in the course, participating pharmacists jabbed each other with flu and hepatitis B vaccinations during an intensive indoctrination program. Seventy pharmacists finished the first training session in November, and some have begun ministering to the nonvaccinated masses.

But a spokeswoman for the Mississippi Medical Association says doctors won’t make it easy for pharmacists who want to stick their patients. "I’m not expecting many physicians, if any, to participate," says Charmaine Thompson, director of government affairs for the organization.

To participate, physicians and pharmacists negotiate standing-order protocols, giving the pharmacist the right to give the injection provided the patient isn’t allergic to eggs, the medication, or has had rheumatoid arthritis. As flu and pneumonia hospitalize tens of thousands of the elderly each year, hospital pharmacists whose states OK similar programs would be able to counsel patients at discharge on new options for getting immunized before the next flu season rolls around.

Vaccines are cheaper, more accessible

The program’s boosters — including the American Pharmaceutical Association (APhA) in Washington, DC — say the program offers two main benefits: access and savings. "Normally, the elderly sit for 21¼2 hours in a doctor’s office and are charged for an office visit and the vaccination," says Bo Dalton, BS, RPh, executive director of the Mississippi Pharmacists Association. "Most of the time, the elderly have transportation problems. The pharmacy is convenient."

Those who aren’t immunized against cold weather respiratory viruses risk falling victim to the sixth leading cause of death in the United States — and the only cause of death whose incidence is rising, says Maj. John D. Grabenstein, MS, an expert on vaccines at the University of North Carolina in Chapel Hill. "Of those who die from influenza, two-thirds had been hospitalized in the previous five years, so they fell through the cracks," Grabenstein says. "In the same group of people, 90% had an outpatient visit in the previous year and weren’t vaccinated and died. This is scandalous."