Introduction
A new recombinant herpes zoster vaccine has advanced efforts to prevent shingles,
but its multidose regimen introduces potential barriers to full protection that must
be managed by community pharmacies. To address this potential patient management challenge,
a pharmacy records clinical support tool was implemented to assist pharmacy staff
in managing herpes zoster vaccine dose completion.
Methods
Beginning in November 2018, a large community pharmacy chain (operating in 36 states)
implemented a provider nudge within its clinical decision support tool across all
locations that fit seamlessly into the existing workflow, alerting the pharmacy staff
of the need for a patient's second dose. Initial and second doses were followed over
2 overlapping, 10-month periods before and after system launch. Differences in vaccine
completion rates before and after the system was operational were assessed by chi-square
tests and predictors of completion, controlling for store- and patient-level characteristics,
and were analyzed by multivariable logistic regression and generalized linear models
throughout 2021.
Results
Across 2,271 pharmacies, 71,459 and 41,982 initial doses of the herpes zoster vaccine
were given in the baseline and intervention period, respectively. The proportion of
patients completing both doses increased slightly after system implementation (before:
71.9%, after: 75.2%; p<0.0001). However, dramatic improvements in time to dose completion were observed
(before: 109.8 days, after: 93.3 days; p<0.001), and changes were significant in stores in all but 4 states.
Conclusions
Results suggest that the use of a clinical nudge improved the occurrence of and time
to herpes zoster vaccine dose completion in adults across the U.S.
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Published online: June 12, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
