Pharmacists play major role in getting rural seniors vaccinated for pneumonia, but shots for the disease are less likely in rural areas

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By Melissa Patrick
Kentucky Health News

Pharmacists play a significant role in getting rural people vaccinated for pneumonia, and presumably other diseases, more so than in urban areas, according to a study by the Rural and Underserved Health Research Center at the University of Kentucky.

The study found pneumonia immunization is less common among seniors in rural areas, and pharmacists could play a major role in closing that gap, the owner of a small pharmacy chain told Kentucky Health News.

Rosemary Smith, a co-owner of six Jordan Drug stores in Eastern Kentucky, said in a telephone interview that the vaccination rate in rural areas is probably lower because they have fewer health-care providers and most of "our people" are not "wellness oriented" -- but almost every community has access to a pharmacist.

"The key is that we see these patients," Smith said. "They may go to their physician two or three times a year, but we see them two or three times a month sometimes. So we are very accessible to them,  especially independents."

The study notes that all 50 states and Washington, D.C. allow pharmacists to provide pneumonia vaccines, and that 93 percent of all Americans live within five miles of a community pharmacy.

Using 2014 data from the Medicare Physician and Other Supplier Public Use Files, the study looked at the rural and urban differences in pneumonia vaccine rates for people 65 and older, and then assessed the impact of pharmacies as an alternative to primary-care providers.

The study found that of the 1.4 million fee-for-service Medicare patients who had received a pneumonia vaccine, 72.5 percent got their vaccine from a primary-care provider and 22.2 percent got it from their pharmacist.

It also found that pharmacists delivered a "significantly greater proportion" of the pneumonia vaccines in rural areas than in urban ones: 29.4 percent and 21.1 percent, respectively. The results suggest that pharmacists could play a major role in increasing vaccination rates in rural areas, especially if they are actively encouraged to do so.

There is a need to do that. The study points out that vaccination rates for pneumonia are 40 percent lower in rural communities than in urban areas: 2.81 percent and 4.66 percent, respectively.

Kentucky's overall pneumonia vaccination rate for seniors was 3.8 percent, with 3.1 percent of the state's eligible population getting the vaccine in rural areas and 4.9 percent in urban areas.

The national rate was 4.26 percent, ranging from 6.3 percent in Colorado to 1.1 percent in Maine.

Why is it important for seniors to get vaccinated for pneumonia? The researchers note that the death rate from pneumonia for seniors doubles, from 20 percent to 40 percent, between the ages of 65 and 85, and despite the recommendation that everyone 65 and older get vaccinated for the disease, fewer than two-thirds do so.

In the interview, pharmacist Smith said patient education and encouragement are important in getting people vaccinated, noting that the Jordan Drug store that provides the most pneumonia vaccines is in a town where the physicians at the local clinic strongly recommend it to their patients.

"The opportunities are there to really move the needle on these vaccinations," said Smith, a founding member of the Kentucky Independent Pharmacist Alliance, which says it represents more than 500 independent pharmacists, with members in all 120 counties.

Smith said she thought pneumonia vaccination rates in pharmacies are likely higher than they were in 2014, since more pharmacies now offer them and people are getting used to the idea that they can go to the pharmacy for them, she said there is room to do more. Jordan Drug didn't start offering vaccinations until 2015.

"I had no idea there was such a difference in the vaccination rate between urban and rural," she said. "So I think we can do more and I think as an independent pharmacy group across the state, being the most accessible health care provider, that we will do more and we will take this study to heart."

Many local, independent pharmacies in Kentucky say they're at risk of closing because they are paid such low dispensing fees by pharmacy benefit managers hired by the managed-care organizations that handle Medicaid. A hard-fought bill to address this issue will go into effect July 1. The new law will put the state Medicaid department in charge of setting reimbursement rates for pharmacists, and require the  pharmacy benefit managers to be more accountable for how they spend the $1.7 billion a year they get to process prescriptions. The bill was sponsored by Sen. Max Wise, R-Campbellsville.

The UK study also measured county-level characteristics associated with pneumonia vaccination and found it more likely with "increasing age of residents, greater proportion of female residents, and availability of inpatient hospital services," and less likely in rural and poor areas.

"Given that over 50 percent of the nation’s primary-care health-professional shortage is in rural areas," the study said, limited access to primary-care providers may limit vaccinations, "resulting in a shift to service delivery in pharmacies, as shown in this study."

The study team was led by UK pharmacy professor Jeff Talbert, director of the UK College of Pharmacy's Institute for Pharmaceutical Outcomes and Policy and associate director of the UK Center for Clinical and Translational Science.