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Projected outcomes of an expanded role for pharmacists in publicly funded immunization services in New Brunswick

Category(s): Health
Status: Closed
Principal: Chris Folkins
Project Number: P0071
Year Approved: 2021
Year Completed: 2022

Project Description

To ensure efficient use of healthcare resources, it is critical that health service delivery models evolve in parallel with changing scopes of health professional practice. A key area of opportunity in this regard is the expanding scope of pharmacy practice, which is increasingly overlapping with physician scope of practice. One of the most significant areas of overlap is the prescribing and administration of vaccines. NB legislation has permitted pharmacists to administer vaccinations to patients aged five or older since 2010, and to independently prescribe vaccines to these patients since 2014. Pharmacists are currently only reimbursed by the province for influenza immunization and must charge patients directly for service fees and drug costs associated with any other vaccinations, including other publicly funded vaccines which are available to patients at no charge from physicians and nurse practitioners (NP). These circumstances present a strong financial disincentive for patients to make use of pharmacist vaccination services, which effectively limits the ability of pharmacists to exercise their full scope of practice and creates an additional barrier to the otherwise improved accessibility to immunization that pharmacists provide. Including pharmacists as reimbursed service providers for publicly funded vaccines other than influenza would be expected to yield cost savings for the province, reduce burden on other practitioners, and improve access to health services for patients. We will use administrative data to evaluate the anticipated impact of expanded public funding for pharmacist immunization services in terms of health care costs, time savings for other practitioners, and patient access to services. 

Comparative analysis of physician service billing data from before and after the introduction of legislation permitting immunization by pharmacists, as well as data from the NB Prescription Drug Program (PDP), the Drug Information System (DIS), and the Public Health Immunization Solution (PHIS), will provide insight into the public usage of pharmacist immunization services for both influenza and other publicly funded vaccines. Expected usage of an expanded publicly funded pharmacist immunization program will be estimated by applying historical proportional usage of pharmacist influenza immunization to recent physician service volumes for other candidate vaccines. The estimated accompanying decrease in physician/NP service volumes will be used to project time savings for these practitioners. Direct cost savings associated with the shift in usage from other practitioners to pharmacists will be estimated based on current reimbursement values for influenza immunization. We will also explore the potential for improved primary care access and consequent indirect cost savings associated with offloading of physician/NP duties permitted by expanded pharmacist reimbursement. Impact of an expanded pharmacist immunization program on public access to vaccination will be estimated based on observed changes in overall influenza vaccination rates following introduction of influenza immunization by pharmacists. 

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