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A shot in the arm for pharmacy

BY Ann Latner

Results from a nationwide survey last year revealed that adults get immunized in pharmacies more frequently than anywhere else, other than physician offices. This should come as no surprise considering the convenient hours, ease of access and frequency of visits to pharmacies. But what is the legal status of pharmacy-based immunization, and what are the roles of the pharmacist?

Status of pharmacist immunizers

Thirty years ago, less than 10 states authorized pharmacists to administer influenza vaccines. By the end of the last decade, all 50 states, plus the District of Columbia and Puerto Rico, allowed pharmacists to immunize. As the numbers of authorizing states has grown, the number of pharmacists getting trained to immunize also has grown. According to the American Pharmacists Association, more than 200,000 pharmacists in the United States were trained to administer vaccines.

State law governs healthcare practice, including immunization practice, and each state has different regulations regarding immunizations. As a general rule, pharmacists have the authority to immunize based on a protocol with a physician — similar to nurses and physician assistants — or by prescription; however, the specifics vary by state, especially with regards to the age of the patient, the immunization process and the particular vaccine. Protocols are basically contracts that specify who has delegated the activity (i.e., a physician), identifies the pharmacist who is authorized by the protocol, states what types of vaccines the pharmacist is authorized to administer and defines procedures and criteria for pharmacists to follow, including when to refer the patient elsewhere and what to do in emergency situations.

Currently, 44 states/territories allow pharmacists to administer any vaccine; South Dakota allows only influenza and zoster (shingles); New York and Florida allow only influenza, pneumonia and zoster; and five other states allow some combination.

The role of the pharmacist
APhA adopted “Guidelines for Pharmacy-Based Advocacy” in 1996, establishing the role of pharmacists in the immunization process. These guidelines were reviewed in 2012 and contain five points:

  • Prevention — Pharmacists should protect their patients’ health by being vaccine advocates;
  • Partnership — Pharmacists who administer immunizations do so in partnership with
  • their community;
  • Quality — Pharmacists must achieve and maintain competence to administer immunizations;
  • Documentation — Pharmacists should document immunizations fully and report clinically significant events appropriately; and
  • Empowerment — Pharmacists should educate patients about immunizations and respect patients’ rights.

APhA identified pharmacists as having three main roles in immunizations. The first is acting as an advocate, and educating and motivating patients to get their flu shot, for example. The second role is as a facilitator — hosting others who vaccinate in the pharmacy. Some pharmacies have done this by inviting nurse practitioners or physician assistants in for a scheduled vaccination clinic. The third role of the pharmacist is as the actual immunizer. Currently close to 20% of adults get their influenza vaccine at the pharmacy, and this number is likely to grow as health care changes.

What does the future hold? Aside from such common immunizations as influenza and pneumonia, we will increasingly see pharmacists immunizing for other diseases — such as zoster, pertussis, tetanus-diptheria, typhoid, chicken pox, hepatitis, meningitis and more. Some pharmacies have travel clinics specifically to immunize patients against travel-related disease, and as new vaccines are developed, such as the HPV vaccination, more collaborative opportunities are created for pharmacists to work with other healthcare practitioners to protect the health of patients.


Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.

 

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Study: Seniors gaining weight at greater risk of dying than seniors already overweight

BY Michael Johnsen

COLUMBUS, Ohio — Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds. According to a nationwide Ohio State University study released Thursday, people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years.

They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

On the other hand, those who started out as very obese in their 50s and whose weight continued to increase were the most likely to die during that period.

Overall, the results suggest that about 7.2% of deaths after the age of 51 are due to weight gain among obese people, at least among the generation in this study, stated Hui Zheng, lead author of the study and assistant professor of sociology at The Ohio State University.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time,” Zheng said.

While some extra weight seemed protective in this study, Zheng cautioned that these results applied only to people over 50. His previous research, published in Social Science & Medicine, suggests that being overweight may not be helpful for younger people.

Why is being slightly overweight protective for older people?

“It is probably because the older population is more likely to get illnesses and disease, especially cancer, that cause dangerous weight loss,” he said.  “In that case, a small amount of extra weight may provide protection against nutritional and energy deficiencies, metabolic stresses, the development of wasting and frailty, and loss of muscle and bone density caused by chronic diseases.”

“Our other research suggests that the negative effect of obesity on health is greater for young people than it is for older people, so young people especially shouldn’t think that being overweight is harmless,” he said.

While slightly overweight people (BMI of 25 to 29.9) whose weight was steady had the highest survival rate, those who moved from overweight to obese (BMI 30 to 34.9) were close behind.

“This suggests that among overweight people at age 51, small weight gains do not significantly lower the probability of survival,” Zheng said.

The third highest survival rate among the six groups was normal weight individuals (BMI of 18.5 to 24.9) whose weight increased slightly, but stayed within normal range.

Next came the Class I obese (BMI of 30 to 34.9) whose weight was moving upward.

Next to last were normal weight individuals who lost weight. Although the study attempted to control for illnesses among those studied, it may be that many of these individuals dropped weight because of illness.

The most obese individuals (BMI of 35 and over) who continued to add weight had the lowest survival rate of the six groups.

There weren’t enough people who started out as overweight and obese and lost weight to include in this analysis, Zheng said.

“We can’t really evaluate the effectiveness of planned weight loss on mortality. Even in the normal-weight people in this study, there was no way to tell whether weight loss was planned,” he said.

Zheng noted that the study took into account a wide variety of demographic and socioeconomic factors that may play a role in both weight and mortality among Americans. The researchers also controlled for whether the respondents smoked, whether they had a variety of chronic illnesses and how they rated their own health. The results stood even after all of these factors were taken into account.

Younger people are less likely to get many of the diseases that afflict older adults, which is one reason extra weight is not good for them, he said.

But Zheng said the main message for everyone, including older adults, is that packing on the pounds, especially if you’re obese, can be hazardous to your health. “Continuing to put on weight can lower your life expectancy,” he said.

This new study was published online this month in the American Journal of Epidemiology


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Prestige Brands solution to pediatric overdosing — unique squeezable, single-dose APAP packet

BY Michael Johnsen

TARRYTOWN, N.Y. — Prestige Brands on Wednesday released PediaCare Single Dose Acetaminophen Fever Reducer/Pain Reliever — the only pre-measured acetaminophen in individual, squeezable packets perfect for anytime dosing, according to the company.

To help educate caregivers about the Single Dose product and offer tips on knowing when a child should be given acetaminophen, PediaCare has partnered with father and pediatrician, Dr. David Hill, author of Dad to Dad: Parenting like a Pro, to develop an informational video on the single dose product.

“Dosing instructions can be confusing for parents," Hill said. “This innovative product takes a trusted medicine and transforms it into an easy-to-use solution.”

PediaCare Single Dose contains the accurate dose for just one treatment and is available in two sizes. The 7.5 mL packet is for children 36-47 lbs. or ages 4 to 5 years, and a 10 mL packet is for children 48-59 lbs. or ages 6 to 8 years. PediaCare Single Dose is specially designed for little mouths to make taking medicine less intimidating, and the squeezable packet helps eliminate spills and creates less mess than a dosing cup. Each packet is child resistant with a fold-and-tear opening process. Caregivers then simply squeeze the medicine from the packet directly into the child’s mouth, similar to the squeezable yogurt and pureed fruit products to which most children have become accustomed.

Child safety was a driving force in the development of PediaCare Single Dose, Prestige Brands reported. Over the counter medications are involved in approximately one-third of emergency department visits among children under the age of 12. Of those visits, 80% of them are due to unsupervised children taking medications on their own and 10% of emergency department visits in this age group are due to medication errors. With only one dose included in each child-resistant packet, the threat of overdosing is greatly decreased.

PediaCare Single Dose Acetaminophen Fever Reducer/Pain Reliever will be available at major retail, mass merchandiser and drug store chains nationwide beginning September 2013.


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