Abstract
Vaccinations are among the most effective measures at preventing the spread of infectious diseases. Pharmacists in Poland were authorized to administer protective vaccinations in 2021. The study aims to research patient experience with vaccinations in connection with pharmacist assistance of pharmacists. This study was conducted in Polish community pharmacies among patients who had received such a vaccination. The research tool was a questionnaire consisting of questions on patient satisfaction and some personal data. Ultimately, 342 patients take part in our research. All respondents believe that vaccinations administered in pharmacies are a convenient form of preventive care. The respondents also appreciated the qualifications and skills of the pharmacists in administering the vaccine and indicated that they would use the pharmacy vaccination service again. Patients utilizing the opportunity to receive vaccinations at the pharmacy were satisfied with the quality of service provided by the pharmacists. They emphasize the convenience of this service and appreciate the pharmacists’ qualifications. The vast majority of the respondents think that the role of pharmacists in delivering protective vaccinations should be expanded.
Introduction
Vaccinations are considered the most effective way to combat infectious diseases. 1 Yet, many patients are reluctant or refuse to be vaccinated,2,3 typically from a low awareness of the benefits of vaccinations or poor access to this service. 4 In Poland, since the COVID-19 pandemic, special attention has been placed on increasing access to preventive vaccinations and the possibility of becoming vaccinated at the most convenient time possible in order to increase vaccination coverage levels. 5
In 2021, pharmacists were authorised to deliver vaccinations. Previously, this service had been provided mainly by nurses, following qualification for the vaccination by a doctor. Currently, pharmacists are authorised to vaccinate against COVID-19 and influenza. The condition for obtaining these qualifications is to complete a special training course in preventive vaccinations and to obtain a certificate.6,7
This situation is significant as pharmacists make up a high percentage of medical staff in Poland. The number of community pharmacies per 100 thousand inhabitants in Poland is 32, which is considerably more than in many OECD countries (28/100 thousand). 8 The high availability of pharmacies increases the ease and access to vaccinations. 9 Many authors have emphasised the significant role of pharmacists in public health protection, eg in relieving the system from the burden of protective vaccinations.10–12
In considering the increase in qualifications of pharmacists delivering protective vaccinations, we decided to carry out a study evaluating patient satisfaction with such vaccinations.
Material and Methods
The study was approved by the Bioethics Committee of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw (decision No. KBT - March 3, 2021).
The study was conducted from May to September 2021 in approximately community pharmacies located in different regions of Poland that had applied to join the national pharmacy vaccination programme. Pharmacies were recruited for the study from those subscribed in the Polish Pharmacist Vaccinate Forum (www.farmaceuciszczepia.pl). The respondents were patients who used the vaccination service provided by those pharmacists.
The survey was fully anonymous. The research tool was a proprietary questionnaire developed for the purpose of this study, comprising 9 questions on patient satisfaction with the vaccination, their COVID-19 symptoms, any adverse events after the vaccination, as well as some personal data.
Following a vaccination at the pharmacy, patients over 16 years of age were given the opportunity to participate in the study. 342 patients agreed to participate in the study and signed an informed consent.
Statistical Methods
Statistical analyses were performed using the statistical suite STATISTICA version 13.0 (StatSoft. Inc. 2017) and Excel.
Quantitative variables were characterised by the arithmetic mean of the standard deviation or median or max/min (range) and 95% confidence intervals. The qualitative variables were presented with the use of count and percentage.
In order to check if a quantitative variable derives from a population of normal distribution, a W Shapiro-Wilk test was used. To prove hypotheses on the homogeneity of variances, Leven (Brown-Forsythe) tests were utilized. To dependence, strength, and direction between variables, correlation analysis was used by determining Pearson or Spearman correlation coefficients. In all the calculations, a statistical significance level of p = 0.05 was used.
Results
Characteristics of the Research Group
The study group gender distribution was 61% male and 39% female. The mean age of the respondents was 35.6 years. A similar number of respondents lived in cities below 200 thousand inhabitants (33.1%) and in cities above 500 thousand inhabitants (34.8%). Practically half of the respondents declared that they were single (48.5%). Nearly 40% of the respondents had higher education, with a similar percentage having secondary education (Table 1).
Characteristics of the Study Group.
Patient Satisfaction with Vaccinations in Community Pharmacies
All respondents believe that vaccinations administered in pharmacies are a convenient form of preventive care. The respondents also appreciated the qualifications and skills of the pharmacists in administering the vaccine and indicated that they would use the pharmacy vaccination service again. (Table 2).
To What Extent Do You Agree with These Statements (1 – Strongly Disagree; 5 – Strongly Agree)?.
A similar percentage of men and women (almost 95%) strongly agreed with the statement that “Getting vaccinated by a pharmacist is convenient” and that “pharmacists possess the relevant skills to administer vaccinations”. Regarding the statement “If possible, I will get vaccinated by a pharmacist again”, 91.30% of men and 93.23% of women strongly agreed, while with the statement “I would like pharmacists to administer other vaccinations in the future”, 89.32% of men and 87.22% of women strongly agreed. Respondents with a primary education less frequently than others strongly agreed with the examined statements, while among respondents with secondary and basic vocational education, the highest percentages of “strongly agree” responses were observed. All respondents who were divorced strongly agreed with the examined statements. Respondents living in cities with a population above 500 thousand inhabitants most often strongly agreed with the examined statements, while among individuals residing in cities with a population of 200–500 thousand inhabitants, such a response appeared the least frequently. None of the described relationships were statistically significant.
In the previous 6 months, 9.1% of the respondents had developed symptoms of COVID-19 (Table 3) – fever (48.0%), loss of smell/taste (35.5.%), flu-like symptoms (29.0%) and a cough (16.1%). SARS-CoV-2 had been detected in 6 out of 31 respondents with COVID-19 symptoms.
Information on COVID-19 and Vaccinations.
In the previous 6 months, 5% of the respondents took sick leave due to coronavirus symptoms, with a mean length of 11.9 days (SD = 8.1).
About 1% of the respondents experienced adverse events following the vaccination: fever (75.0%) and a sore arm (25.0%).
Respondents who had not developed any symptoms that could indicate COVID-19 in the previous 6 months more often strongly agreed with the examined statements. The Pearson's Chi-squared test indicated that this relationship is statistically significant for the statements “If possible, I will get vaccinated by a pharmacist again” (p = 0.00) and “I would like pharmacists to administer other vaccinations in the future” (p = 0.00). The V. Cramer's tests revealed that both first relationships were rather weak.
Individuals who had taken sick leave due to symptoms in the previous 6 months more frequently agreed with the examined statements, however, this relationship was not statistically significant. Regarding the statement “I would like pharmacists to administer other vaccinations in the future”, it was primarily agreed upon by individuals with no adverse events following the vaccination. The Pearson's Chi-squared test showed that this relationship was statistically significant (p = 0.00), and the V. Cramer's test indicated that this relationship was moderately strong.
Discussion
This study indicates that Polish patients are very satisfied with vaccinations delivered by pharmacists. The results show that nearly all the patients emphasize the convenience of these vaccinations and are of the opinion that pharmacists possess the relevant skills to provide these services. The respondents also appreciated the qualifications and skills of the pharmacists in administering the vaccine and indicated that they would use the pharmacy vaccination service again.
Our studies coincide with previously published results regarding patient experience with vaccinations in vaccination centers, 13 where nearly 97% of the respondents indicated that vaccinations administered in pharmacies are a convenient form of preventive care. The respondents also appreciated the qualifications and skills of the pharmacists in administering the vaccine and indicated that they would use the pharmacy vaccination service again.
Another study carried out in Poland by Grzegorczyk-Karolak I et al among patients vaccinated by pharmacists indicates that 94.5% of Polish people were satisfied with the vaccinations delivered by pharmacists. More than 98% of the patients felt safe while getting a vaccine, while nearly 90% indicated that they would like to become vaccinated in a pharmacy again. The respondents named availability connected with convenient pharmacy locations and opening hours as the greatest advantages of vaccinations. More importantly, the patients were very satisfied with the information provided by pharmacists on vaccinations and vaccination techniques. 14
In France, 99% of patients are of the opinion that vaccinations in pharmacies are significantly more available than those delivered in outpatient clinics. The study on satisfaction with vaccinations administered by pharmacists showed that the mean patient satisfaction was 4.92 out of 5.00, so nearly all the patients were satisfied. What is more, the patients expressed their willingness to have additional vaccinations delivered by pharmacists. 15
Similarly, a study on satisfaction with COVID-19 vaccinations delivered in pharmacies carried out among 427 patients in 11 pharmacies in Germany revealed that 91.5% of the respondents were very satisfied, and 7.8% were satisfied with the service. The respondents were particularly satisfied with the quick visit to the pharmacy, short waiting time, the information received in the pharmacies and the feeling of safety while getting the vaccine. 10
Similar results were obtained by researchers in other countries, where patient satisfaction was above 99%. The patients appreciated first and foremost the easy access to vaccinations delivered by the pharmacists. They also emphasised that the service was less stressful, and that the pharmacists possessed the relevant knowledge and competence to perform this service.16,17
Authorising pharmacists to administer protective vaccinations during COVID-19 was a response to the intensive and effective activities of pharmacists to minimise the spread of the pandemic.18,19 The high availability of pharmacies and pharmacists in this particular period, giving information on appropriate health behaviours, providing personal protective equipment and preventing medical disinformation are only few examples of pharmacists’ activities in public health protection during the pandemic.10,20,21
There is a high probability that better access to vaccinations in pharmacies can increase vaccination coverage levels against infectious diseases.4,15,22 It is extremely important that pharmacists authorised to provide vaccinations are well prepared for this service. 23 Currently, pharmacists in Poland who would like to perform vaccinations are obliged to complete a training course that consists of theoretical and practical parts. Reducing organisational barriers is also significant,24,25 eg a dynamic change of legal acts with clear interpretation of the scope of services.
In many countries, vaccinations delivered by pharmacists have been practised for many years and are appreciated by patients due to the availability and convenience. 23 This approach is of particular importance in high-risk populations, eg among elderly people and patients with multiple diseases. Providing availability (primary health care physicians who qualify for vaccinations and nurses who deliver vaccinations) in areas where access to outpatient clinics is difficult is also significant.
Limitations of the Study
Like all studies, this study has its limitations. First of all, we are aware that the sample of patients in this study is not representative. The pharmacies that participated in this study were not representative either, eg with respect to location (cities and towns). We also realise that the range of questions in the questionnaire was limited. We tried to concentrate on the most important issues connected with satisfaction with vaccinations and formulated the questions in such a way that patients could answer them relatively quickly following vaccination. Expanding the questionnaire with other questions, eg reasons for choosing pharmacies to become vaccinated or evaluating the conditions of vaccinations (pharmacy equipment, maintaining privacy) could provide a significantly broader picture of the subject matter of the research.
Conclusions
Patients utilizing the opportunity to receive vaccinations at the pharmacy were satisfied with the quality of service provided by the pharmacists. They appreciate the convenience and access to this type of services, as well as pharmacist competence. The majority of the patients would like to become vaccinated in the pharmacy again. The respondents also stated that they to a large extent supported expanding pharmacist qualifications in delivering vaccinations.
Footnotes
Acknowledgements
Not applicable.
Authors’ Contributions
A. Study design/planning: UR, PM;
B. Data collection/entry: UR, PM;
C. Data analysis/statistics: AB;
D. Data interpretation: AB, KW, UR, MB;
E. Preparation of manuscript: UR, RV, JK, MB, EB, BC, JP, AB, KW, ANP, KPR, KFS,PM
F. Literature analysis/search: AB, KW;
G. Funds collection: not applicable
Data Availability Statement
All data are available from the corresponding author.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Institutional Review Board Statement
The study was approved by the Bioethics Committee of the National Geriatrics, Reumatology and Rehabilitation Institute in Warsaw (decision no. KBT - 3/3/2021).
Informed Consent Statement
Written informed consent was obtained from all participants.
