This story is based on real events:
I attempted to make a flu shot appointment with my internist on 3 separate occasions and hung up each time after being on hold for over 5 minutes each time. I was able to get through finally on my 4th attempt, but although my physician’s website stated “vaccinations” were part of her services and her priority was “preventative care”, she didn’t have any immunizations in her inventory.
Clearly this doesn’t make sense.
The ideal place to receive immunizations is in the physician’s office. This is an opportunity to develop relationships with patients when they are well. This strategy of course is more human, but simultaneously builds a more meaningful story in the patient’s medical record and leads to improved patient retention.
An additional reason a physician’s office is the best place to receive this scope of care is general medical care competence. Although pharmacies carry and administer some immunizations, and is a better option than not getting the vaccines at all, I’m not sure a fainting or anaphylactic shock episode would be best “handled” by a pharmacy tech. Granted, this isn’t a common occurrence but what about dosage and administration, storage and handling?
While waiting recently in a large chain pharmacy advertising immunization services, I inquired if they gave Zostavax for shingles. The pharmacy tech replied they did have Zostavax in their inventory but I’d have to “wait 1 hour for it to defrost.” What?!! Didn’t they read the prescribing information? This essential information, MDs know as a “detail”, is reviewed by professional representatives when meeting with physicians, not something done as frequently with pharmacists.
Case in point: Zostavax should be immediately reconstituted upon removal from the freezer and administered immediately after reconstitution. Please refer to section 2.2 in full prescribing information. http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf
Since it’s National Influenza Week, let’s return to the Influenza vaccine quest. After listening, unvaccinated no less, to the recent CDC Influenza health advisory telebriefing, I had to get my flu shot. To avoid the flu as well as avoiding being a hypocrite I caved and got it at a pharmacy. It wasn’t planned, I just happened to be in a large warehouse store that had a get your “flu shots here” banner. Understanding that immunization opportunities shouldn’t be missed, I was in a hurry and how hard could a flu shot be for a pharmacy tech? I stepped up to the window.
As soon as I requested the flu shot I wanted, FLUZONE quadrivalent I realized this person might be confused. There is after all a great variety of flu vaccine options today in modern medicine. The tech said they did have Fluzone HD but I was too young to get that. Yes, true although that’s not the vaccine I requested, I was glad he knew the age indication for FLUZONE HD. I tried again, it’s the FLUZONE quadrivalent I wanted, no they didn’t have the “quadrivalent” just the standard. I asked if they had Flumist thinking that might be simpler since Flumist only comes quadrivalent. No, they didn’t have Flumist (LAIV) either. Oh well, it will have to be IIV3 not IIV4 this year.
While pulling up my sleeve I asked where the pharmacy tech received his training on this immunization procedure. He replied by asking if I wanted the head pharmacist to give it to me. “No, it’s ok, I just wanted to know how you got your training?” He replied that the store sent him somewhere. I gave up the inquisition for more specifics in order to avoid distracting him.
Fortunately, I did survive in the end, I didn’t bleed profusely, get an embolism or go into shock or anything, not that I really expected to but I wasn’t entirely confident.
I departed the designated “shot area” and reviewed my paperwork. After all that…they didn’t even give me FLUZONE! At least it was a flu shot, it just happened to be another manufacturer’s brand! Perhaps I deserved it for being so selective, next time I’ll ask to see the vial – or – better yet, help my internist order some vaccines for her practice. Adult immunizations rates can be improved and competent delivery is important to the ultimate goal of disease prevention.