Across the United States, including St. Albans, Vermont, a shortage of Shingrix Vaccine has left many patients without effective protection from shingles. The purpose of this project was to identify how patients could obtain the vaccine within a reasonable amount of time, and avoid being placed on long wait-lists at pharmacies. Four different pharmacies in St. Albans were contacted. Pharmacists and pharmacy technicians explained what patients can do to receive the vaccine with less hassle. These tips will be given to patients in handouts at NOTCH along with information about the significant benefits of Shingrix vs the previous Zostravax.https://scholarworks.uvm.edu/fmclerk/1554/thumbnail.jp

Hussein, Ibrahim Sobhi-Luther

English

UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2019Availability of Shingrix Vaccine in St. Albans and itsBenefits vs ZostavaxIbrahim Sobhi-Luther HusseinUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationHussein, Ibrahim Sobhi-Luther, "Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax" (2019). Family MedicineClerkship Student Projects. 485.https://scholarworks.uvm.edu/fmclerk/485Availability of Shingrix Vaccine in St. Albans and its Benefits vs ZostavaxIBRAHIM HUSSEINST. ALBANS, NORTHERN TIER CENTER FOR HEALTH (NOTCH)JUNE 2018MAX BAYARD MDProblem Identification◦ Shingrix vaccine is in a shortage across the United States, including St. Albans and parts of Franklin County. [1]◦ Often patients complain of their inability to acquire the vaccine during regular appointmentsat NOTCH. Although they have a prescription, pharmacies lack a sufficient quantity of ShingrixVaccine and waitlists for the vaccine become long, leaving patients waiting several months.◦ The purpose of this project is to identify the shortage of the new Shingrix vaccine in St. Albans, Vermont. This will provide patients with helpful information on how to acquire the new vaccine the quickest way possible.Problem Identification (cont.)◦ This is a problem for the St Albans community because Shingrix is significantly more effective than Zostavax as the old vaccinations efficacy wanes with time and advanced age. [2]◦ Shingrix vaccine can be given to immunocompromised patients as it is an inactivated vaccine, whereas the Zostavax vaccine is a live virus vaccine. It’s also significantly more effective. [3]◦ Patients who don’t report a past episode of varicella should still receive the Shingles Vaccine if they are older than 50. [3]Public health cost15.6% of people in St Albans are over the age of 65 (age 50 being the age the CDC recommends to start vaccination). [2]1 out of 3 people will have a shingles outbreak in their lifetime. [4]10-15% of patients who have an episode of shingles will experiences symptoms of postherpetic neuralgia. [4]The annual health care cost of treating herpes zoster is $1.1 billion in the United States, with patients over 50 years old being the most effected population. [6]Intervention and Methodology◦ Pharmacies will be contacted around St. Albans and Franklin county to identify the shortage and wait time for patients to receive the Shingrix vaccine. Information on how to acquire the vaccine most effectively will be collected and given to patients.◦ A handout containing evidence-based information and scholarly journal articles providing information about Shingrix vaccine and its benefits vs Zostavax. ◦ Because vaccination recommendations start at age 50, a handout will be more helpful for some patients who aren’t familiar with using the internet to filter information.Community Perspective on Issue and Support for Project◦ Matt (PharmD) is a pharmacist in St. Albans. He states there’s a shortage of Shingrix because of back order on the vaccine. He states at his pharmacy in St. Albans, they reserve 2 doses of the vaccine for each patient, so they don’t need to be placed on a second wait list after their first dose. He states his current wait list is 22 people and none can receive the vaccine at the moment because shipment is only available in bulk order. He recommends patients call weekly to their pharmacy to see if their stocked, and getting their names onto the waitlist as early as possible.◦ Allison (pharmacy technician) says at her pharmacy in St. Albans orders as much Shingrix vaccine as they’re allowed too. They prioritize patients based on medical reasons. Those patients who need the vaccine are put at the beginning of the list. Patients who are waitlisted for a second dose are also prioritized over patients who are receiving their first dose. She states the current wait list at her establishment is 100+ patients.◦ Jesse (Pharmacy technician) says patients at his pharmacy only have 10 days to receive their vaccine after they are called from the waitlist. If they don’t arrive within 10 days, they lose their spot on the wait list. This can cause an issue for patients with ◦ Sam (PharmD) states that at his pharmacy in St. Albans, they receive Shingrix from other regional stores. Because of this, they have no waitlist. He recommends calling multiple locations before putting ones name on a waitlist to obtain the vaccine the quickest.Results/Response DataTips to obtain the Shingrix Vaccine quickly in St. Albans:◦ Call your pharmacy and ask if they have the vaccine in stock. If not stocked, secure a place on the waitlist or try calling other pharmacies.◦ Obtain first and second doses at the same facility. Patients receiving their second dose have a higher priority on the waitlist after receiving their first dose; some pharmacies will reserve your second dose.◦ Call your insurance provider; ask if they cover the vaccine. Medicare part D covers the cost of the vaccine or you may be eligible to be reimbursed based on your insurance provider, whereas Medicare part B does not cover the cost. [3]◦ Letting patients know they should receive the Shingrix Vaccine even if they have already gotten the Zostavax (although they should wait at least 8 months before receiving Zostavax before receiving Shingrix). CDC reports Shingrix being 97% effective after 2 doses, and reports Zostavax vaccine as only 51% effective. [3]◦ If you have an underlying medical condition is present, consult a physician to increase your chances of receiving higher priority for the vaccination. [3]Evaluation of effectiveness and limitations ◦ Not all patients who receive healthcare from NOTCH live within a 15 mile radius, which is location the pharmacies in this project were contacted.◦ The handout from this project was only distributed to NOTCH clinic. Only patients receiving health care from this practice have access to the handout.◦ Some pharmacies have a policy where patients must get their shot within 10 days of receiving a phone call from the wait list. If the patient does not arrive, they lose their opportunity to receive the vaccine. Many of these patients live in places without reliable public transportation, don’t drive, or have trouble transporting themselves.◦ Shingrix is a 2-part shot, so patients should be reminded to return after their first dose. (2-6 months after the first dose) [5]◦ Not all patients will ask for information about the Shingrix Vaccine. Recommendations for future interventions/projects◦ Creation of a list with restocking dates of vaccine in St. Albans pharmacies.◦ Adding to the NOTCH EMR a notification for providers to offer vaccine to patients over 50.◦ Prioritizing pharmacies in the EMR based on vaccine availability. ◦ Collect information about the vaccine shortage in other neighboring counties.◦ Creation of a log with updated pharmacy policies and information regarding vaccine distribution frequency.◦ See research from other states where shortage was recorded and their responses to it.◦ Interview patients to better understand their needs in obtaining the vaccine including the patient’s perspective and their understanding of the virus.References1) “Current Vaccine Shortages and Delays | CDC,” April 9, 2019. https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html.2) “Rankings | County Health Rankings & Roadmaps.” Accessed June 13, 2019. https://www.countyhealthrankings.org/app/vermont/2019/measure/factors/53/data.3) “Fact Sheet: Get the New Shingles Vaccine If You Are 50 or Older | Herpes Zoster | CDC,” February 11, 2019. https://www.cdc.gov/shingles/fact-sheets/shingles-factsheet-adults.html.4) “Shingrix Shingles Vaccination | What You Should Know | CDC,” May 30, 2019. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html.5) “Herpes Zoster Shingrix Vaccine Recommendations | Shingles | CDC,” April 15, 2019. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html.6) Yawn, Barbara P., Robbin F. Itzler, Peter C. Wollan, James M. Pellissier, Lina S. Sy, and Patricia Saddier. “Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population.” Mayo Clinic Proceedings 84, no. 9 (September 2009): 787–94. https://doi.org/10.1016/S0025-6196(11)60488-6.Consent FormThank you for agreeing to be interviewed. This project is a requirement for theFamily Medicine clerkship. It will be stored on the Dana Library ScholarWorkswebsite. Your name will be attached to your interview and you may be citeddirectly or indirectly in subsequent unpublished or published work. Theinterviewer affirms that he/she has explained the nature and purpose of thisproject. The interviewee affirms that he/she has consented to this interview.Consented: Yes (Verbally consented over the phome)Name: _____Matt_________________________________________________________Name: _____Allison_________________________________________________________Name: _____Jesse_________________________________________________________Name: _____Sam_________________________________________________________

Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax

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Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax

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