Relationship between pharmacist density and adult influenza vaccination after controlling for individual and neighborhood effects

Objectives: Since 2009, all 50 states have passed legislation to allow pharmacists to administer influenza vaccinations. Pharmacies have become the second most common place for influenza vaccination, after a doctor's office. The aim of this study was to provide nationally representative results on the relationship between pharmacist density and influenza vaccination after controlling for both individual-and county-level characteristics. Design: Retrospective data analysis with the use of merged individual data from the 2008-2012 Behavioral Risk Factor Surveillance System (BRFSS) and county data from the 2010 Area Health Resources Files. Sample-weighted multivariate logistic models were estimated to predict influenza vaccinations with the use of number of pharmacists per 1000 population as the key predictor. Setting and participants: BRFSS is a telephone-based national survey across 50 states. A nationally representative sample of 1,696,119 adults 18 years of age and older were included in this analysis. Results: The number of pharmacists per 1000 population was associated with higher odds of influenza vaccination (adjusted odds ratio [AOR] 1.13, 95% confidence interval [CI] 1.11-1.15) and was significant for non-Hispanic whites (AOR 1.06, 95% CI 1.04-1.08) and Hispanics (AOR 1.35, 95% CI 1.24-1.48). It varied across county types and employment status. The largest effects were found in urban counties (AOR 1.16, 95% CI 1.11-1.21) and among the self-employed (AOR 1.18, 95% CI 1.10-1.26), homemakers (AOR 1.18, 95% CI 1.10-1.26), and the retired (AOR 1.18, 95% CI, 1.14-1.22). Conclusion: Pharmacists play an important role in influenza vaccination and are an important alternative to traditional settings such as doctors' offices and health clinics. Future research is needed to investigate reasons and barriers behind their different effects in different regions and population groups. By covering in-pharmacy vaccinations in health plans and removing other barriers, pharmacists can help to alleviate the shortage of other health care providers and help increase vaccination rates. (C) 2017 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.