UTHSC College of Pharmacy, Kroger Health partner to improve shingles vaccination completion rates

The College of Pharmacy at the University of Tennessee Health Science Center has partnered with Kroger Health, the healthcare arm of The Kroger Co., on a nationwide, randomized controlled study across more than 2,200 community pharmacy locations to improve second-dose vaccination completion rates for the shingles vaccine. Elements of the project are funded through a grant from GlaxoSmithKline.

Shingles is a viral infection that causes sharp pain accompanied by a painful blistering rash caused by the varicella-zoster virus, the same virus that causes chickenpox. The virus lies dormant in individuals who've had the chickenpox, and years later may reactivate as shingles. An estimated 1 million cases of shingles are reported each year in the United States, most commonly in people over the age of 50.

The Centers for Disease Control and Prevention recommends the SHINGRIX vaccine, by GlaxoSmithKline, for adults over 50. The vaccine is administered in a two-dose series in the upper arm and is 90 percent effective at preventing shingles in clinical trials. After the first dose is administered, there is an eight-week to six-month window for the patient to complete the second dose for optimal effectiveness. College of Pharmacy faculty involved in the study collaborated with Kroger Health to build and test two complementary interventions. The first is a clinical decision support tool within the pharmacy software system that will "nudge" the pharmacist to provide the second-dose recommendation to patients. The second intervention is timed motivational text messages sent to patients at defined intervals in order to remind them when the second dose is due.

The automated, personalized text messages are customized using new technology developed by the College of Pharmacy in collaboration with Kroger Health's program development team and 84.51° data scientists. The capabilities were built within the existing software system used in Kroger Health pharmacies. The text messages use behavioral health theory to motivate, educate, and engage patients to complete their second dose in the vaccine series.

This technology we are using is extremely innovative. Patients may forget they are due for their second dose and it may not be a priority for them to remember. We know from other vaccines that the second dose is just not completed. This technology hasn't really been used in pharmacies. As community pharmacists increasingly take on new clinical roles it's important to leverage technology to make those new roles feasible within their busy workflow. In this study the software will 'nudge' pharmacists at the point of service to recommend and provide the second vaccine dose based on eligibility criteria and date of last dose. The automated text messages complement this by both reminding and engaging patients. It's based in behavioral health theory and will make patients think about their health in ways that they normally wouldn't. It's interactive...it's almost a conversation.

Kenneth Hohmeier, PharmD, associate professor and Director of Community Affairs, UTHSC College of Pharmacy

People like feeling engaged and connected to others through technology, and we think through texting, since it's ubiquitous, quick, simple, and cheap, you are able to get messages out to a wide range of people easily. The hardest part is trying to craft impactful messages in 160 characters that work well, but if you are good at it, then it can have really cost-effective impacts on patient behavior.

Dr. Justin Gatwood, PhD, MPH, assistant professor, UTHSC College of Pharmacy

At Kroger Health, our mission is to simplify healthcare by creating solutions that combine health, wellness and nutrition, connecting with patients on a personal and emotional level. Combining an associate-facing clinical decision support tool with a customer-facing text message is an innovative way to not only encourage vaccine series completion, but to also help patients feel connected to their healthcare providers. This study is a step in the right direction toward a solution to the problem of vaccine adherence that ultimately improves individual and population health. Our strategic partnership with UTHSC and GSK demonstrates a shared goal to reduce vaccine-preventable disease and furthers our vision at Kroger Health, to help people live healthier lives.

Jim Kirby, Senior Director of Kroger Health Services

The study will evaluate the effectiveness of the two technologies, as well as assess its implementation process to accelerate its scalability. The pharmacist recommendation portion was rolled out nationwide, followed by a multi-phase rollout of the text messaging component. This will allow investigators in the UTHSC College of Pharmacy to look at the marginal impacts that the technologies have on vaccine completion.

Investigators from the UTHSC College of Pharmacy include Justin Gatwood, PhD, MPH, assistant professor, Kenneth Hohmeier, PharmD, associate professor and director of Community Affairs, and Tracy Hagemann, PharmD, professor and associate dean. The study team also includes Chi-Yang Chiu, PhD, assistant professor in the College of Medicine, and Sujith Ramachandran, PhD, an assistant professor at the University of Mississippi School of Pharmacy.

Results of the nationwide study are expected in 2020.

"The UTHSC College of Pharmacy is invested in what community pharmacists can do for public health," Dr. Hohmeier said. "Tennessee has a large amount of urban and rural underserved areas. Community pharmacies are an underutilized access point and we are making great strides to help community pharmacists deliver the patient care services they are trained to deliver as the most accessible health professional in the country. Kroger Health is committed to their mission to simplify health care and is a leader in this space, offering a wide range of convenient, quality patient care services right in the patient's home community. We hope this is just the beginning in a long partnership with Kroger and other pharmacies who have a desire to take a bigger role in serving public health through community pharmacy patient care access."

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