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ASHP Supports Addition of Pneumococcal Vaccine Measure to HEDIS 2001

Noting that the pneumococcal vaccine measure proposed by the National Committee for Quality Assurance (NCQA) fits well with pharmacists' ongoing efforts to increase immunization rates, ASHP provided comments on the proposed Health Plan Employer Data and Information Set (HEDIS) for 2001. The new performance measure, Pneumonia Vaccination Status for Older Adults, will evaluate the percentage of Medicare beneficiaries age 65 and older who report having received the pneumococcal vaccine. NCQA says that the final version of HEDIS 2001 will be available in July.

March 23, 2000

Daphney Paul
Measures Development
National Committee for Quality Assurance
2000 L Street, NW
Suite 500 

Washington, DC 20036 

Dear Ms. Paul:

The American Society of Health-System Pharmacists (ASHP) is pleased to provide comments on the National Committee for Quality Assurance’s draft specifications for HEDIS 2001. ASHP is the 30,000-member national professional association that represents pharmacists practicing in health maintenance organizations, hospitals, long-term care facilities, home care agencies, and other components of health care systems.

ASHP is very supportive of the proposed HEDIS 2001 new measure – Pneumococcal Vaccination Status for Older Adults. Pneumococcal disease results in more deaths than all other vaccine-preventable diseases combined. Potentially half of these deaths could be prevented through the use of vaccine. The pneumococcal vaccine is underused in that it is estimated to be administered to less than 30% of individuals greater than 65 years old. Therefore, ASHP encourages vaccination of all persons at-risk for acquiring pneumococcal disease. Furthermore, vaccination may potentially reduce further development of penicillin-resistant strains. Pharmacists play an active role in identifying at-risk patients and advocating pneumococcal vaccinations for these patients.

Pharmacists promote immunizations through a variety of methods. Pharmacists work on various committees with other healthcare professionals to assist in the development of policies and procedures to improve pneumococcal immunization rates. Pharmacists also educate other health professionals about the importance of pneumococcal vaccination. Pharmacists use opportunities such as National Pharmacy Week and National Adult Immunization Week (each in October) to further promote immunization. Adhesive warning labels that read, "You may need pneumonia or flu vaccine: ask your doctor or pharmacist," are affixed to prescription labels of at-risk patients. Prescription bag "stuffers" are used to provide information on immunization. Lists of at-risk patients are generated in order to send postcards or letters to patients urging them to check with a health care professional about pneumococcal vaccination. Pharmacists volunteer to speak at local organizations and support group meetings to increase awareness about immunization. Thirty states have laws and regulations that include administration of vaccines within a pharmacist’s scope of practice. While pharmacists as immunizers may not be feasible in all practice settings, it is an option for some pharmacists as a way to promote immunization. Pharmacists act in a variety of roles as educators, facilitators and/or immunizers to help ensure the aging population gets vaccinated, particularly against pneumococcal disease.

In 1998, the ASHP Research and Education Foundation, with an unrestricted educational grant from Merck Vaccine Division, embarked on a multifaceted public health initiative in the area of immunization advocacy. The program, Protecting Our Elderly: Pharmacists as Immunization Advocates, is aimed at enhancing the role of health-system pharmacists in improving immunization rates of elderly patients who receive health care services in integrated health systems throughout the United States. ASHP offers an Action Kit for pharmacists with information resources to assist in implementing and promoting immunization programs. In addition, ASHP provides other educational materials published in the American Journal of Health-System Pharmacy, such as Health-system pharmacists’ role in immunizing adults against pneumococcal disease and influenza, which has been included for your review.

We urge NCQA to consider the impact of pharmacists’ involvement in instituting comprehensive vaccination programs with the intent of decreasing the morbidity and mortality associated with invasive pneumococcal disease. Vaccines are drugs. It is the responsibility of pharmacists to assist patients in the appropriate use of drugs. In addition, pharmacists are one of the most accessible health care professionals. Therefore, the public can benefit from pharmacists providing information and access to immunizations.

ASHP appreciates the opportunity to provide comments to NCQA on proposed measures for HEDIS 2001. If we can be of further service in this matter or others relating to quality in health care, please contact us.


Henri R. Manasse, Jr., Ph.D., Sc.D.
Executive Vice President and Chief Executive Officer 

Enclosure:AJHP Supplement to September 1, 1999, issue