Presentation Type
Oral Presentation
Category
Social Sciences/Humanities
Abstract/Artist Statement
Pharmacy-based immunization (PBI) has been heralded as a barrier-reducing way to immunize Americans and reach public health targets. PBI programs vary by state; some states prohibit child vaccination in pharmacies while others allow pharmacists to prescribe and administer immunizations to persons of any age. Pediatricians are concerned generous PBI programs may boost vaccination rates at the cost of well-child visits, an unacceptable tradeoff they argue. This is logical when considered in the lens of economic theory regarding health investments; parents may see PBI as an alternative to the doctor’s office rather than as a complement and choose to immunize their adolescent at the pharmacy and forego any kind of well-child visit. Adolescents are already a group disproportionately disconnected from healthcare and missed well-child visits can be detrimental to adolescent health. Pediatricians seeking to practice the best care for their patients and public health advisors seeking to recommend the best policy for the public need to know if the benefits to PBI outweigh the costs. This study estimates the effect of state PBI policies on state-level adolescent 11–12-year-old well-child visitation rates to provide quantitative data to inform the debate between immunization access and comprehensive care.
This study takes advantage of the natural experiment presented by differing state PBI policies. I used secondary data from the Centers for Disease Control National Immunization Survey-Teen 2019 and provider density data from the Association of American Medical Colleges along with primary PBI age restriction data gathered from Policy Surveillance Program, LexisNexis, and Justia Law to estimate the effect of state PBI laws. I generated estimates using probit regression to compare the proportion of adolescents that received well-child visits in states with PBI against states without PBI for adolescents. I also conducted other estimation strategies to test the robustness of the results.
This investigation fills multiple gaps in the literature; it investigates the understudied adolescent population, quantifies the importance of PBIs for adolescents, and addresses concerns about access to health care. This question of PBI influence on well-check visits has only been studied in the context of adults. This is a unique contribution applying economic theory on health investments to an unstudied population to quantify a concern of healthcare providers. A finding of either increased visitation rates or decreased visitation rates is significant, indicating either PBI supports public health community vaccination initiatives expansive PBI or should concern public health officials or. Preliminary regressions indicate a null finding, which undermines the argument that PBI lowers well-child visitation rates and alleviates concerns about the costs of expanded PBI.
This work is especially important in the context of the Department of Health and Human Services emergency authorization order allowing vaccination of patients of all ages for all indicated vaccines at pharmacies from 2020 to 2024. The findings of this study have implications for the future of immunization strategies for adolescents in pharmacies and beyond by providing evidence to the debate between access and comprehensive care.
Mentor Name
Katrina Mullan
Personal Statement
This work is important as a narrow research question with broad implications for public health policy. Immunizations are among the top ten public health achievements of the 20th century, but despite the benefit to individuals and society immunization rates do not meet public health targets. In conducting my research for this study, I gained a comprehensive understanding of what is known about determinants of vaccination uptake. This research led me to one key determinant of vaccination: access. If parents want to vaccinate their children, they must first have access to vaccination services, regardless of philosophical leanings or personal hesitancy. Pharmacy-based immunization removes one barrier to vaccination for the benefit of parents, children, and the community by creating a convenient access point to vaccination that can save parents time and act as a gateway to comprehensive medical homes. The potential of pharmacies to provide frontline healthcare has become evident in the last two years. Quantifying the costs and benefits of greater utilization of pharmacies as healthcare providers by reaching into historical data on adolescents is beneficial for the future of public health policy. This research required me to employ all the skills I have learned in my graduate program at the University of Montana. In this research, I used quantitative and qualitative methods, created primary data sources for future researchers to use in addition to investigating secondary data sources, and explored research from fields beyond economics like epidemiology, immunology, pediatrics to inform my methods and conclusions. Executing this project has trained me in the ways of thinking necessary to conduct worthwhile research that has influence beyond meeting degree requirements. Sharpening these skills through this research has prepared me for a profession in health economics research and public health policy, readying me to continue the body of work I have started at the University of Montana.
Avery_GradCon
PHARMACY-BASED IMMUNIZATION LAWS AND ADOLESCENT WELL-CHILD CHECKUP TRADEOFFS: RESULTS FROM THE NIS-TEEN
UC 327
Pharmacy-based immunization (PBI) has been heralded as a barrier-reducing way to immunize Americans and reach public health targets. PBI programs vary by state; some states prohibit child vaccination in pharmacies while others allow pharmacists to prescribe and administer immunizations to persons of any age. Pediatricians are concerned generous PBI programs may boost vaccination rates at the cost of well-child visits, an unacceptable tradeoff they argue. This is logical when considered in the lens of economic theory regarding health investments; parents may see PBI as an alternative to the doctor’s office rather than as a complement and choose to immunize their adolescent at the pharmacy and forego any kind of well-child visit. Adolescents are already a group disproportionately disconnected from healthcare and missed well-child visits can be detrimental to adolescent health. Pediatricians seeking to practice the best care for their patients and public health advisors seeking to recommend the best policy for the public need to know if the benefits to PBI outweigh the costs. This study estimates the effect of state PBI policies on state-level adolescent 11–12-year-old well-child visitation rates to provide quantitative data to inform the debate between immunization access and comprehensive care.
This study takes advantage of the natural experiment presented by differing state PBI policies. I used secondary data from the Centers for Disease Control National Immunization Survey-Teen 2019 and provider density data from the Association of American Medical Colleges along with primary PBI age restriction data gathered from Policy Surveillance Program, LexisNexis, and Justia Law to estimate the effect of state PBI laws. I generated estimates using probit regression to compare the proportion of adolescents that received well-child visits in states with PBI against states without PBI for adolescents. I also conducted other estimation strategies to test the robustness of the results.
This investigation fills multiple gaps in the literature; it investigates the understudied adolescent population, quantifies the importance of PBIs for adolescents, and addresses concerns about access to health care. This question of PBI influence on well-check visits has only been studied in the context of adults. This is a unique contribution applying economic theory on health investments to an unstudied population to quantify a concern of healthcare providers. A finding of either increased visitation rates or decreased visitation rates is significant, indicating either PBI supports public health community vaccination initiatives expansive PBI or should concern public health officials or. Preliminary regressions indicate a null finding, which undermines the argument that PBI lowers well-child visitation rates and alleviates concerns about the costs of expanded PBI.
This work is especially important in the context of the Department of Health and Human Services emergency authorization order allowing vaccination of patients of all ages for all indicated vaccines at pharmacies from 2020 to 2024. The findings of this study have implications for the future of immunization strategies for adolescents in pharmacies and beyond by providing evidence to the debate between access and comprehensive care.