Allowing pharmacists to give more vaccines to children became a debate about access versus the fracturing of health care Tuesday in the House Health and Human Services Committee.
House Bill 2646 drew support from pharmacist associations while groups representing doctors opposed it, citing concerns about record-keeping and continuity of care.
HB 2646 would allow properly certified pharmacists to administer all vaccines to children 6 and older, opening the possibility of a slate of adolescent shots being given at a pharmacy rather than a doctor’s office. Infant and kindergarten vaccines would not be included.
Pharmacists can administer the flu vaccine to children 6 and older and can administer any vaccine to adults, according to the bill’s fiscal note.
According to the Kansas Pharmacists Association, the goal of the bill is to increase access to vaccines. In 2012, two counties didn’t have a single physician serving them and seven didn’t have any primary care physicians, according to the Kansas Department of Health and Environment.
Lis Houchen, a representative from the National Association of Chain Drug Stores, cited a 2004 study in her written testimony that said vaccination rates were higher in states that allowed pharmacists to administer vaccines. The study looked at rates of influenza vaccines for patients over the age of 65.
She said the more flexible hours and increased access through pharmacists could raise vaccination rates in Kansas.
Low rates of vaccination
Kansas lags the rest of the nation for coverage rates of three recommended adolescent vaccines, which the bill would allow pharmacists to administer.
The federal Centers for Disease Control and Prevention recommends four vaccines for teens: Tdap, meningococcal, human papillomavirus (HPV) and the flu vaccine. Kansas is about 5 percent behind the national average for the Td or Tdap vaccine, but the gap is worse for others, according to data from the CDC’s 2014 National Immunization Survey.
The state lags the national average — 24.8 percent for Kansas to the nation’s 39.7 percent — and all but three states for girls receiving all three shots of the HPV vaccine series. For boys, the Kansas rate is 19.5 percent who complete the series versus 21.6 percent nationwide. Kansas ranks last in the nation, at 38.3 percent, for the rate of girls who get at least one shot in the HPV series.
HPV can cause a number of cancers, according to the CDC.
Increased access or fractured care
During the hearing, doctor associations raised concerns that patients wouldn’t come in for examinations if they were able to get immunizations from a pharmacist. Vaccinations are an important reason to get children in the office for care, they said.
Wakon Fowler, a physician from Pratt who testified on behalf of the Kansas Academy of Family Physicians, said his concern wasn’t about the qualification of the pharmacists but the importance of providing consistent care.
“When you have a home base, it tends to give Kansans better care, and it costs less,” Fowler said.
Physician input is important, according to written testimony from the Kansas Medical Society, because there are multiple vaccinations for each illness. The group, which represents Kansas physicians, said the optimal time and type of vaccine can vary depending on the patient.
Another concern from doctors was communication between the pharmacy and physicians. The bill requires any pharmacist administering vaccines to report the vaccination to the patient’s primary care physician and “appropriate county or state immunization registries.”
But the vaccination wouldn’t be immediately entered in the patient’s electronic medical record, according to the Kansas Medical Society and Rep. Barbara Bollier, a Republican from Mission Hills and a retired doctor.
“We absolutely need them (the pharmacists giving vaccinations) reporting to a central registry,” Bollier said. “Otherwise, you’re going to have excess immunizations because no one is going to know who gave what to who or when they gave it.”
In her written testimony, Houchen said the ability to go to a pharmacist for immunizations wouldn’t take away from physicians’ ability to care for their patients.
“This is to enhance what they do and to provide a setting where families who either don’t have time, perhaps don’t have health care, perhaps have a health savings account, where they can go see a pharmacist for the immunizations,” she said.