UCSF

OBJECTIVE: This study describes the implementation of a brief tobacco cessation intervention (Ask, Advise, Refer: AAR) into routine vaccination workflows. METHODS: Using a convergent mixed methods approach, data were collected from 10 community pharmacies in (independent, hospital outpatient, and chain locations) via electronic documentation during vaccine administration and semi-structured interviews with pharmacy staff. The Consolidated Framework for Implementation Research served as a framework to guide qualitative interview coding and analyses, and quantitative data were analyzed descriptively. Findings were triangulated following the analyses. RESULTS: Pharmacy staff members (14 pharmacists, 3 pharmacy technicians) participated in interviews and electronic intervention documentation was submitted by 8 of the 10 pharmacies. Participants found the AAR intervention to be appropriate, feasible, and compatible with existing vaccination workflows. Seven of the 10 pharmacies included a question about tobacco use on their vaccine intake forms, capturing the tobacco use status in 987 patients (73%). However, staff noted that individuals receiving for vaccines tended to be more health-conscious, limiting the reach of the intervention to individuals who use tobacco. Quantitative data confirmed this, with 6% of screened patients reporting tobacco use. Asking about tobacco use on both the intake form and verbally appeared to be the most effective method of identifying individuals who use tobacco. Other facilitators noted during interviews included having a designated vaccination room and strategic placement of materials to enhance reach. Factors identified to support continued delivery included additional staffing during busy times and leveraging other appointment-based services in the pharmacy. CONCLUSION: Despite a limited reach, pharmacy personnel reported that that it was feasible and acceptable to integrate AAR into routine vaccine workflows. Future work should examine other workflow points to expand reach in community pharmacies.