In light of recent research documenting elderly patients’ hospitalization patterns, a University of Wisconsin pharmacy professor partnered with a Milwaukee pharmacy to launch an immunization project geared toward cognitive-issue patients and their caregivers.
UW pharmacy Professor Betty Chewning partnered with Hayat Pharmacies, a chain of 19 pharmacies in Milwaukee, to initiate Immunize Wisconsin. The project will mobilize pharmacists to increase immunizations for homebound patients, specifically patients struggling with the challenges of dementia and Alzheimer’s disease.
Chewning said the project’s two main goals are to provide immunizations to low-income residents with increased vulnerability and “refine and test” a sustainable model for pharmacists to deliver immunizations to patients who may have difficulties due to cognitive issues.
The School of Pharmacy’s 2015 Lemberger Report motivated Chewning to start looking at how pharmacists could make a difference in older patients’ access to immunizations. The comprehensive report on health issues in Wisconsin captured an epidemic within older populations’ hospitalization rates due to lack of immunizations for preventable illnesses.
“I was surprised to see bacterial pneumonia was the second most frequent ambulatory [care] sensitive diagnosis at hospital discharge,” Chewning said. “Pharmacists are trained to give immunizations for adults and can do so without a physician prescription in most cases. Yet, aside from the flu, pharmacists tend not to offer immunizations to that many individuals … a person doesn’t have to go to a clinic, and instead can take advantage of the accessibility of pharmacies.”
According to the report, almost one in every three hospitalizations of patients 65 and older were because of bacterial pneumonia. A closer look at the study reveals the cause of such high hospitalization rates: depending on the county in Wisconsin, bacterial pneumonia immunization rates ranged from 70% to just 30% in some areas.
Hayat chief clinical officer and UW-Madison Pharmacy School alumna Dimmy Sokhal is a key player in Milwaukee working with Chewning. Sokhal said adding pharmacists to the equation is key to increasing immunization rates and lowering hospitalization rates for highly contagious illnesses like influenza and bacterial pneumonia.
“Pharmacists have [vaccinations] available,” Sokhal said. “Through this project, we wanted to bring it out that for the patients that were not usually able to make it to their clinics and schedule an appointment, there is this service that is under utilized where a pharmacist can help.”
As Sokhal and Chewning highlighted, patients with cognitive issues and their caregivers face specific challenges making them the primary focus of Immunize Wisconsin. UW freshman Olivia Van Hammond worked with patients in the dementia unit in Appleton as a full-time CNA in a nursing home. Van Hammond said the patients with Alzheimer’s had behaviors and mobility restrictions which made it much more difficult to care for them.
“I thought that I would be prepared for it. My grandma had Alzheimer’s, and I thought that it wouldn’t be much different taking care of them than other residents,” Van Hammond said. “I was very wrong.”
UW freshman and CNA Larissa Blazek also worked with dementia and Alzheimer’s patients. Her experiences mirror Van Hammond’s as she explained the difficulties that can arise when working with Alzheimer’s patients.
Blazek said that Alzheimer’s patients were more likely to lash out or be frightened by different environments.
“A lot of times [Alzheimer’s patients] think they are younger than they are,” Blazek said. “So when they can’t walk by themselves, you have to use a gait belt to help them and sometimes they need two people to help them or a lift. But they don’t remember that.”
Van Hammond said the cognitive short-term memory issues make it difficult to ensure they take the medication they need. Blazek also highlighted that not every patient with Alzheimer’s reacts the same way and that communication between caregivers is a strenuous but necessary task to ensure caregivers meet their patients’ individualized needs.
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Van Hammond also said many caregivers are already overworked in nursing home scenarios, making it difficult to differentiate early on between symptoms of the common cold or something like bacteria pneumonia that vaccines could easily solve. Chewning’s personal experience as a caregiver also serves as a motivation and sense of understanding to reach out to dementia and Alzheimer’s community.
“As a caregiver myself with a husband who has dementia, I can tell you that many caregivers have little time except for the most urgent medical tasks,” Chewning said. “Particularly if the loved one with dementia and/or Alzheimer’s can no longer move safely except in a wheelchair it is all the harder to transport someone to a clinic which makes the in-home care option all the more attractive.”
Sokhal said Hayat’s ability to reach patients through home visits and their use of existing relations will be valuable components in reaching the target groups to eliminate barriers for these patients.
Chewning said Hayat’s mobility and connections in the community make them an essential partner in the project.
“Hayat Pharmacy is unique in that it makes home visits to offer medication therapy management services and at the same visit as a result of our project would have the opportunity to offer immunizations,” Chewning said.
Since the project launched in September, the UW School of Pharmacy and Hayat have also worked with the Alzheimer’s Association Wisconsin Chapter and the Muslim Community and Health Center to reach out to potential clients. Chewning said the goal is to immunize 200 people 65 and older and 200 of their caregivers 30 or older during the flu season.