Use of Pharmacy Data Reporting to Explore Community Uptake of Flu on Call™ in Milwaukee County

BACKGROUND: The National Association of County and City Health Officials (NACCHO) has been a key partner in the development of Flu on Call™ since 2011. Flu on Call™ is a pandemic influenza capability that establishes a national network of telephone triage lines. During an emergency, the Centers for Disease Control and Prevention (CDC) makes the decision to activate Flu on Call™ and then states choose to “opt in”. In some states, emergency declarations may enable Flu on Call™ clinicians to prescribe antiviral prescriptions, when appropriate. These prescriptions would then be sent directly to a pharmacy located near the caller. Because the Flu on Call™ demonstration project took place during seasonal flu response, no antiviral recommendations or prescriptions were on offer. That said, NACCHO chose to explore whether any Flu on Call™ callers ultimately received an antiviral prescription from a provider, or, in the case of well patients, received an influenza vaccine. METHODS:  NACCHO worked with the Pharmacy Society of Wisconsin to select 12 outpatient and/or retail pharmacies in Milwaukee County to report antiviral prescription and vaccine data throughout the project. Three multi-location pharmacies were selected: Aurora Pharmacy (6 locations), Hayat Pharmacy (4 locations), and Froedtert Pharmacy (2 locations). These locations were high-traffic and evenly distributed across Milwaukee County. Between January 11^th and February 18^th, the 12 pharmacy locations provided: A) Daily reports on their antiviral drug inventories. Using a simple form, pharmacists indicated the number of on-hand boxes they had for four formulations of Tamiflu and one formulation of Relenza. Pharmacists also provided a supply estimate for how long this inventory would last (between 0 and 48 hours). B) Weekly reports on the total number of Tamiflu and Relenza prescriptions filled in the prior week. C) A weekly tally of patients that had received an antiviral prescription or flu vaccine and had also heard of or used Flu on Call™. Any patient that had an antiviral prescription filled or received a flu vaccine at a participating pharmacy was asked if they had heard about Flu on Call™ or used Flu on Call™ services. Their answers were recorded on cards, which were delivered to NACCHO at the end of the project. The weekly antiviral prescription reports were compared to health department flu surveillance data. Participating pharmacies’ 2015 antiviral prescription data was used as a baseline.  No patient information was collected and all data was aggregated. RESULTS: While the reporting sample size was small, the participating pharmacies provided sentinel data that offered insights into community uptake of Flu on Call™.  CONCLUSIONS: Pharmacies, vaccine clinics, and other entry points to care can provide important information on the uptake of public health resources, as well as useful sentinel surveillance data. During future testing of Flu on Call™, patient follow-up through pharmacies, vaccine clinics, etc. will be one way to assess the reach of Flu on Call™ and whether patient behavior was influenced by the recommendations of Flu on Call™ information specialists and medical providers.