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Shared Clinical Decision-Making and the Pharmacist's Role

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Recent changes to childhood vaccine recommendations have introduced shared clinical decision‑making for several immunizations that were previously universally recommended, creating confusion among patients and providers alike. This course explains what shared clinical decision‑making means in the context of immunizations, examines how it affects pediatric vaccine discussions, and highlights opportunities for pharmacists to support informed, individualized conversations with patients and caregivers. You will gain clarity on how to apply shared clinical decision‑making principles—alongside proven health coaching strategies—to strengthen patient trust and foster more meaningful dialogue in pharmacy practice.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Elizabeth Skoy, PharmD, RPh
Professor
North Dakota State University

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The GameChangers Clinical Update Series for Pharmacists delivers 52 expert-led podcast episodes and 30+ hours of clinically actionable continuing education, all for a one-time purchase of just $99—that’s less than $3 per hour for high-impact learning you can apply immediately in practice. Click here to enroll. 


PRACTICE RESOURCE
Receive the exclusive Practice Resource to use as a reference guide for this episode by purchasing the GameChangers Clinical Update Series.

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation to claim credit:


 CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe shared clinical decision-making and how it applies to recent pediatric vaccine recommendations.
2. Identify the pharmacist's roles in counseling, education, and facilitating shared clinical decision-making conversations with patients and caregivers. 

Rachel Maynard and Elizabeth Skoy have no relevant financial relationships with ineligible companies to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-26-077-H01-P
Initial release date: 3/2/2026
Expiration date: 3/2/2027
Additional CPE details can be found here.

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Welcome And CE Credit Reminder

SPEAKER_00

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop for listening? You can earn state credit for this episode and hundreds more. Hey CE Impact subscribers, welcome to the Game Changers Clinical Update podcast. I'm your host, Rachel Maynard, and today we'll be discussing the critical issue of shared clinical decision making for immunization, a topic that affects patients and pharmacy teams across the country on a daily basis. This is coming up even more often now because earlier this year, the Centers for Disease Control and Prevention, or CDC, made a number of revisions to the pediatric immunization schedule, including that shared clinical decision making would now be used for certain pediatric vaccines that were previously routinely recommended for all children, including influenza, COVID-19, and several others. But these changes have raised a lot of questions and confusion from patients, parents, and pharmacy teams. So I'm very excited to have an expert in this area, Dr. Elizabeth Skoy, to help us walk through practical advice for managing this confusion and addressing common questions. So welcome, Elizabeth. So happy to have you. Thanks for having me. I'm happy to be here. Excellent. And I know you've done a number of podcasts with us before. And so listeners may be familiar with you, but for those who aren't, could you just share a little bit about your background, your current role, and why you're interested in this topic?

SPEAKER_02

Yeah, so I'm a faculty professor at the School of Pharmacy at North Dakota State University. I'm also a community pharmacy pharmacist currently, and have that's always been my practice area. I really have done a lot of work in the area of vaccination, you know, with training pharmacists and pharmacy technicians and preparing them to provide vaccines, as well as just kind of becoming an expert in that space of vaccine hesitancy and healthcare recommendations and things like that. More recently, until the ACIP was overturned with the new administration, I was a member of the ACIP workgroup for adult RSV vaccine. I was the appointee from the American Pharmacist Association to stand on that working group. And so I worked on that work group for adult RSV vaccine for a few years. And so got a really wonderful experience and kind of that in-depth behind the scenes look at how vaccine decisions used to be made in our country. And so, yeah, and so just kind of you know have a lot vested in a lot of interest in research area in this particular topic. So I always like to like to talk about things like this.

SPEAKER_00

Excellent. Well, we are so happy to have your practical expertise and also your expertise on the sort of back-end side of things and knowing how operations were. So yeah, that's great, great perspective to bring to this discussion. And I think, you know, to start things out, one of the most important things that we just need to get on the same page with is what is shared clinical decision making? What does it mean in the context of vaccinations and just describing where that definition comes from and what we need to think about in terms of the context there?

Pharmacists’ Role And ACIP Context

SPEAKER_02

Yeah, so the topic of shared clinical decision making isn't necessarily new to vaccination. We've had that as a recommendation from the ACIP previously, uh, before, you know, more recently with the recommendations for broader, broader application of shared clinical decision making. But shared clinical decision making is really having, you know, I always like to say there's two experts in the room and they both have equal power. And so when we talk sometimes about, you know, in the in the scope of healthcare, a lot of times the healthcare professional, whether it's the pharmacist or a medical doctor, might be the ex, you know, have a higher level of expertise in that room. And so they're the ones that are making a recommendation to a patient. The patient is expected to accept that recommendation. If they don't accept that recommendation, then sometimes we go through processes of like medical, you know, motivational interviewing to get them to accept the recommendation that we have. This is a little bit of a different approach in the fact that when you are doing true shared clinical decision making, there's two experts in the room at equal power. The patient is the expert in their life and their circumstances and their values and goals. And then the the pharmacist or the you know other provider is the expert in the healthcare part of things. And so um, there have been times that shared clinical decision making and that recommendation have been previously applied to vaccination. And you know, so you know, some of those have been like historically the HPV vaccine for individuals 27 through 45, um the hepatitis B vaccine for individuals 60 plus with diabetes, or just a couple of recommendations. But then, you know, as you as you kind of previously mentioned, some newer recommendations from the CDC have put a broader context as to how that's going to be applied to vaccines.

SPEAKER_00

So that's a that's a great overview. And I I think one thing that you highlighted is that pharmacists are one of these healthcare providers that can be involved in the shared clinical decision making. It could be any, you know, the healthcare provider in general, but pharmacists are one of those healthcare providers, the medication experts that have that expertise, and they can be one of that the medical expert with the patient expert coming to that discussion. Is that right? 100%. Yeah.

CDC Pediatric Shifts Vs AAP Schedule

SPEAKER_02

And so, and that we're you know, explicitly mentioned in the CDC's definition of shared clinical decision making. So of individuals or healthcare professionals that can participate in shared clinical decision making, pharmacists are specifically mentioned in there as one of those that can do that and should be doing that. You know, another just kind of a note too, as we're talking about this, that you know, the term shared decision making gets a little confusing, but the shared the term shared decision making has really been around for a number of years. Almost, you know, almost 20 years it's been kind of utilized in the literature and as as an application to care. Historically speaking, I think the area that is probably the most most documented would be in oncology, where you have, you know, there's different treatment options and you are working with the patient to kind of figure out what their goals are, what's important to them, and quality of life versus you know, morbidity versus mortality, that type of a thing. And then you're coming together to make a decision. When shared clinical decision making came and was used as from the ACIP as one of the recommendations, it's kind of inserted the word clinical or you know, C the word you know, C in there as a way to do that. And so when they created that definition as one of the three options for vaccine recommendation, pharmacists were specifically mentioned it there. So just to really, like you said, really highlight that, especially since this is our audience as pharmacists today, that yes, you are you are just as equal as everyone else, the medical doctors, omnish practitioners that are going to be providing that service to patients.

SPEAKER_00

Absolutely. And super important that they highlighted that too, because pharmacists are one of the main providers of immunizations in the US. And so recognizing I remember when that term was first sort of coming out and there was a lot of confusion around do we qualify? And the answer is yes. So just to just to make that clear, I think that's great. So what sort of prompted this topic was the change in pediatric recommendations from CDC. And as I mentioned, a lot of the recommendations that were routinely recommended for pediatric patients in the past are now under this shared clinical decision making sort of model. And so maybe you could actually clarify that too. What is the difference between what does that mean between now that we have say influenza COVID used to be routine, now there's shared clinical decision making? What is the difference? That that means that patients and clinicians now have to have this conversation before the vaccine is given, or what is what exactly does that mean and how does it compare to what they were before?

Evidence-To-Recommendation Framework Changes

SPEAKER_02

Yeah, so I think maybe to take just one step back, you know, and for the audience that's listening right now, you might already be aware of this, but it's really interesting to me how many, how many individuals, patients, as definitely patients as well as healthcare professionals, even just look at the CDC schedule every year, get the updates, and then they're like, oh, good to go. Okay, now that's the new update, and they move on, without kind of having that more behind the scenes aspect of things. And so since I was on the ACIP work group for RSV delay um RSV vaccine, I was able to really see the in live, you know, how the CDC had previously made recommendations. And that was using utilizing a framework called evidence to recommendation. There were very specific questions. I'm not going to go through it all right now, just probably for time for the podcast. And it's probably something that would be better to be re read or reviewed, but looking at very in-depth evidence for a number of questions as to like the morbidity and mortality of a disease in a certain group and population, um, the, you know, as to like the effectiveness of the vaccine, the side effects of that vaccine, and really making a very strong, you know, strong evidence-based recommendation to have that appear on the schedule. And and especially with newer vaccines, and we probably can remember this with the adult RSV vaccine, sometimes that evidence changes. So when the adult RSV vaccine came out, you guys can probably remember there was shared clinical decision making attached to that vaccine. And then it came to a regular recommendation. There's three recommendations typically that have historically been provided by the ACIP. The first is the evidence, a first recommendation is just like the blanket recommendation, meaning in a certain age group or say a certain patient population, everyone should get vaccinated. The second would be a catch-up, um, individuals who haven't been vaccinated, or if there's a better newer vaccine out, you know, how to get them that vaccine recommendation. And then the third is the shared clinical decision making. And historically speaking, that shared clinical decision making has been made when the evidence to recommendation just isn't strong enough to do a blanket um you know, vaccine recommendation to an age group. So, example, I think that probably pharmacists are the most familiar with, probably, you know, for widely speaking, might be the HPV vaccine for that 27 to 45 years old or potentially the HP or I'm sorry, the hepatitis B vaccine for 60 plus diabetics. You know, when we're looking at those recommendations, it means that we don't want to exclude them from the opportunity to get vaccinated because there's some people that will very greatly benefit from this vaccine, but the evidence is not strong enough to to um to vaccine an entire group or population. Okay. So I like to put that in our like, you know, in a bucket in our brain right now. So that's the historical context, right? So evidence to recommendation has not been the evidence has not been there to show that you should vaccinate an entire group or population. So when these newer recommendations have come out, the CDC with the new um ACIP structure from the CDC director and the the secretary of HHS for the US, Secretary Kennedy, they, as you probably, you know, all the listeners know, have they replaced the ACIP and then they ended up kind of going away from the evidence to recommendation framework. So when these newer recommendations came out for influenza, you know, for pediatric for, oh, well, you know, shared clinical decision making, you know, COVID-19, and we're going through those, there wasn't an evidence to recommendation framework. There wasn't that evidence. There wasn't the, well, why? You know, what what why is that? What's the evidence behind that? Whereas historically speaking, you can look at the evidence to recommendation framework for those other previously recommended vaccines and you know exactly why. So if I'm having a conversation with a patient who's, you know, hasn't been vaccinated with the HPV vaccine, and they're, you know, 30 years old and they've been married for, you know, the last, you know, 12 years of their life, and they, you know, have had, you know, normal cervical cancer screenings and they've had very few like previous sexual partners, they're probably not qualified. That like the shared clinical decision making between me and that patient, it would be surprising to me if when we talk together that we would get two vaccinations. We might, you know, she might say, well, you know, I might get divorced in a few years, or I, you know, who knows what that might be. Um, and so, but this isn't the case. We don't have that. And so that's kind of where this has put us in a really unique situation, that these this recommendation is there. And so how we really apply that into practice is kind of a a little bit yet to be determined.

SPEAKER_00

Okay. Okay, that's that's good perspective. Good to hear that clarification. Um, because as you said, part of that discussion is around benefits, risks, assessing individualized preferences, and and how that all ties in with the patient. So that does make it challenging. So I guess to to sort of provide context too, we still do have American Academy of Pediatrics AAP recommendations for pediatric vaccinations as well. And maybe you can just speak to what those look like and how they compare to the updated CDC recommendations, any things, any key things for us to be aware of there.

Applying SCDM In Pharmacy Practice

Three-Talk Model For Vaccine Conversations

SPEAKER_02

Yeah, so the AAP schedule, which has really been endorsed by most medical groups as well as the American Pharmacist Association, that schedule is the previous schedule, right? It's the schedule we had, you know, a year ago. Like, for instance, influenza, everyone for six months and older. Um, and so it kind of puts, I think for the first time in a long time, although there's been some disagreements maybe between some medical groups and the CDC in the past, but for the most part, the schedule has been endorsed and come to terms with, or maybe like slight, you know, slight statements made from groups. But this is kind of the first time that a whole that I've that I've been around where a whole new schedule has been approved from various organizations. So I think as pharmacists to know that that's happening, right? To know that maybe medical providers, you know, pharmacists might want to be considering to follow that American, you know, Academy of Pediatrics schedule and knowing why that is, you know, and I think that background where I would just say that, you know, we don't have the evidence as to why all of a sudden we wouldn't blanket, you know, vaccinate every child six months and older with influenza vaccine. We we don't have the evidence to that. Personally, if there's evidence for why not, I would love, I would love to see that. You know, I'd love to see an ETR framework of that. And then that kind of changes the game if you have experts looking at that and saying, oh, wow, okay. Um, but we don't really have that. And so I think that's, you know, without talking with every member of those organizations that made those decisions, you can kind of imply that that's kind of where we are and why we're there right now as to why so many groups are looking at that schedule. So I think for our listeners uh with the podcast, that you know, what that means for you as a pharmacist is that that might be a difference in, for instance, if you have a standing order or a state protocol that only allows you to follow the CDC's schedule, right? You have to know that your state or your what you know what is allowing you and binding you to to vaccinate in your state is going off of you know a CDC schedule. But you also have to know that if you have like a more of a you know collaborative practice agreement, that that medical professional who might sign off in that probably practice agreement for six and older has the backing of the medical community to make that decision as well. So, you know, just depending upon how you vaccinate under what laws and legality within your own state and how you're prescribing vaccinations within your state. So know that. Now, also the CDC has said that all vaccine coverage will not go interrupted, at least in through December. And so, meaning that there's not going to be a denial for someone to get a vaccine, you know, a child, like for instance, a child if they're two years old and get an influenza vaccine, there shouldn't be a denial from that from the CDC said that what happens after that, we don't know. Also, we don't know if certain provider or certain insurance companies might require some sort of additional documentation, an attestation, maybe that um that shared decision making has taken place. That's really going to be dependent upon the you know third party. But at least what we saw with you know some of the the changes in recommendation from COVID vaccine uh this last year, most insurance companies were still paying for that without without hesitation, at least from my personal experience, what I saw was just probably because they realized that vaccinating is going to be a lot less expensive for them as a th as a payer than than having to hospitalize somebody with with you know COVID-19, for instance, or any other infectious diseases or you know, so it's kind of where we're at. It's a I wish I had answers. I wish I could say this is exactly what we need to do and how we need to do it, but this is kind of as we've experienced in the last couple of years, a little bit of unprecedented territory of what it's going to look like.

Workflow, Time, And Billing Realities

SPEAKER_00

Yeah. Yeah. Okay. Well, I think you brought up a couple really important points that it is important to know how you're vaccinating, what you're using to vaccinate, what authority you have, and and what that's following. Because if it is following CDC, then that means, you know, you have to think about how this shared clinical decision making fits into your authority to vaccinate. But it may or may not, depending on your state and your standing order or collaborative practice agreement. So you sort of have to know your specifics there. And also the insurance coverage is not something we expect to be infected, but sort of just need to be aware of potential considerations maybe down the road there. But I, you know, I think I think that's helpful perspective to understand why uh the shared clinical decision-making concept, we need to be aware of it, despite the differences in those sort of groups of vaccine recommendations. But we are often having discussions with patients around vaccinations in general and and sort of wing, especially in, you know, with a lot of questions about vaccines coming up recently in general, we are often having these discussions anyway. And so maybe we can be thinking about how how this fits into practice and what we are already doing and how we can just sort of optimize what we're already doing to ensure that we are doing this shared clinical decision making. So maybe we can walk through a little bit more of that specifics around the process and what that conversation looks like with patients. Is there sort of a structure we can follow or like a step-by-step process that we can be thinking about? Well, how how what does this look like when you're actually talking with a patient?

Access, Stocking, And Staying The Course

SPEAKER_02

Yeah. And so I think it's going to vary a little bit, and especially when we have vaccines that have it'll be interesting because you know, you have vaccines that haven't had the the shared clinical decision making attached to them in the past, and then now all of a sudden we are, right? And so how does that how does that work? Um, I think one way to to kind of be aware is that, you know, historically, I'm gonna just go to influenza because I think it's probably the most common, obviously, that you know, we we vaccinate with in pharmacies and for that age group. And in the past, a patient would come in and you would say or caregiver would come in for a pediatric patient and you would say, Oh, you know, you know, Rachel hasn't received their vaccine yet today. Um, so it's it's time for them to get their influenza vaccine. And would you like to get that today? Kind of that presumptive approach that they're going to be vaccinating. You're really following shared clinical decision making. If you're actually following the process, that's not what we would do. And so, you know, there again, if you're following the AAP schedule, then you would say time for your vaccine. And but if you're following more of that shared clinical decision making recommendation, um, there needs to be an open dialogue and conversation, and it does take a little bit more time. I would say that you can still be the expert in that conversation when the patient is there, right? So you can still say, you know, based off of kind of, I'd like to have a conversation that we should have a conversation today about you know, Rachel getting the influenza vaccine based off of you know their risk and whatever, you know, I think that they should get that. You know, what are and you can ask them, you know, kind of what their their thoughts are and risks are. Now, again, without evidence to recommendation, it's really hard to have a true shared clinical decision making because I don't know what would put that child, you know. I'm saying Rachel, obviously you're not a child, but I I don't know what would not put them at risk for influenza. I don't have evidence to tell me like what wouldn't, but you can still have that conversation with them and be that expert and say, you know, you based off of the evidence that you're aware of, they should get the, you know, you think they should get the vaccination. And There any reasons that you know they feel like they shouldn't get the vaccine um and they can share that expertise with you. Or do you feel like there's any reasons why they wouldn't be at risk? And you can kind of share that that conversation back and forth and then go ahead and and come to a conclusion together on what should be done. Um, you know, there's a there's a model that's been used in the literature for a really long time. It's been around now for almost a decade and has been kind of you know cited the most of all the models, and it's called the three-talk model. And it's pretty easy to follow. That's why I like it. It's three-talk model, but it's having a conversation of a patient with team talk, meaning like both parties come together as a team and they talk about the decision that needs to be made and about their own experiences and goals. Then you have option talk, which is okay, now that I have that information, what are your options? And then decision talk and having that go through. So if you're following that model with maybe something like a pediatric influenza vaccination, coming together as a team and having that conversation with the parent or caregiver, that you should, it's that time of year and they should decide. Um, you know, you together should decide whether or not that child's going to get vaccinated. That would be like a decision talk and identifying if there's any reasons that they feel like they shouldn't get vaccinated and you sharing, you know, potentially what it is that you know they should do, and their options are either vaccinated or not vaccinated, and then decision coming together whether or not they should be vaccinated or not. So if you're following like a true shared clinical decision making, that's that's kind of that process.

SPEAKER_00

Okay. So I it's helpful to hear sort of that model a team talk, decision talk or team talk, action, option talk, and then decision talk. Okay, team talk, option talk, decision talk. Right, that makes sense. Okay, so working through that is sort of your framework to follow, that's helpful. And you mentioned that that might take a little bit more time. So how any sort of best practices for having that conversation efficiently or you know, how do how to how to fit that into workflow?

Rural Access And Identifying At-Risk Patients

SPEAKER_02

Yeah, so I definitely think that having I you know, personally speaking, you know, I think one of the challenges that we've had with shared decision making is the the differences in you know EHRs and software systems as to how they're flagging shared decision making recommendations. So I personally I hope that we continue to flag those these pediatric patients as people that we should be talking to with for vaccination or their caregivers. But then I think workflow is you know, having, you know, this isn't something where, again, you have maybe the pharmacy technician at the checkout and saying, Oh, it looks like you're we have a note here that you're due for your influenza vaccine. We can get that for you right now today. It's not, it's not that easy. It is more of a, oh, we have a note here that the pharmacist wants to talk to you about influenza vaccine. Can I have them come over and talk with you about it? One of the challenges with that is that it does take more time. It, you know, it's been documented in the literature, at least for when physicians were were surveyed as to shared clinical decision making versus non-90% said it took more time, and which we can see, right? I mean, we just gave two examples and one's gonna take more time. It's not um it, but at the same time, it doesn't have to take, you know, 20 minutes, it can be a few minutes. Um, I think one of the challenges, again, that we have as pharmacists, and even providers sometimes have this challenge is that you don't get paid for that time always. So as a pharmacist, we don't get paid typically for that time. Some states, and North Dakota is one of these states, that we are we are recognized as providers for state Medicaid. And so, under our state Medicaid, a pharmacist can have a can get paid for their conversation for vaccination for a pediatric patient. It has to be under 18. Okay. And and then we can get paid for our time to have a conversation with them. Um, interestingly, interestingly enough, though, is that if they don't get the vaccine, then we we can't actually bill for it. We can only bill if they don't take the vaccine. So it's an interesting, it's a little illustration. Every state's different. I mean, just look at it's bad North Dakota. I don't want anyone to think that it's like that in their state. And also not every state where pharmacists can provide medical billing under Medicaid. So you'll want to look at that. But there is a there is an opportunity for pharmacists to actually get paid for having that conversation in some states.

Health Coaching, MI, And SCDM Overlap

SPEAKER_00

I think that's super important to call out because, as you said, if there is additional time being taken to have these conversations and just being aware of what's available in your state in terms of billing and what you might be able to be reimbursed for that extra time, that is super important because I do know there are some other states that have a similar model where you can bill Medicaid for these conversations, and some do allow you to bill even if the patient refuses vaccination. So it's very variable and just another important reason why, you know, advocacy is important and making sure we're we're pushing for the value of pharmacists and having these conversations, but also just being familiar with that the fact that this is an option and something to look into, especially if you're concerned about the time aspect of things. So in terms of sort of thinking about how to how to have these conversations and and getting it sort of, I guess I'm thinking about the patients who maybe haven't heard that anything has changed or or not really concerned about the fact that the recommendations from CDC have changed for pediatrics, they come in for their flu shot for their child. It's not mandated. I mean, like I get I again, it depends on what your state what you're following, I guess. But what if the patient agrees up front how how would that situation look like? If they sort of come in and ask for the vaccine proactively, is does that change how you would have that conversation?

The Game Changer: What Hasn’t Changed

Resources And CE Claim Instructions

SPEAKER_02

Um yeah, I mean, I'll be honest, if you're really following a shared decision-making model, yeah, it does. You know what when when the RSV vaccine I'll give an example with RSV vaccine, because there was evidence at that time for shared decision making. I'd have patients who would hear about the RSV vaccine and they would come and say, I want the the RSV vaccine. And I would recognize that and know that that's their goal, but I would also just provide some information based off of the evidence to recommendation again. But I would provide some information as why it is that we aren't doing a blanket recommendation for everybody. And I would talk about their age and their risk factors. And the conversation would have been very different for somebody who was, you know, maybe 67, you know, 68 years old or something like that and didn't have any health conditions versus somebody who was 75 years old and or 74 years old and had, you know, diabetes and and emphysema. You know, so I think sharing those in for that information is important. But uh, yeah, I'll be honest, like I think that's why people are getting a little up at arms about this, because we don't want to do and what we've never done, and especially as pharmacists, is be like, oh, well, you know, patient care doesn't really matter, you know, like that doesn't matter. And and and we've never done that. We've always been so great and the, you know, I would argue the best at patient care. And so if you're really actually following shared decision making, then you should have a little bit more of a conversation. But at the same time, if someone comes in with a child and says, Oh, I'd like to get my child vaccinated against influenza, and you can say, Okay, that sounds good, you know, I would, you know, I, you know, the evidence does show that everyone, blah, blah, blah, should be vaccinated. And, you know, do you have any, you know, have any thoughts or you know, concerns or questions about the vaccine and kind of go from there? But it's a great area because really, you know, shared decision making isn't informed consent. And so it's just if you're really following the model the way it's was intended to originally as a right recommendation from the CDC, there should be a little bit more of a conversation about that. But um, you know, I would say that there's also a reason why the AAP that has their own schedule, the American Pharmacy Association has endorsed that schedule too. Right. So I would say it would go down to as to your state law and legality of which schedule you have to follow, and then as well as if there's any documentation you need to provide that decision making has been had or conversations been had.

SPEAKER_00

Yep. Okay, really important point there. Okay, that's great perspective. And and like I say, I do think we are often having these conversations with patients anyway, as pharmacists, and especially for patients who may have been more hesitant for whatever reason in the past. These are these are sort of routine conversations that are going on around vaccines every day. Um, it's just sort of changing the scope of when you might be thinking about needing to have that proactively compared to what it might have been before. But I do think all of this helps to illustrate the critical role of pharmacists in working with patients and providing vaccinations, in preventing disease, and uh supporting, you know, protective herd immunity, all of these sorts of things. Maybe you can just speak a little bit, you know, about the the benefits of pharmacists and what we can do as how we are empowered to take on a uh particular role here given these changes. I think maybe we can be a bit empowering, you know, with some of this uh Right.

SPEAKER_02

Well, I will say a few things, there's a few things that have not changed, right? We're still the most accessible healthcare provider, we're still arguably the most trusted health professional in the country. And we are still heavily relied upon by our patients to provide vaccines. So, and other things in that change is that you know a strong recommendation. So, you being the expert is one of the leading things that can lead to vaccination. And the evidence behind these vaccines, unless shown otherwise, hasn't changed. So before we before we go to, oh my gosh, this new change, you know, chicken little, the sky is falling. Take a deep breath and realize this has not changed. This is the same. And and so it's just a little, it's a little bump in the road of maybe clarifying of how you need to document something or how you need to follow legally the protocol in your state if there's anything your board of pharmacy would require you to do. But other than that, let's say that probably your approach isn't really gonna change. And you know, another thing too is is, and I can't stress this enough, is don't stop carrying these vaccines. We cannot decrease our access to care because of this. You know, the worst thing that can happen is, especially when we're relied upon so heavily by our patients, is to say, oh, well, you know, this is just seems like a lot of work. I'm not going to not gonna do this right now, or you know, they can go get it somewhere else, or please do not do that because our patients are relying on you. And as we can see what, you know, lack of vaccination is doing in our country, like just look at measles right now. I mean, it is going to be critical that we still are providing these life-saving um prevention, preventative measures to our patients. And so I would just say focus on what really hasn't changed. And a lot of most of it hasn't. So I just to, but just to be aware of kind of the nuances with these scheduled recommendations.

SPEAKER_00

Elizabeth, I'm so glad you you gave that bottom line because I think that just emphasizes, again, the important role of pharmacists in providing that access to care, preventing disease, improving patient outcomes, making sure that patients have access to life-saving preventive measures. That's that's critical and just such an important role that we play. So I just think you summarize that really well and think about what hasn't changed. I love that because the evidence hasn't changed, the strength of our recommendations doesn't need to change. It's just a matter of whether we how we need to maybe communicate that with the patient, if you know, depending on the situation. And you actually mentioned states too. The other thing I just thought of is that some states are also changing their their vaccine recommendations or standing orders or various things to comply with maybe other organizations as well. So it's also a state-specific thing from that perspective in terms of what protocols might follow. So that's another consideration to be aware of where the the state itself may follow certain protocol or sort of certain recommendations versus others. So yeah, really important point there. I think And I also really appreciate they mentioned making sure to continue to sort of operate business as usual in terms of making sure you have vaccine on hand. We don't want to be having a shortage, especially in light of all of these changes we're seeing with increased infectious diseases sort of popping up across the country. So super important point there. And I do want to tie that into the concept of rural areas because I know pharmacists, pharmacies are often maybe one of the very few providers in a rural area. And so we can play a critical role there too, and being that continued source of preventive care for many patients. I don't know if that's something that is you have experience with personally, or if you can speak to that at all in terms of the role pharmacists play in that rural setting, too, specifically.

SPEAKER_02

Yeah, well, I'm from North Dakota, so I have a lot of, I can I can tell you, I have a lot of experience and I can speak to that very well. Um, and so yeah, and in North Dakota, we also have a state law that requires the pharmacist to be, you know, the the the owner of a pharmacy needs to be a pharmacist, at least 51% ownership of the stock. And so the very large majority of pharmacies in the state are are independent pharmacies or or at least pharmacy-owned pharmacies. So or pharmacist-owned pharmacies. So I will say that with that said, that our pharmacies are such a critical access. You know, we've done some mapping in some of our states, and the pharmacist is literally the only healthcare provider in a county. You know, so if you do not offer the vaccine, this patient cannot get that vaccine anywhere within like probably a reasonable driving distance, because we have a lot of land area in North Dakota and our counties are quite large. So, you know, to be thinking of that of access to care, but also even in our rural or our urban areas, you know, it's sometimes even the urban areas of pharmacists are definitely the most accessible because of transportation or social determinants of health or other measures. And so that doesn't, you know, I would say that that that access and the importance of you know knowing the nuances right now with the vaccine recommendations and making sure you're stocking those vaccines, making sure you're having these conversations with the patients. There's there can still definitely flag anyone that you know is under that because they they should. That's one of the problems with social or shared clinical decision making in general, is that some times patients who really need it historically haven't been identified because they've just kind of been forgotten about. Um, and so please make sure that's not happening either, making sure that we're still flagging all these patients and ensuring that we're having these conversations with them and to to see to give them our our ideas and our recommendation and our expert, which you do in share decision making of them getting vaccinated.

SPEAKER_00

Absolutely. Yeah, great, great emphasis there. Um I I do want to just sort of tie in the concept of health coaching here because I I think that's another area that pharmacists, and you mentioned motivational interviewing before too, but just the idea of pharmacists supporting patients in overall health and well-being. And Elizabeth, I know you have some expertise in this area too, health coaching specifically. So maybe you can sort of uh tie together like how do those concepts compare shared clinical decision making and health coaching? How do they work together, if at all? Yeah.

SPEAKER_02

You know, they're really similar in in a lot of areas, you know, in a health coaching environment, you're still the expert. It's like shared decision making. You're the expert as a healthcare professional on this. And then the the patient is the expert in their lives and trying to gather information from that patient is very important in both models. Um, also leading with empathy and leading with, you know, understanding and in trying to, you know, gather inform that information and having ongoing conversations with our patients in both models is really applicable. So I think that, you know, even you know, social surgery to clinical decision making is very different also than motivational interviewing. There's still pieces of all of those that can be played into each of these, of having asking open-ended questions, trying to gain understanding, uh, trying to still be the expert of health, health and the patient, if you know what you know about the guidelines and the evidence and providing that information and also asking the patient to provide information. Um, both of those, you know, in health coaching, the skills that you use in health coaching are 100% applied in shared decision making.

SPEAKER_00

So there's a lot of overlap, but also differences too.

SPEAKER_02

Um yeah, slight, slight differences in the fact of a lot of times with health coaching, you're kind of trying to get the patient to move the needle to like where you want them to be. And again, in shared decision making, historically speaking, of how it was laid out, there there is a little bit of a goal, but the goal is not I'm going to get them to exercise five times a day, or I'm gonna get them to do this, I'm gonna get them to, you know, get this vaccine. That is not that's that's not what true share decision making is. It's gathering information from both sides and then coming to a conclusion together. So there is a little slight difference, but still a lot of the same principles and your expertise in in what you need to talk about are very similar.

SPEAKER_00

Okay. Okay, that's great clarification. And and all of this is about strengthening these relationships with patients. Um, I do want to mention that CE Impact does have a health coaching course on our website. It's called Get Off the Sidelines, How to Engage in Pharmacist Led Health Coaching. And it's, I know, Elizabeth, I think you were involved in the development of that course as well. And so just helping to understand sort of a range of topics, including behavior change and motivational interviewing and some of these communication techniques, like you mentioned, open-ended questions as an example, um, just to have a sort of broad-based understanding of how health coaching can be applied in practice. And also you can bill for these services too, potentially. So just a good opportunity to get those tools and and keep making that positive impact on patient care. So, Elizabeth, I know we're out of time. I do want to wrap up. It is our game changers podcast. And so we always end the conversation with what do you think is the game changer for our listeners to walk away with? So, what's the most important point you think that we need to take away from this, the these changes in this update?

SPEAKER_02

Yeah, I would just say the the game changer is understanding that, you know, a lot hasn't changed, you know. So I'm just gonna highlight that. And yeah, you know, so although it's a game changer, I think that the game changer is that so much has not changed. The evidence hasn't changed the pharmacist's ability and expectation to engage and shared decision making and making those recommendations, and the ability and necessity of the pharmacist to provide vaccination um hasn't changed at all. And so I think the game changer would be even just the highlighting of that with in light of these new recommendations um coming from the CDC to highlight that our role and what hasn't changed.

SPEAKER_00

I love that sort of flipping that concept on its head.

SPEAKER_02

It seems not ever have I flipped it, but I'm I'm going to kind of, I feel like I've I've given a couple of podcasts before and I can always think of the game changer, but this I'm gonna flip it back as to a little bit is to a lot has not changed.

SPEAKER_00

I think it's great. And going back to your comment about chicken little, you know, like it let's not the sky's not falling, let's think about what hasn't changed and how we just can continue to provide these vaccines and provide improve access to care for our patients, and that the evidence hasn't changed either. So that's just a really great take-home message. So thank you so much. Really appreciate your time, Elizabeth, and really thankful for your expertise in this area. You great have a lot of great practical examples and lots of important considerations for us to be thinking about. So really appreciate it. Absolutely. Thanks for having me. It's always a pleasure. Excellent. Well, listeners, we talked about a lot of great practical tips today, and these will also be summarized in the practice resource that goes along with this podcast on the CE Impact website. So I just mentioned that so you can take a peek at that as long as as well as the podcast, sort of side by side there. And be sure to claim your CE credit for the tip of this game changers by logging in at ceimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.