Interprofessional Collaboration and Exploratory Implementation Support for Community Pharmacy Influenza Vaccination in Northwestern Romania: A Cross-Sectional Survey of Pharmacists and Family Physicians

Abstract

Background: Romania introduced pharmacist-administered influenza vaccination in community pharmacies in 2022, but implementation depends on professional support, workflow capacity, and interprofessional coordination. Because the present questionnaire did not measure the full organisational construct of implementation readiness, we developed an exploratory, study-specific implementation-support score (IRS) from three attitudinal items. Methods: We conducted a cross-sectional survey in Northwestern Romania between 1 October 2025 and 30 April 2026. Of 761 questionnaires distributed, 700 were returned; 22 completely blank questionnaires were excluded, leaving 678 analysable responses (340 pharmacists and 338 family physicians). The IRS was the mean of perceived contribution to vaccination coverage, the pharmacist’s role in the multidisciplinary team, and willingness to recommend pharmacy-based vaccination. Internal coherence was assessed in the development sample. Associations with IRS ≥ 4 were examined using multivariable logistic regression, and a heteroskedasticity-robust linear regression using the continuous IRS was prespecified as a sensitivity analysis. Results: The overall IRS median was 3.00 (IQR 2.33–4.00); the mean was 3.09 ± 1.10. Pharmacists had higher scores than family physicians (median 3.67 vs. 2.67; mean 3.47 ± 1.02 vs. 2.70 ± 1.03; Mann–Whitney U = 81,200.5, p < 0.001). An IRS ≥ 4 was observed in 185 participants (27.3%), including 136 pharmacists (40.0%) and 49 family physicians (14.5%). In the adjusted logistic model, pharmacist status (aOR 4.41, 95% CI 2.66–7.33), considering direct collaboration absolutely necessary (aOR 4.22, 95% CI 1.42–12.52), annual influenza vaccination (aOR 2.98, 95% CI 1.56–5.69), and awareness of pharmacy vaccination (aOR 2.06, 95% CI 1.10–3.85) were associated with IRS ≥ 4. The continuous-score sensitivity analysis showed similar associations: pharmacist status (β 0.68, 95% CI 0.49–0.87), direct collaboration absolutely necessary (β 1.17, 95% CI 0.85–1.49), annual vaccination (β 0.51, 95% CI 0.28–0.74), and awareness (β 0.24, 95% CI 0.02–0.46). Conclusions: The three-item IRS showed internal coherence in this sample but represents proximal professional support rather than a validated measure of organisational implementation readiness. The findings are exploratory and associative; they should not be used as a validated institutional or policy decision threshold.