Résumé
Background: streptococcus pneumoniae causes infections especially in patient at-risk, like those having immunodeficiency or specific comorbidities (e.g. diabetes, asthma). It is the leading cause of bacterial pneumonia and meningitis, but many cases could be avoided by pneumococcal vaccination (PV). However, the PV coverage of population at-risk of invasive pneumococcal diseases (IPD) is only 20% in France. Many studies assess methods onvaccination coverage improvement, but none evaluates medical-pharmaceutical collaboration in hospital on the PV coverage of hospitalized patients at-risk of IPD. Methods: this study is a multicentric stepped-wedged randomized trial involving 12 units of 9 French hospitals during 4 periods of 12 weeks. Chosen departments have already clinical pharmacy activities. 3 clusters will be made, each composed randomly by medicine and surgery units of one university hospital and medicine and surgery units of 2 different hospitals. Each cluster will start by a control phase and switch to an experimental one after another at different times, to have finally all in an experimental phase. For each period, one unit will have to include 16 hospitalized patients at-risk of IPD and non-vaccinated, to have a total of 768 recruited patients at the end of the study. The control phase will be an usual patient management, whereas during the interventional period, the pharmacist will communicate the indication and benefits of PV to the physician, who will suggest it to the patient, report PV value in the discharge letter and prescribe vaccines for the return home. In addition, the pharmacist will do a discharge consultation to explain the protocol and send a discharge letter to his usual community pharmacy. Follow-ups at 1 and 6 months post-hospitalization will be made. The primary outcome will assess the impact of the intervention on completed PV protocol after 6 months. Secondary outcomes will evaluate primary observance, uncompleted protocol rate, healthcare collaboration and subgroup analysis will be made.Discussion: this study aims to assess the impact of medical-pharmaceutical collaboration in hospital on the PV coverage in hospitalized patients at-risk of IPD. Hospitalization could be a room to promote vaccination and enhance healthcare system performance.