Originally printed in the South Dakota Medicine Journal, August 2017.
Stephan Schroeder, MD, CMQ, CMD Medical Director, South Dakota Foundation for Medical Care
The decision-making process for adult immunization can be complex in how it affects both providers and patients. Multiple social, psychological and economic factors influence vaccination rates and the goal to improve those numbers. While the value of vaccination has evidence-based support, the spectrum of vaccine decision-making covers a broad range of factors. Cost, available access, health literacy and social media all play a role in delivering vaccine in a timely and efficient manner.
From their initial inception to the present, vaccines have always raised a safety and effectiveness concern. Though not perfectly safe or completely effective, data is clear that their public health benefit is very strong and overwhelmingly safe. For patients who are hesitant or against vaccine, there are numerous communication strategies to help educate and motivate them to receive vaccination.
Providers, regardless of their specialty or location, should strongly recommend and encourage immunization. Most important is the direct influence of the provider to remind the patient to keep updated on vaccinations. This should include all levels of clinic staff from the front desk to administration. If appropriate, the use of posters, flyers and information sheets along with social media can remind and incentivize patients to obtain the needed vaccines. Clinic work flow and electronic medical records need to remind and emphasize updated vaccination status. Often, nurses and medical assistants are leading efforts to make sure immunization status is timely.
Collaborating with pharmacies in reference to vaccine administration is another tool to improve rates and assist with efficient payment of herpes zoster vaccine. Other sources to utilize include the State Department of Health, county and public health nurses, home health agencies and neighboring physician offices. Multiple professional associations and advocacy groups along with the Centers for Disease Control and Prevention (CDC) can provide resources and advice while also acknowledging and celebrating success in reaching immunization goals.
Immunization Information System (IIS) is a database to help clinical systems communicate with one another regarding patient immunization status. This registry allows providers to partner in delivering appropriate and timely immunizations by providing comprehensive and up-to-date vaccination records to all health care facilities. Also, the Medicare Quality Payment Program (QPP) has initiatives that allow providers to use immunization registry reporting as a tool to achieve quality payment measures.
FluFIT is another program that promotes vaccination by combining yearly influenza vaccine with fecal immunochemical tests (FIT) for colorectal cancer. Providing two important health maintenance elements as a bundle is an efficient use of patient time. The impact of underserved and minority populations as well as diminished patient health literacy can lower rates and require ongoing efforts to encourage health maintenance including immunization.
The Great Plains QIN is working with providers and patients to increase immunization rates for influenza, pneumonia and herpes zoster. The challenge of infectious disease prevention lies in increasing the percentage receiving timely administration of these extremely important agents.
Please contact myself (Stephan.schroeder@greatplainsqin.org) or Katy Burket, RN, (katy.burket@greatplainsqin.org) for further information on tools and technical assistance for increasing immunizations.
- Poland CM, Bronson EK, The need for multidisciplinary perspective on vaccine hesitancy Vaccine 2015 Jan 3, 33(2):277-9