This is part of a series by the STFM Group on Immunization Education for National Immunization Awareness Month.
The CDC estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years. The Affordable Care Act requires health plans to cover Advisory Committee on Immunization Practices (ACIP) immunization recommendations made after September 2009 without cost-sharing to patients.
Nonetheless, vaccination rates for both children and adults in the United States fell below Healthy People 2010 objectives and will not meet Healthy People 2020 goals unless vaccine delivery barriers can be overcome.
Some of the many barriers to improved vaccination rates cited include:
- Lack of regular assessment of vaccine status
- Lack of physician and other health care provider knowledge on up-to-date vaccine recommendations
- Vaccination cost to both physician and patient
- Limited use of electronic records, tools, and immunization registries
- Missed opportunities
- Patient hesitancy and vaccine refusal
It has been shown by many studies and supported by CDC recommendations that orientating a practice to promote vaccination through practice system-based changes shows improved vaccination rates. Using the patient-centered medical home (PCMH) principles to incorporate system-based changes to a practice improves vaccination rates by overcoming some of the barriers.
Creating a Practice Care Team and Vaccine Champion
One way to create a practice focus on vaccinations is through the development of the Practice Care Team and a Vaccine Champion.
The Practice Care Team can include physicians, midlevel providers, nurses, medical assistants, pharmacists, social workers, or other staff. The Practice Care Team shifts responsibilities from physicians who traditionally have held the responsibility for vaccine promotion and delivery, to others in the practice. The team can be taught how to coach patients and be given permission to implement standing orders for vaccine delivery.
The practice vaccine champion within the team can be a physician, nurse, or another team member. The vaccine champion oversees quality improvement for vaccine rates and motivates the team toward improving vaccination rates. For example, the vaccine champion can perform chart reviews the day before scheduled appointments or the day of appointments before patients arrive to identify immunizations due and alert the care team. The champion is the “go-to” person in the practice to answer immunization questions. The champion keeps abreast of vaccine recommendations and keeps the care team apprised of updates and changes to schedules in addition to overseeing quality improvement through giving feedback on vaccination rates to physicians and the team.
Immunization and Practice Improvement Resources
Many resources and practice improvement ideas can by found in publications from several sources including the Immunization Action Coalition (IAC). Practice tips and resources, including vaccine administration information and information on coding/billing, storage, and handling and documentation of vaccines, can be found at http://www.immunize.org/clinic/.
Additional resources for the most up-to-date information on vaccination scheduling and vaccination updates include the Centers for Disease Control and Prevention guidelines (http://www.cdc.gov/vaccines/hcp.htm) with ACIP updates and Morbidity and Mortality Weekly Report (MMWR) updates.
Another easy-to-read vaccine information guideline, which includes both children and adult schedules, prepared, edited, and updated annually by family physicians and members of the Society of Teachers of Family Medicine Group on Immunization Education is SHOTS ONLINE: http://shotsonline.immunizationed.org/. In addition, it can be downloaded as a free mobile app: http://www.immunizationed.org/Shots-Mobile-App.
Who will be your vaccine champion?
In summary, consider forming a Practice Care Team of office members including physicians, staff, and other health care professionals as a system-based practice improvement to help improve immunization rates for both children and adults. Within the practice care team, nominate a vaccine champion to oversee regular immunization updates, reminders, and quality control.
So who will your vaccine champion be? Will be it you? With immunization and practice improvement resources at hand, feel confident to be the one to volunteer to move your practice to improve the vaccination rates and overall health of your patients.
I love the idea of creating a “champion” but two questions arise: (1) is the champion compensated for their time and effort, and (2) what functions will s/he cease doing to allow time for this work?
Dr Sussman, we informed Dr Rockwell of your questions and she’ll get back to you here in a few days.