https://immattersacp.org/archives/2015/10/immunization.htm
Adult Immunization | October 2015

General internists crucial to raising adult immunization rates

The single most important factor in promoting adult immunization is strong advocacy from a physician, and the recommendation of a general internist is a vital factor in whether patients receive needed vaccines.

By Bernard M. Rosof, MD, MACP, and William Schaffner, MD, MACP

Immunizations are one of the most effective and cost-effective ways to help patients stay healthy, especially those who are older and have chronic health conditions. The single most important factor in promoting adult immunization is strong advocacy from a physician, and the recommendation of a general internist is a vital factor in whether patients receive needed vaccines.

Immunization can prevent illness, hospitalization, and loss of wages for patients. According to estimates from the Centers for Disease Control and Prevention (CDC), for the 2013-2014 influenza season, influenza vaccination prevented approximately 7.2 million illnesses, 3.1 million medically attended illnesses, and 90,000 hospitalizations associated with influenza.

Photo by moodboard
Photo by moodboard

Unfortunately, most patients do not get recommended vaccines or even know that they should be getting them. Each year, the CDC's Advisory Committee on Immunization Practices (ACIP) publishes an adult immunization schedule, along with recommendations to help guide clinicians to vaccinate their patients. Yet, according to a 2014 CDC report, only 20% of adults 19 to 64 years of age with high-risk conditions and only 60% of adults 65 years of age and older reported receiving a pneumococcal vaccination. Also, among adults over 60 years of age, only 20% reported receiving herpes zoster vaccine despite it being recommended for essentially all adults over 60. Each year, rates have barely increased, showing how crucial it is for physicians to focus on immunizations.

Research indicates that most adults believe vaccines are important and are likely to receive them if recommended by their physician and other health care professionals. Physicians and their teams have the responsibility to routinely assess patient immunization status and to strongly recommend the vaccines that patients need. Patients need to clearly hear that their physician recommends that they should receive vaccines and stresses their importance, for example by saying, “You should receive the pneumococcal vaccine today because it can protect you from diseases caused by pneumococcal bacteria, including pneumonia. These diseases could be very serious for you now that you are older and you smoke. In our practice, we are committed to protecting all our patients against these serious diseases.”

To help streamline this practice, the Community Preventive Services Task Force recommends using strategies such as standing orders to raise immunization rates. Standing orders alone can help raise vaccination rates up to 53 percentage points. There is no substitute or bigger advocate for adult immunization than physicians. Physicians need to assess patients' vaccination history regularly, to strongly recommend to patients which immunizations they need, to vaccinate, and to document the vaccine receipt in patients' health records or state registries. Clinicians who do not stock vaccines should discuss needed vaccines with their patients, write a vaccine-specific recommendation, and then refer them to a clinic or pharmacy that provides vaccination services.

Physicians can face barriers to properly providing vaccinations, everything from changing and complex recommendations to the inability to ascertain what vaccines patients have already received, as well as concerns about financial and time costs to the practice. ACP is working to develop tools that can help internists circumvent these barriers. ACP's new program from the Center for Quality, called “I Raise the Rates: Initiative to Raise the Adult Immunization Rates in Primary Care,” is a collaborative, data-driven program to support patients, physicians, health care teams, systems, and communities raise adult immunization rates and reduce vaccine-preventable diseases.

The program seeks to assist internists and other primary care health care professionals in both understanding the immunization rates of their patients and making practice changes, based on evidence-based strategies, that promote immunizations. In the I Raise the Rates initiative, ACP has pulled together print and Web-based resources that can help internists:

  • make a strong recommendation to patients about the importance of immunization, including practice staff, and provide access to educational resources;
  • implement team-based approaches to immunizing, including a learning webinar series;
  • determine the costs and possible revenue of providing immunizations; and
  • create effective and 2-way referral relationships with other immunizing clinicians in the community, should physicians be unable to provide a vaccine.

ACP is excited to promote the development of physician immunization advocates around the U.S. and ultimately raise the adult immunization rates to reduce disease burdens. These resources will help ensure that all patients receive their recommended vaccines. In addition to ACP resources, these websites provide useful information and tools to raise patients' adult immunization rates:

For more information and to learn more about the resources at ACP, send an e-mail.

Dr. Rosof is professor of medicine at Hofstra North Shore-LIJ School of Medicine in Hempstead, N.Y., and CEO of QHC Advisory Group, LLC, in Huntington, N.Y. Dr. Schaffner is professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine in Nashville, Tenn.