Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Irregular visits and individualized needs can make it difficult for clinicians to help keep adult patients up-to-date on immunizations. Find out what you can do to keep your patients covered.
Keeping adult patients up-to-date on recommended vaccines can be a challenge, particularly for patients who don’t have regular visits with their physician.
“I think the hardest thing with adult vaccines-unlike childhood vaccines-is that they are not tied to your age, they are tied to your medical condition,” said Margot Savoy, MD, MPH, a practicing family physician and chair of Family and Community Medicine at the Lewis Katz School of Medicine at Temple University. “It makes it a lot harder for patients and providers to remember vaccines.”
Savoy shared some ideas with Medical Economics to help clinicians keep on top of both recommended and optional immunizations for adults.
Start the visit with a checklist
When bringing a patient in for an exam, there are certain items that are usually done by staff before the physician even enters the room-blood pressure assessment, checking current medications, and finding out the reason for the visit or other concerns to address. By adding a simple question to this initial assessment about vaccination history and needs, every patient can be screened, and the physician can address concerns when they come into the room, Savoy said. It’s a great way to review vaccinations and see what patients may be due to receive, she said.
Empower staff to take action
In some health systems, clinicians may also be able to enact a vaccine protocol that allows staff members who can administer vaccines within their scope of practice to provide immunizations before the clinician even enters the room. Questions about vaccines can be programmed into an electronic health record with a standing order set that could allow caregivers like nurses to obtain and administer immunizations for which the patient is due before the clinician sees the patient, Savoy said.
By involving other staff members, if helps to get the entire practice on the same page, and can help keep caregivers from forgetting to administer the vaccine at the end of a busy visit. Additionally, it can give the clinician another chance to address vaccine refusal with a patient once the visit begins.
“This way you’ve got everybody on the same page and everybody’s talking the same talk,” Savoy said. “If someone drops the ball there’s someone who can pick it up.”
Focus on anticipatory guidance
In pediatric visits, clinicians usually review with parents what to expect by their next regular visit in terms of milestones and vaccinations. It helps parents prepare for what will happen at the next appointment. Clinicians can do the same thing for adults, Savoy said.
Talk to patients about flu shots in advance. Find out their travel plans. Even adult patients can be scared of getting shots, and may not be willing to receive a vaccine when they don’t expect it. By preparing patients for what may be coming next, they can prepare and make plans, and it also gives clinicians an opportunity to provide additional education to patients who refuse or are hesitant well in advance of the need for a vaccine. Savoy said she started offering anticipatory guidance for all of her patients she sees regularly, letting them know what to expect at their next appointment. She addresses the flu shot and other vaccines, and lets her patients know what to expect.
“I think there’s a real opportunity there,” she said.
Plan ahead for special circumstances
Oftentimes, healthy adults, especially seniors, have overlooked needs when it comes to immunizations. Particularly when it comes to travel plans, clinicians should assess the needs of their patients and offer guidance ahead of time.
For example, Savoy said healthy, active seniors may not consider the flu vaccine, but recently heard of a healthy, older couple who skipped the flu vaccine only to fall ill on a cruise. In that case, the flu was fatal for the couple, as they didn’t receive the care they needed until the ship reached its port. Travel may also require special vaccines depending on the destination, and not all vaccines are commonly stocked in practices, Savoy said. Travelers may need to plan ahead to find out where they can receive some less common vaccines for diseases like yellow fever, and plan ahead to ensure they can receive the full series of certain vaccines before their travel date.
“I use the CDC website to figure out what people need. If patients are going to somewhere exotic, they might need time to get the vaccine and have limited options,” Savoy said. “Tell patients when they are planning trips to check the CDC website for what they might need and plan accordingly.”
Combat chronic conditions
Sometimes, clinicians can have a difficult time keeping up with vaccines that could be helpful in combatting costly chronic conditions. There is an increased focus on teaching medical students the value of certain vaccines for chronic diseases, but in practice, these vaccines often slip through the cracks.
“A lot of practitioners don’t realize that the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) updates a table with chronic medical conditions each year,” Savoy said. The table, available in ACIP’s annual guidance, offers a simple guide as to what vaccines are safe for patients with a variety of conditions, and what vaccines are needed and useful.
Advocate for registries
The medical community should also push for better vaccination registries for adults, Savoy said.
“I’m very disappointed on how our vaccine registration system rallied around kids but left out adults. The fact that you can’t find adult vaccines in the registry is a real detriment,” she said.
There has been a crackdown on prescription drug monitoring systems for opiate abuse, and it’s easy to see who is getting prescriptions and where, Savoy noted. Yet clinicians are hard-pressed to find out any information about adult vaccines that might have been received in other practices or pharmacies.
“If we can figure out where and when someone got an opiate prescription, why can’t we do that with vaccines?” Savoy asked.