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> Outcome Report

Building an Adult Immunization Practice: The Primary Care Physician's Role in Disease Prevention
A Program Series at AFP-AOA State Chapter Annual Meetings

Vaccines have been highly effective in eliminating or significantly reducing the occurrence of many once-common diseases. However, barriers to immunization, particularly in older adults, have played a significant factor in the rising incidence of some vaccine-preventable diseases. Cost, reduced accessibility to vaccines, and complex or changing schedules for adult immunization have contributed to low immunization rates in at-risk adult populations. This can lead to significant clinical consequences due to vaccine-preventable diseases and related complications.

Addressing Barriers to Adult Immunization: The Role of Primary Care Providers
Primary care providers (PCPs) play an important role in administering recommended vaccines to their patients. However, PCPs must not only be knowledgeable about vaccines, they must incorporate systems in their offices to record, remind, and recall patients for vaccinations. They must also clearly communicate vaccine benefits and risks while understanding those factors that affect a patient’s acceptance and perception of vaccines.

Continuously building healthcare provider awareness of current immunization guidelines as well as the benefits of immunization is critical in not only ensuring patient vaccination, but also improving vaccination rates. "Building an Adult Immunization Practice: The Primary Care Physician's Role in Disease Prevention" Initiative has aimed to address practice and knowledge gaps in an effort to ensure and improve adult immunization. PCPs are on the frontline of managing all patients, and can therefore lead the way in these efforts by educating their patients about vaccine-preventable diseases and taking proactive measures within their clinical practice to ensure patients are vaccinated when indicated.

Learning Objectives
Learning Objectives were specifically defined to address the PCPs need in adult immunization:

  • Recognize the clinical consequences of vaccine-preventable diseases in adults
  • Identify adult patients who will benefit from vaccination
  • Educate patients about the benefits of vaccines
  • Reduce and remove system- and patient-related barriers to vaccination

SUMMARY OF PROGRAMS

Meeting/Congress Date, Location No. of Participants
North Carolina AFP Winter Meeting
December 3, 2011
Asheville, NC
450
Nevada AFP Winter CME Meeting
January 25, 2012
South Lake Tahoe, NV
75
Texas Osteopathic Medical Association
Mid Winter Conference
February 3, 2012
Dallas, TX
110
Maryland AFP Winter Regional Conference
February 25, 2012
Hunt Valley, MD
35
Colorado AFP Annual Scientific Congress
April 21, 2012
Colorado Springs, CO
100

MULTIDISCIPLINARY FACULTY
The faculty for this series is comprised of NFID Board of Directors and Members, leaders in the field of infectious diseases, vaccinology, and primary care:

Thomas M. File, Jr, MD, MACP
NFID President
Infectious Diseases Specialist

George Z. Zhanel, PhD, PharmD
Pharmacologist and Microbiologist
Pneumococcal Disease Expert

Patrick Joseph, MD, FIDSA, FSHEA
NFID Vice-President
Infectious Diseases Specialist

Robert H. Hopkins, Jr. MD, FAAP, FACP
Primary Care Physician and ID Specialist

Michael Hogue, PharmD, FAPhA
Infectious Diseases Pharmacist
Vaccination Expert

Debra Goff, PharmD, FCCP
NFID Continuing Medical Education Committee
Infectious Diseases Pharmacist

Donald E. Low, MD
Infectious Diseases Specialist
Influenza Expert

The multidisciplinary faculty, including both physicians and pharmacists, emphasizes the importance of interdisciplinary approach when striving to improve adult immunization rates. The expert panel and audience discussion was an opportunity to discuss numerous issues related to vaccines and for learners to have many of their questions related to pharmacy, primary care, and infectious diseases answered by multidisciplinary faculty.

EDUCATIONAL FORMAT
In order to achieve the learning objectives, an educational format with an interactive sequential approach was utilized that

  1. Assessed learners' baseline approach (awareness and perception)
  2. Presented practical and clinically applicable evidence-based information
  3. Demonstrated how PCPs can implement processes in their practice to reduce barriers to adult vaccination

Agenda

Welcome and Introduction: Recognizing the Current Challenges
BUILDING COMPETENCE: Promoting Adult Immunization Against Vaccine-Preventable Diseases
  1. Pneumococcal Disease
  2. Influenza
  3. Shingles (Herpes Zoster) and Pertussis
Increasing Immunization Rates in Your Practice (Panel and Audience Discussion)
  • Addressing patient- and system-related barriers to adult vaccination
Open Forum: Q&A

During each of the programs, there have been many questions asked ranging from appropriate use and administration of vaccines, possible interactions, to insurance coverage. The quantity and scope of audience questions at each of the programs reinforces the need for educational programs to clarify current adult immunization recommendations for primary care.

Frequently Asked Questions

  • Why do we not immunize healthcare workers against pneumococcus?
  • Can you provide us with guidance on pneumococcal revaccination?
  • Do you recommend immunizing at time of discharge from the hospitalization or waiting for a follow-up?
  • Can pregnant women get the influenza vaccine? Any trimester?
  • Is there any data regarding shingles prevention in recipients of zoster vaccine?
  • What do I do about patients who refuse to get the flu shot because they claim that they get really sick from it?
  • If a patient (<50y/o) has shingles once or multiple times, would you recommend zoster vaccines? What if it was ocular shingles?
  • Should Tdap be given early in pregnancy to help with fetal antibody production?
  • Should I start routine Tdap for all patients without vaccination records?
  • How concerned should I be about the neomycin allergy in shingles vaccination?

ASSESSMENT OF THE IMPACT OF EDUCATIONAL INITIATIVE
Following the activity, participants were asked if they planned to make any changes to their practice behavior based on participating in the program. An overwhelming 85% of the learners said that they would make a change in their practice following the activity.

Most Common Commitments to Change Identified by Learners
  • Increase use of vaccines; proactively recommend vaccinations
  • Try to effectively convince patients to get vaccinated; educate patient more
  • Use well office visits and annual physicals as a time to evaluate need for vaccination
  • To be more aware of who would benefit from a vaccine
  • Adjust office procedures to better identify those in need of vaccines and update records
  • Set office goals for vaccination rates
  • Increase nursing education on adult immunization
  • Include/incorporate pharmacist in clinic for immunizations
  • Identify a vaccine champion at clinic
  • Flag all charts of patients 65 and older and high risk patients for pneumococcal vaccine status
  • Utilize standing orders for nurses
  • Begin to use community pharmacists for immunization


Barriers in Adult Immunization
Participants were asked to identify barriers that may impact their ability to implement changes in their practice to improve adult immunization. By far, the most common response was related to cost and reimbursement issues. The most frequent responses are:
  • Vaccine cost; patient finances; insurance coverage; reimbursement for vaccines
  • Lack of time to discuss vaccination with patients
  • Counteracting fears and myths of adult patients who have rejected vaccine recommendations
  • Addressing patient fear of side effects
  • Lack of vaccine availability
  • Lack of a reminder system to check need for immunization
  • Lack of immunization registry; incomplete patient immunization history
  • Fear of injections

Knowledge and Practice Gaps
After participating in the program, learners recognized the importance of primary care in promoting adult vaccination and stated that they are now confident in identifying those adults who would benefit from immunization.

After participating… Yes Somewhat No
Do you feel PCPs should play an active role
in promoting adult vaccination?
97% 2% 1%

After participating… Very
Confident
Somewhat
confident
Not
Confident
How confident are you in recognizing adults
who would benefit from vaccination
according to current ACIP
recommendations?
79% 21% 0

Learner Feedback

  • Wow, what a great panel! Great speakers - knowledgeable and enthusiastic, great speakers, all very knowledgeable
  • Great lectures – up-to-date and real, excellent speakers and presentation, very eye-opening!
  • Excellent discussion
  • Very informative, excellent and highly relevant presentations
  • Excellent lectures – learned a lot!
  • Faculty were very knowledgeable, conscientious, and willing to help with questions
  • Relevant and useful
  • Wonderful presentation of the subject, great expertise
  • Very knowledgeable, conscientious, willing to help with questions, well presented
  • I am more confident than before in recognizing adults who would benefit from vaccination according to current ACIP recommendations

 


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