Public Health

6 steps for practices to improve adult vaccination rates

Sara Berg, MS , News Editor

While school-entry requirements often oblige parents to vaccinate their children or at least submit an opt-out form, there is no requirement for adults to be up to date on their immunizations. Despite a growing public health need for adult vaccinations, administrative and financial burdens hamper physician efforts to implement adult vaccination programs.

Adult vaccinations are recommended based on their age, underlying medical conditions, lifestyle and other considerations. However, even with recommendations from the Centers for Disease Control and Prevention, vaccination coverage among adults in the United States is low. More than 50,000 adults in the U.S. die from vaccine-preventable diseases, particularly due to influenza and its complications, according to the CDC.

About 25 percent of physicians believe age-based vaccination recommendations for adults are difficult for patients to follow, according to the CDC.

Physicians and other health professionals can learn more about creating a team based approach for adult vaccination programs within their practice through a new AMA STEPS Forward™ module. This free online module addresses concerns over an immunization program and provides a comprehensive guide for implementing a program within their practice.

Through this education module on vaccinations, physicians can follow six steps to create a successful team-based adult immunization program.

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Physicians set the tone for advocating adult vaccinations. The main influencing factor in deciding to get vaccinated is a physician’s recommendation. By conveying strong support for vaccination, team members and patients will be on the same page. From asking team members for their opinions on vaccinations to requiring staff vaccinations, physicians can work with their team to begin an immunization program.

To providing training for their practice, physicians can use the “Adult Immunizations: Team Training Program.” The STEPS Forward module offers five training sessions with speaker notes including:

  • Vaccine fundamentals.
  • Communicating benefits and risks of vaccines.
  • Preparation, administration and adverse event reporting.
  • Storage and handling.
  • Billing, coding and documentation (includes standing orders).

Each session is about 30–60 minutes in length and can be used as is or with modifications to meet the team’s needs.

Due to misinformation available through various news outlets, friends, family and other sources, patients might have inaccurate information on vaccinations. A lack of accurate knowledge can impede informed decision-making regarding immunizations. However, physician recommendations will still carry more weight than what most patients hear elsewhere. By addressing common patient questions and concerns about vaccinations, physicians and their teams can help ensure patients that vaccines are safe, necessary and effective.

From pre-visit planning to assessing, recommending, vaccinating, or referring and documenting, it is important to implement a standardized process. In doing so, physicians can maximize vaccination rates. The use of standardized processes helps practice team members feel valued and allows everyone to work to the top of their licensure.

Physicians and their teams can consider using the following standardized processes, but it is important—before implementation—to take into account their own workflow. Practices should:

  • Identify patients who are due for vaccines and which ones are needed.
  • Have front-desk staff prepare and hand patients a preprinted vaccine information statement at check in.
  • Use standing order sets for vaccine administration before the physician component of the appointment and for documentation.
  • If a patient declines vaccination, ask why and provide further counseling and encouragement.
  • Use standard protocols for managing and reporting adverse events from vaccinations.

By reducing wasted vaccines, practices can minimize the risk for financial losses. Physicians should educate their staff on safe vaccine storage and handling to avoid common mistakes such as improper vaccine refrigerator temperatures.

To helping nurses or medical assistants take the lead on immunizations, physicians can designate a chief vaccination officer who performs the following duties:

  • Tracking the number of vaccines given each day.
  • Pulling vaccines from their central storage location in a small, set number of vaccine doses per day.
  • Reconciling the administration record with the number checked out from storage.
  • Overseeing billing at the end of each day.

Implementing an adult vaccination program requires hard work and commitment from a practice. Through daily debriefings, physicians can review unexpected challenges and how to overcome them with their team members. And when a practice’s team is on board with an immunization program, it is important to recognize and reward their participation.

The module may be completed for continuing medical education credit. The AMA’s STEPS Forward collection features 49 practice-improvement modules. Several come thanks to a grant from, and in collaboration with, the Transforming Clinical Practices Initiative (TCPI).

By bringing the unique STEPS Forward strategic resources on practice transformation to the practice transformation networks (PTNs) and their enrolled practices in TCPI, the AMA can accelerate the pace of transformation and spread it beyond clinicians. The AMA develops planned demonstrations with PTNs on focused  parts of the change package and through these efforts can show what advanced transformation looks like in practice.