Immunization is one of the most effective interventions for improving public health. Yet each year more than 50,000 adults die from vaccine-preventable diseases or other complications, according to the Centers for Disease Control and Prevention. Because patients avoid vaccination for a variety of reasons, it is important to be mindful of patient concerns and misconceptions. Here are four ways physicians and their teams can improve adult immunization rates.
“Patients who wanted vaccines wanted it to be easy for them,” said Eileen Barrett, MD, in an interview with AMA Wire®. “And the patients who were vaccine hesitant often just needed an extra nudge to make it easy for them.”
Dr. Barrett, an internist and now an assistant professor of internal medicine at the University of New Mexico Health Sciences Center, helped write the AMA STEPS Forward™ education module on taking a team-based approach to adult vaccinations.
For easier access, Dr. Barrett and her team created a free-standing immunization clinic with hours of operation between 8 a.m. and 8 p.m., seven days a week, during flu season. And because the clinic was managed by licensed practical nurses (LPNs) with help from an office clerk, physicians’ work days went uninterrupted. However, because the clinic was set up in the lobby of the medical practice, physicians were available to address patient uncertainty about vaccinations.
While statistics are important, making it personal by harnessing the power of anecdotes helps get the message across better.
“I would say, ‘I know a doctor—and this is actually true—who got the flu, had a 104-degree fever and was in bed for five days unable to get up,’” said Dr. Barrett. “I now tell that story because I had just mentioned it to a patient and she gasped and then decided to get her flu shot.”
As an internist, she addressed her older patients’ needs and concerns by explaining that the flu shot would protect babies. This resonated with her patients because they often care for their grandchildren. She recommended letting them know that because their grandchildren’s immune systems aren’t strong enough, they can’t get their vaccinations until they are six months old.
Another way to say it is, “If you won’t do it for yourself, do it for your granddaughter because she can’t get her shots. Then you can tell everyone else in the family to come in and get their shots to protect her.”
Patients are much likelier to get immunized if their physicians recommend it. To identify patients who need a vaccination, use the electronic health record. For example, based on EHR prompts, Dr. Barrett and the other physicians in the practice sent out letters to patients in need of receiving immunizations. The letters informed patients about which vaccine they needed and that they could bring along their family to get immunized.
“It would cause some people to come in with five members of their families,” she said.
The letters were written in simple, plain English and included the site’s hours of operation. They also stated that the flu shot can save lives and that if the patient had any questions to talk to their doctor.
“It would drum up some interest and people would come in holding the letter they received,” said Dr. Barrett.
Having certain team members responsible for monitoring vaccination needs and persuading patients is key. Working together also helps physicians get to know their team better.
For example, a standing order was created that said any appropriately credentialed and trained provider can give any evidence-based vaccine based on guidelines from the Centers for Disease Control and Prevention or the Advisory Committee on Immunization Practices. This meant a midwife could give a flu shot or an LPN could give a Tdap. Each team member received proper training on who should and who shouldn’t get the vaccine.
Teamwork and an empathic approach improves patient trust, which leads to an increase in vaccination rates. And when the team enjoys coming to work, it can even prevent burnout.
“It really helped prevent burnout because I had such a good time working with these wonderful people on something we were passionate about,” said Dr. Barrett. “Besides the intrinsic value to the patients of getting vaccinated, you get to be part of this thing that you love to do with the people you begin to learn more about. It is really professionally rewarding.”
AMA’s STEPS Forward is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools. Based on best practices from the field, STEPS Forward modules empower practices to identify areas or opportunities for improvement, set meaningful and achievable goals, and implement transformative changes designed to increase operational efficiencies, elevate clinical team engagement, and improve patient care.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.