Mr. Paul Galewitz of USA Today missed an opportunity in his article last week (http://www.usatoday.com/story/news/2015/09/12/kaiser-ouch-vaccination-rates-among-elderly-lag/72147204/) to do something The New York Times and The Wall Street Journal routinely do … provide insight to the lay public regarding what really works to improve healthcare outcomes in the US.
Mr. Galewitz very appropriately calls out the low US vaccination rates in seniors for influenza (65%), varicella (24%), pertussis (50%) and pneumococcus (60%), but fails to report on the well-published science of what health systems can do to make those rates higher.
Instead, Mr. Galewitz uses his airtime to quote doctors who believe (a) it’s the patient’s responsibility to know what vaccines they need (Dr. Robert Wergin, president of the AAFP), (b) billing Medicare administrators is complex (Dr. Reid Blackwelder, chairman of the AAFP), or (c) the main reason for the low vaccination use is the lower effectiveness of adult vaccinations when compared to childhood vaccinations (Dr. Bruce Gellin of HHS). Ugh.
Here’s what Mr. Galewitz should have reported:
“Every year, 5% of the health systems and doctor’s offices in the US achieve the highest vaccination rates in the country (for example, see any of the 6 Kaiser Permanente regions, for both adult and childhood vaccinations). That begs the question, ‘What are those doctor’s offices doing that the bulk of US physician practices are not?’ The healthcare industry has known that answer for the last 15 years, yet it hasn’t spread those best practices. Why is the spread of best practices so difficult for the US health system?”
Anyway, here’s the list of what works for adult vaccinations (see sources below):
- Non-physician staff (receptionists, MAs, LPNs, RN’s) assess vaccination needs for each patient prior to the physician walking into the exam room
- They communicate a strong recommendation from the physician to vaccinate, which the physician reinforces if needed
- The care-team addresses misconceptions head-on (e.g., “the flu vaccine can NOT give you the flu”; “the shingles vaccine does NOT mean you were a bad person in your younger years” [Wikipedia describes it as a herpes virus]; “What are the barriers to you receiving the vaccine today?”)
- Physician-directed nurse protocols provide the vaccination before, during or after the visit
- EMR-prompts (such as EPIC’s Best Practice Alerts), provide the safety net
Rather than point to pop culture bling (these days everybody believes Uber will solve the world’s problems), Mr. Galewitz missed an opportunity to tell his readers how to recognize better healthcare when they see it (the list above). He gets one thing right though – he highlights one practice (University of Pittsburgh Primary Care) that increased its vaccination rates by 40% in one year (!!) by deploying the front office workflows and nurse protocols described above, but he buries that point at the end of the article; most readers probably gave up by then.
Jan 2000 – Am J Preventive Medicine
June 2005 – Hopkins NS, Shefer A, et al. Am J Preventive Medicine 28:5S
April 2015 – http://www.medscapte.com/viewarticle/842874