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Immunization rates in the United States are high, but gaps still exist. Healthcare providers in convenient care settings can do much to maintain or increase immunization rates.
Although vaccine-preventable disease rates in the United States are at low levels, this should not breed complacency about vaccination. Focus on immunization rates remains crucial for several reasons, including possible resurgence of disease, introduction of new vaccines, suboptimal immunization levels, cost-effectiveness and gaps in sustainable immunization efforts.1Standards for vaccination practices are designed to assist in implementing vaccination programs and to maximize their benefits.2,3Any person or institution that provides vaccination services should adopt these standards to improve vaccination delivery and protect infants, children, adolescents and adults from vaccine-preventable diseases.
Epidemiology
In 2007, only 43 cases of measles, 12 cases of rubella, 28 cases of tetanus and no cases of diphtheria or polio were reported to the Centers for Disease Control and Prevention.1
Although levels of disease are the ultimate outcome of interest, these are late indicators of the effectiveness of the United States immunization system. Childhood immunization rates remain suboptimal, perhaps due in part to the existence of racial and economic disparities. Improvements in adult immunization rates have tapered off as well.
Strategies
Throughout the years, many strategies have been used to increase immunizations. Strategies such as school entry laws, reduced costs, linking immunization to food stamp services, mass vaccination seminars and home visits have helped increase rates among specific populations.
In today's economy, nurse practitioners in convenient care clinics are in a prime position to increase immunizations. A combination of strategies directed at providers and the public is necessary.
Patient immunization records are of vital importance and must be accurate. All records must be kept up-to-date and complete. Because patients often receive vaccines at more than one provider office, communication and accurate maintenance of immunization records are of utmost importance.
The mandatory use of vaccination registries can greatly simplify this task - and provide a single data source that is accessible to all providers.4 Vaccination registries are available in most states.
Recommendations from healthcare providers are powerful motivators for adherence to vaccination recommendations. Education about immunizations is also a vital factor in compliance.
Written schedules and reminders can ultimately result in greater compliance as well. Both the Standards for Child and Adolescent Immunization Practices and the Standards for Adult Immunization Practices call upon providers to develop and implement aggressive tracking systems.1
Reducing missed opportunities to vaccinate will also increase immunizations. A missed opportunity is a healthcare encounter in which a person is eligible to receive a vaccination but is not vaccinated completely. Common reasons are avoidance of simultaneous administration of vaccines, lack of awareness about the need for vaccination, invalid contraindications, inappropriate policies, and reimbursement deficiencies.1
Several studies have shown that eliminating missed opportunities could increase vaccination coverage by up to 20%.1 Strategies such as the use of standing orders or protocols, provider education with feedback, and provider reminder or recall systems will help reduce missed opportunities.
Despite provider efforts to adhere to appropriate immunization practices, obstacles such as physical and psychological barriers may exist yet be unknown to the provider.
Physical barriers such as waiting times, travel distance and inconvenient hours, and psychological barriers such as unpleasant past experiences and concerns about vaccine safety, are obstacles easily conquered by the use of convenient care services. These clinics are accessible, easily located in the community and offer extended hours without long wait periods.
Nurse practitioners are skilled at addressing fears and misconceptions and providing a supportive and encouraging environment for patients.
Find the most up-to-date immunization schedules at the Centers for Disease Control and Prevention website, http://www.cdc.gov/vaccines/recs/schedules/.
References
1. CDC. Programmatic strategies to increase vaccination rates - assessment and feedback of provider-based vaccination coverage information. MMWR. 1996;45(10):219-220.
2. The National Vaccine Advisory Committee. Standards for child and adolescent immunization practices. Pediatrics. 2003;112(4):958-963.
3. Poland GA, et al. Standards for adult immunization practices. Am J Prev Med. 2003;25(2):144-150.
4. Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians: use of reminder and recall by vaccination providers to increase vaccination rates. MMWR. 1998;47(34):715-717.
Jennifer Ruel is a family nurse practitioner who has experience in convenient care clinics. She is an assistant professor at the University of Detroit Mercy in Detroit and has earned a doctorate in nursing practice.
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