Office-based medical practice can promote vaccination in adults

Promoting immunizations as a part of routine office-based medical practice is needed to improve adult vaccination rates, a highly effective way to curb the spread of diseases across communities, prevent needless illness and deaths, and lower health care costs, according to a new RAND Corporation study.

Increasingly, vaccinations are being offered outside of physician offices at pharmacies, workplaces and retail medical clinics. Even so, office-based medical practice continues to be central to the delivery of recommended vaccinations to adults.

"Regardless of where vaccines are actually administered, office-based providers are uniquely positioned to identify patients who need vaccination, to communicate credibly about the benefits and risks of vaccination, and to ensure that vaccination histories are properly maintained," said Katherine Harris, the study's lead author and a senior economist at RAND, a nonprofit research organization.

The RAND study outlines improvements needed to strengthen the role of office-based medical providers to promote vaccination to adult patients. These include creating tools to improve communications between patients and providers about vaccinations, and stronger incentives to encourage health providers to refer patients to community sites that administer vaccinations if they do not offer them.

Diseases that can be readily prevented by vaccines take a heavy toll on adults in the United States despite the wide-spread availability of this generally safe and effective preventive care. The yearly health care and productivity costs blamed on influenza -- a common illness that can be prevented by vaccination -- is as high as $90 billion, depending on the severity of the annual outbreak.

In contrast to childhood vaccination rates, which are generally high, adult vaccination rates remain disappointingly low. Even in the case of influenza, inoculation rates for even those at the highest risk of death do not exceed 70 percent. Vaccines recommended for adults can prevent influenza, pneumococcal sepsis, shingles, hepatitis A and B, pertussis (whooping cough) and the human papillomavirus -- the leading cause of cervical cancer.

Researchers say recent changes in the policy and practice environments provide a unique window of opportunity to improve the delivery of vaccinations to adults. Health care reform legislation promotes preventive care and improves financial access to adult vaccinations.

RAND researchers identified bottlenecks that have stalled delivery of adult vaccinations and propose strategies to overcome these shortcomings. Their effort included a review of past research about adult vaccination, a stakeholder workshop, interviews with experts, and a short telephone survey of adults to learn about the relationship between influenza vaccination and public beliefs and misperceptions about its safety.

The study reports that while medical offices are the location where most adults receive vaccinations, only about one-fourth of physician offices stock all recommended vaccines for adults. Reasons include the fact that some vaccines have a short shelf life and insurance payments for administering adult vaccines may not cover the doctor's costs.

Researchers say one priority is to collect better national information about the patterns of office-based vaccination of adults to pinpoint gaps in practice, which could then be targeted for improvement efforts.

Better guidance should be developed to help health providers effectively promote and administer vaccines, including structured vaccination counseling protocols. Providers also need tools to help them evaluate whether to administer vaccines onsite or refer their patients to community resources such as pharmacies and flu vaccine clinics, according to the study.

Systems also must be developed to credit primary care providers for providing vaccine counseling, whether their patients receive the vaccination on-site or go elsewhere to get it.