RAND 'Blueprint' Outlines Opportunities, Obstacles in Battle to Boost Adult Vaccination Rates

A new study from Santa Monica, Calif.-based RAND Health examines the barriers that continue to keep many adult patients from getting vaccinated and proposes concrete steps to overcome those hurdles.

Specifically, the report -- A Blueprint for Improving the Promotion and Delivery of Adult Vaccination in the United States -- identifies where previous efforts to improve vaccination delivery have stalled and recommends "targeted strategies to address these bottlenecks."

Some of the barriers the team of researchers looked at include

In addition to noting that office-based health care professionals remain the primary source of vaccination, the researchers pointed to the role physicians play in vaccine delivery.

"Physicians are also a highly influential source of advice about vaccinations," the researchers said. "National survey data suggest that by March 2009, 44 percent of the 160 million U.S. adults … recommended for influenza vaccination were not vaccinated and did not intend to be. In this group, almost half (20 percent of all recommended adults) indicated a willingness to be vaccinated with a strong recommendation from a health care provider."

Yet despite that ability to influence their adult patients' vaccination decisions, the study data indicated that a substantial portion of physicians who treat adults do not administer vaccinations, and few are discussing it.

"Moreover," the researchers said, "we identified few ongoing efforts to evaluate and improve provider communication regarding the safety and benefits of vaccination with adult patients."

Vaccination promotion efforts can contribute to and gain from efforts to strengthen primary care, said the researchers, but stakeholders must seize on the opportunity to promote and talk about vaccinations in routine practice.

"Recent changes in the policy and practice environment surrounding adult vaccination create a unique window of opportunity to take concrete action to improve the delivery of vaccinations to adults," the researchers said. "Recent health care reform legislation promotes preventive care generally and improves financial access to adult vaccination specifically."

The blueprint listed five recommendations for improving the delivery of adult vaccinations:

Strengthen the evidence surrounding practice gaps and strategies for promoting vaccination.
By collecting national data, researchers will be able to chart office-based vaccination patterns for adults. Using those data, they can measure the economic value of various approaches for promoting adult vaccination.

Improve guidance to providers about vaccinating adults.
By developing structured vaccination counseling protocols, the medical establishment can provide clear guidance for adults with missing or incomplete vaccination histories. Doctors then can periodically evaluate vaccination status based on the age of the patient.

Assist health professionals in making informed decisions about whether to administer vaccinations on-site.
The researchers recommend developing a decision tool to help office-based health care professionals make informed choices about the viability of vaccinating on-site. But they cautioned that support is thin in this area.

"We were unable to locate resources specifically designed to assist providers in assessing whether vaccinating adults is economically viable for their specific practice," they said. "While providers know the price of the vaccine they order, indirect costs associated with vaccination are more difficult to measure. Thus, the economic viability of vaccinating adults in office-based settings may not be immediately apparent."

Formalize procedures for referring patients to complementary vaccinators.
Several factors deserve scrutiny as part of this process, such as providing information about the vaccinations that are recommended, locations and hours for community vaccinators offering the recommended vaccinations, contact information for the referring health professional, and preferences for the return of documentation to the referring health professional. Determining how best to handle patient self-referrals for universally recommended vaccinations, such as seasonal influenza, also could be a focus.

Document vaccination support efforts to facilitate performance-based payment.
Several avenues exist through which documentation of vaccination support could be developed, including applying for procedure codes specific to vaccination counseling, developing a checklist to assess the effectiveness of office-based health professionals in ensuring that their adult patients are vaccinated as recommended and, finally, using national surveys to gauge health professionals' effectiveness in promoting vaccination to patients.

Finally, said the researchers, "Efforts to make the promotion and administration of adult vaccines more efficient and effective require the same infrastructure that is needed to improve the delivery of other beneficial preventive care services and the management of chronic disease. Thus, efforts to expand adult vaccination may benefit as much, or more, from the success of federal and private sector initiatives aimed at transforming the delivery and financing of primary care as from the implementation of vaccination-specific provisions of health care reform legislation."

In the end, success hangs on the ability to capture savings from these initiatives' success and leveraging them to invest in practice-improving technologies, the researchers said. "Whether the transformation envisioned by primary care advocates is possible in practice is highly uncertain and depends on the ability of primary care advocates to demonstrate economic value on an ongoing basis in the face of other budgetary priorities.

"Seen in this context, efforts to promote vaccination can contribute to, as well as gain from, efforts to strengthen primary care."