AAFP Presses AMA to Step Up Immunization Advocacy Efforts

Perseverance paid off during the annual meeting of the AMA House of Delegates here June 23-27, when the AAFP delegation to the AMA house rallied other primary care delegates and supporters, scoring a win for FPs and other health care professionals who provide immunizations.

At issue was a resolution crafted by the Academy and supported by the American Academy of Pediatrics, or AAP, and the American College of Physicians. Parts of that measure, as introduced, direct the AMA to

One clause of the original resolution created a stir among those testifying in a June 24 reference committee hearing on the topic, however. That resolve asked the AMA to step up its advocacy efforts with vaccine manufacturers and distributors to "assure that physician practices, hospitals, long-term care facilities and other medical facilities receive priority in obtaining immunizations."

"Immunizations were one of the success stories of the last century, but they've created a great deal of frustration for physicians in this century," said AAFP President Rick Kellerman, M.D., of Wichita, Kan., during the reference committee hearing. Kellerman, who is a member of the Academy's delegation to the AMA house, explained that the AAFP has studied the immunization issue for several years, paying particular attention to difficulties FPs have reported in acquiring some vaccine products, especially seasonal influenza vaccine.

Citing preliminary results from the AAFP's most recent member survey on immunizations, Kellerman said that the resolution represented the Academy's attempt to spotlight problems with the overall vaccine acquisition and distribution system that continue to plague AAFP members. For example, more than one in four survey respondents reported having trouble ordering annual influenza vaccine for the 2006-07 season, up more than 8 percent from the previous season. And nearly 60 percent of respondents said some or all of their influenza vaccine shipment was delayed.

Carol Berkowitz, M.D., a member of the AAP delegation to the AMA house, testified at the hearing that AAP members also had experienced problems akin to what FPs saw during the most recent influenza season. "During the 2006-2007 season, we did receive calls from our members saying that they had been unable to obtain vaccine until November," said Berkowitz.

Still, a number of those testifying at the hearing claimed that when it comes to distributing vaccine, allowing physician practices and other medical facilities to "go to the front of the line" isn't always in patients' best interests.

Abigail Shefer, M.D., a captain in the U.S. Public Health Service and associate director for science in the Immunization Services Division of the CDC's National Center for Immunization and Respiratory Diseases, told those at the hearing in no uncertain terms: "CDC opposes the concept of preferentially making vaccine available for any one group."

"Instead of focusing on getting vaccine prioritized directly to physicians, our AMA should focus on removing barriers that keep docs from getting ready access" to vaccine products, suggested a member of the AMA Council on Science and Public Health.

Apparently swayed by testimony at the hearing, the reference committee recommended that the prioritization clause be deleted from the immunization measure when it came before the full house on June 25; the house adopted that recommendation.

The Academy's delegates remained committed to preserving the spirit of the original resolution, however, and proposed adding the following clause in place of the omitted language:

"Resolved, that the Board of Trustees study the impact on vaccine supply to medical practices, hospitals and other medical facilities that results from the large contracts, with preferential distribution, between vaccine manufacturers/distributors and large nongovernment purchasers, such as national retail health clinics, with particular attention to patient outcomes for clinical preventive services and chronic disease management."

"This amendment addresses all immunizations, not just influenza," Kellerman assured delegates when he introduced the proposed change. When physician offices are unable to offer routine vaccines to their patients, the overall function of the medical home can be breached, resulting in fragmentation of care and disruption of clinical preventive services and chronic disease management.

"We hope that this study will do two things: first of all, study the impact of large contracts with guaranteed delivery, such as to large retail purchasers, and the effect that that has on small practices, and then also study the effect on what happens in our offices when we don't have vaccines -- on things such as evaluating children for developmental delays or elderly patients who have chronic disease."

In the end, the delegates signaled their approval of this middle ground by adopting the amended resolution, which also calls for a report back to the house at the 2008 annual meeting.

The AAFP achieved a second victory of sorts when AMA delegates adopted a resolution calling for the AMA to study issues surrounding limited availability of psychiatric beds in the nation's hospitals.

At the behest of the American College of Emergency Physicians, or ACEP, the AAFP, the AAP and numerous other groups signed onto a resolution calling for the AMA to study the issue of psychiatric bed availability and associated effects on emergency room overuse and to recommend solutions.

ACEP President-Elect Linda Lawrence, M.D., spoke passionately on behalf of this and a related resolution during reference committee testimony June 24.

"This is a critical issue for which there are data available," said Lawrence. "If we don't come up with some solutions, these patients will be left on the sidelines. They're already spending the longest times in the ER, going across state lines to try to get care. They're being admitted to inhospital care that doesn't address their specific psychiatric needs. These patients are not getting the appropriate care that they need."

Delegates eventually gave a thumbs-up to a combined measure that directed the AMA to work with such stakeholder groups as ACEP, the American Psychiatric Association and others "to study and develop recommendations regarding the national scope of the problem of psychiatric bed availability and its impact on the nation's emergency and general medicine resources, including emergency department overcrowding."