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Adult Immunization: Strategies That Work
Private Practice Strategies
Pulsifer Medical Associates, Rochester, NY

Background
Strategies
Implementation
Resources Required
Barriers
Results
CDC's Basic Strategy


Background
Pulsifer Medical Associates is a group of seven internists and a physician assistant. Two internists are infection control consultants for Rochester's Genesee Hospital, and one is a gastro-enterologist. The group serves about 20,000 patients. Sixty percent are HMO members who select Pulsifer physicians as their primary care physicians; two percent are Medicaid patients; the rest are a combination of Medicare and private insurance patients. Practice partner Geoffrey Morris, MD, described the adult immunization strategies of his practice for us.

(Note: See CDC recommendations on the next page for a comprehensive basic strategy for private practice.)

Strategies

Places a health maintenance sheet in the front of every patient's chart. Influenza, pneumococcal, tetanus-diphtheria, MMR, and hepatitis B are checkoff items on the sheet. (Note: CDC also recommends that varicella be a checkoff item.)

Identifies high-risk patients and patients age 65 or older when charts are pulled and reviewed the night before appointments. When patients check in during influenza season, staff asks if they have been immunized, and if not, staff gives immunizations via standing orders. Each physician within the group handles pneumococcal immunizations differently.

Accepts walk-ins for influenza vaccine without arranging an office visit, unless needed. Never makes patients wait for influenza immunizations.

Recognizes the power of physician advice in the physician-patient relationship and encourages undecided patients to receive immunizations. For influenza, Dr. Morris emphasizes that HE gets influenza immunizations and that there are no significant side effects to influenza immunization. He also points out that influenza can be a deadly disease for seniors or those with chronic medical problems.

Places informational posters in the waiting room.

Uses self-stick labels printed with vaccine batch numbers as a time-saver. Labels are applied to patient charts and initialed when patients are immunized.

Targets school teachers and health care workers.

Implementation

Participated in a pilot study several years ago to increase influenza immunization levels. The study was organized by the Monroe County health department and Marc LaForce, MD, of Genesee Hospital. Placed posters and pamphlets provided by the county for patient education in the waiting room during influenza season. Pulsifer physicians competed with each other to immunize the most high-risk patients during influenza season. "Scores" were tracked on a graph displayed in the office.

Continued to use posters and graphs after the study was completed, since they were successful.

Resources Required
Time in training medical assistants to prioritize patient flow during influenza season. Vaccine ordering time. Billing time. "Paperwork is minimal," according to Dr. Morris. The group accepts Medicare assignment for influenza and pneumococcal immunizations. Local HMOs do not require a co-pay for influenza immunizations.The county health department provides posters for free.

Barriers
Barriers are few, since the entire community supports adult immunizations, and patients frequently initiate immunizations. Computer-based records, rather than paper-based records would facilitate the identification of patients who are high-risk and 65 or older for outreach activities.

Results
During the pilot study, influenza immunization levels approached 90%. Dr. Morris estimates that they currently immunize 80% of patients who are high-risk and age 65 or older against influenza.

CDC Recommends this Basic Strategy:

  • Establish changes in office systems among physician and non-physician personnel to prompt and support activities which enhance delivery of vaccination services (motivation plans, intake procedures, cues, standing orders, feedback)
  • Identify all patients in the practice with indications for vaccination by reviews of office records and patient histories
  • Display vaccination goals and chart progress (e.g., wall posters/graphs) so all staff can share in your success
  • Set up opportunities to offer vaccination services to patients during scheduled office visits for other purposes and special vaccination clinics (e.g. influenza walk-in clinics)--use standing order systems
  • Use physician and patient reminder systems (chart stickers, computer prompts, call-back systems)
  • Establish Continuous Quality Improvement systems.

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This page last modified on August 2, 2001

   

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