Geriatric Immunization Study Highlights Need to Promote Vaccination Culture

According to the Office of Disease Prevention and Health Promotion, about 42,000 adults die from vaccine-preventable diseases in the U.S. each year. These deaths tend to affect older adults, a population segment that could greatly benefit from scheduled immunizations.

Even when elderly patients survive vaccine-preventable illnesses, they are often left with debilitating side effects. For example, shingles survivors may suffer from blindness and postherpetic neuralgia.

“Immunizations are incredibly important, universally accepted tools in medicine,” explains geriatrician Kenneth Koncilja, MD. “Since many doctors still struggle to communicate the benefits and true perceived risks, older adults are still dying from preventable diseases at alarming rates.”

The Gerontological Society of America (GSA) recently conducted a study designed to increase the rate of immunizations in older adults at hundreds of participating medical centers. “The results of the study show that increasing immunization rates is the shared responsibility of everyone who comes in contact with the patient,” notes Dr. Koncilja.

Potential barriers to immunization

In primary care settings, physicians often face challenges in convincing the elderly and their caregivers about the benefits of vaccines. Most medical schools and residency programs do not provide adequate training for physicians to properly defend vaccines in view of the risks.

Other barriers involve financial payor differences. Based on insurance and payment models, some vaccines can be administered in primary care clinics while others must be given in a pharmacy. “Sometimes, a doctor may spend 10 minutes explaining the importance of vaccinations to a patient (or caregiver) only to tell the person that he or she must leave the office and go to a pharmacy to get the vaccine,” explains Dr. Koncilja. “The more walls we build between patients and good medical care, the less likely they’ll get the care they deserve.”

Participant demographics and educational toolkit

Prior to the GSA study, thought leaders from various areas of medicine identified seven major problems contributing to the geriatric vaccination problem. Then, based on existing resources and member interest, they chose to identify providers (nurses and physicians) and lay champions (not healthcare) to promote immunizations.

The GSA study leaders recruited 212 participants from healthcare systems and hospitals across the U.S. About 30 percent of participants were front-line care providers, including physicians, nurse practitioners and physician assistants. About 50 percent of participants were nurses. The remaining participants included social workers and administrative assistants.

Participants took a motivational training course on vaccinations that focused on best practices from a toolkit called the Immunization Champions, Advocates and Mentors Program (ICAMP) intervention. The toolkit included educational materials published by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices.

Participants were taught how to use social cognitive theory as a way to motivate behavioral changes. “Their goal was not to tell people to get vaccinated but to motivate them to want the vaccine for themselves or their family members,” explains Dr. Koncilja.

Participants were asked to collect survey data 90 days before and 90 days after implementing the ICAMP intervention.

Rate of impact

Out of the 212 participants, 186 of them successfully made changes to their immunization practices within their care settings. “Interestingly, this study demonstrates that the vaccination crisis is not strictly fixed by doctors,” says Dr. Koncilja. “In fact, we are finding immunization champions across all parts of a healthcare system or practice.”

Andrea Pallotta, PharmD, a pharmacist at Cleveland Clinic who specializes in infectious disease issues, was a participant in the ICAMP training. “Pallotta has a longstanding interest in adult immunization and piloted a vaccine reminder program targeting physicians caring for patients with specific chronic illnesses,” explains infectious disease physician Susan Rehm, MD. “She was able to implement what she learned at ICAMP by expanding the health maintenance reminders for internal medicine throughout the enterprise. We are currently tracking annual data for immunization rates.”

Steps for improving vaccination rates

To improve vaccination rates, it’s important to conduct motivational training across the organization. “Everyone must understand the benefit of promoting a vaccination culture,” notes Dr. Koncilja. “We must actively make our environment a safe place to ask questions about vaccines.”

This open environment also helps patients who may feel nervous about discussing issues related to vaccinations. “Be open to listening to people’s fears and concerns about potential risks,” explains Dr. Koncilja. “We must strive to become motivational educators rather than medical lecturers.”

When it comes to vaccine education, Dr. Koncilja warns: “Don’t reinvent the wheel!” Hospital leaders should take advantage of available educational resources, using them to promote enthusiasm about immunization. For example, the CDC offers several free resources for promoting flu vaccines.

Future research goals

According to the GSA study, “Future research should consider including a more comprehensive theoretic model such as the Consolidated Framework for Implementation Science and also consider using clinical decision support systems to gather immunization rates in real-world clinical settings.”