Building an Adult Immunization Practice: The Primary Care Physician's Role in Disease Prevention
A Program Series at AFP-AOA State Chapter Annual Meetings

Vaccines have been highly effective in eliminating or significantly reducing the occurrence of many once-common diseases. However, barriers to immunization, particularly in older adults, have played a significant factor in the rising incidence of some vaccine-preventable diseases. Cost, reduced accessibility to vaccines, and complex or changing schedules for adult immunization have contributed to low immunization rates in at-risk adult populations. This can lead to significant clinical consequences due to vaccine-preventable diseases and related complications.

Addressing Barriers to Adult Immunization: The Role of Primary Care Providers
Primary care providers (PCPs) play an important role in administering recommended vaccines to their patients. However, PCPs must not only be knowledgeable about vaccines, they must incorporate systems in their offices to record, remind, and recall patients for vaccinations. They must also clearly communicate vaccine benefits and risks while understanding those factors that affect a patient’s acceptance and perception of vaccines.

Continuously building healthcare provider awareness of current immunization guidelines as well as the benefits of immunization is critical in not only ensuring patient vaccination, but also improving vaccination rates. "Building an Adult Immunization Practice: The Primary Care Physician's Role in Disease Prevention" Initiative has aimed to address practice and knowledge gaps in an effort to ensure and improve adult immunization. PCPs are on the frontline of managing all patients, and can therefore lead the way in these efforts by educating their patients about vaccine-preventable diseases and taking proactive measures within their clinical practice to ensure patients are vaccinated when indicated.

Learning Objectives
Learning Objectives were specifically defined to address the PCPs need in adult immunization:

• Recognize the clinical consequences of vaccine-preventable diseases in adults
• Identify adult patients who will benefit from vaccination
• Educate patients about the benefits of vaccines
• Reduce and remove system- and patient-related barriers to vaccination

SUMMARY OF PROGRAMS

MULTIDISCIPLINARY FACULTY
The faculty for this series is comprised of NFID Board of Directors and Members, leaders in the field of infectious diseases, vaccinology, and primary care:

The multidisciplinary faculty, including both physicians and pharmacists, emphasizes the importance of interdisciplinary approach when striving to improve adult immunization rates. The expert panel and audience discussion was an opportunity to discuss numerous issues related to vaccines and for learners to have many of their questions related to pharmacy, primary care, and infectious diseases answered by multidisciplinary faculty.

EDUCATIONAL FORMAT
In order to achieve the learning objectives, an educational format with an interactive sequential approach was utilized that

1. Assessed learners' baseline approach (awareness and perception)
2. Presented practical and clinically applicable evidence-based information
3. Demonstrated how PCPs can implement processes in their practice to reduce barriers to adult vaccination

Agenda

During each of the programs, there have been many questions asked ranging from appropriate use and administration of vaccines, possible interactions, to insurance coverage. The quantity and scope of audience questions at each of the programs reinforces the need for educational programs to clarify current adult immunization recommendations for primary care.

Frequently Asked Questions

• Why do we not immunize healthcare workers against pneumococcus?
• Can you provide us with guidance on pneumococcal revaccination?
• Do you recommend immunizing at time of discharge from the hospitalization or waiting for a follow-up?
• Can pregnant women get the influenza vaccine? Any trimester?
• Is there any data regarding shingles prevention in recipients of zoster vaccine?
• What do I do about patients who refuse to get the flu shot because they claim that they get really sick from it?
• If a patient (<50y/o) has shingles once or multiple times, would you recommend zoster vaccines? What if it was ocular shingles?
• Should Tdap be given early in pregnancy to help with fetal antibody production?
• Should I start routine Tdap for all patients without vaccination records?
• How concerned should I be about the neomycin allergy in shingles vaccination?

ASSESSMENT OF THE IMPACT OF EDUCATIONAL INITIATIVE
Following the activity, participants were asked if they planned to make any changes to their practice behavior based on participating in the program. An overwhelming 85% of the learners said that they would make a change in their practice following the activity.

Knowledge and Practice Gaps
After participating in the program, learners recognized the importance of primary care in promoting adult vaccination and stated that they are now confident in identifying those adults who would benefit from immunization.

Learner Feedback

• Wow, what a great panel! Great speakers - knowledgeable and enthusiastic, great speakers, all very knowledgeable
• Great lectures – up-to-date and real, excellent speakers and presentation, very eye-opening!
• Excellent discussion
• Very informative, excellent and highly relevant presentations
• Excellent lectures – learned a lot!
• Faculty were very knowledgeable, conscientious, and willing to help with questions
• Relevant and useful
• Wonderful presentation of the subject, great expertise
• Very knowledgeable, conscientious, willing to help with questions, well presented
• I am more confident than before in recognizing adults who would benefit from vaccination according to current ACIP recommendations