by Dr. Susan Kressly
Vaccines save lives.
We can all agree that advances in vaccines have revolutionized modern medicine and over the last decades have helped save millions of lives. Many of our young colleagues have no experience dealing with HIB epiglottitis or pneumococcal meningitis, let alone seeing a case of measles, mumps, or congenital rubella. The chief complaint from patients we see in our offices every day has been significantly impacted by advances in vaccines. Instead of buccal cellulitis and significant bacterial pneumonia, we are caring for anxiety, ADHD, and obesity. We no longer always reach for antibiotics for patients with otitis media, because many of them are caused by viruses.
While we may have become complacent about the diseases we are preventing in our patients, we cannot falter in our continued efforts to get all of our patients up to date on all vaccines at every opportunity. When we work hard at this, everyone wins: the families, our communities, and our practices.
This has been even more challenging during the COVID-19 public health emergency as many parents may be frightened to come to the pediatric office for routine well visits and immunizations. In addition, most parents have never known a family where a child suffered from bacterial meningitis, died from pertussis, or is permanently deaf or sterile from mumps. Those problems which we prevent with immunizations are not on their radar. It seems reasonable, from a parent perspective, to delay well visits and vaccines until “things settle down.” However, pediatricians know that is not reasonable and we run the risk of a second public health emergency from a vaccine-preventable disease as immunization rates plummet across the country and herd immunity is threatened.
What does it take to succeed? Understanding who your patients are, using clinical decision support (CDS) tools to give the right vaccines to the right patients, and managing inventory to ensure you always have the vaccines to administer.
Population health is not just a buzzword. It applies to all of us who care for families. Giving good care to your patients starts with identifying and understanding who they are. For example, do you have a way to identify all of your 5-year-old active patients so you can reach out to them over the summer and recall those missing school-mandated vaccines prior to the first day of school? Can you identify and close care gaps for 16-year-olds who need their second MCV4?
According to the Advisory Committee on Immunization Practices (ACIP), the most fundamental clinical decision support tool that pediatricians want to reliably care for patients is vaccine forecasting, including catch up schedules. The ACIP schedule is complex. New combination vaccines with various age specifications and minimal intervals are adding to the complexity all the time. Having a computer tool to sanity-check your mental processes is key to reducing errors. Prompting team members at every opportunity with which vaccines are due, reduces missed opportunities to vaccinate. A good immunization CDS tool puts that information in front of the triage nurse, the front desk at check-in, the clinical staff, the provider, and the family on the patient portal.
Most pediatricians (except for those in universal purchase states) have the additional challenge of providing vaccines supplied from two different sources: VFC (Vaccines for Children) and private stock. Managing two separate inventories, minimizing errors for using the wrong stock, having the ability for integrated inventory within the EHR can reduce practice burden.
Vaccines are the second most costly item for a pediatric practice (only surpassed by payroll) and when managed well, can be a source of profit. Having a tool which facilitates upcoming inventory needs based on ages of your patients, and knowing at all times current stock (and how much money you have in that refrigerator!) can inform smart business decisions for vaccine ordering.
So what happens when your children are all vaccinated and up to date? Your patients, your families, and your communities are all healthier. Partnering with families, you can be the difference between a preventable outbreak in your community or a community that is safe and protected.
Use your relationships with your families, reach out to them in creative ways to let them know you are open for business, and are providing safe and important care, including well visits. Outline the steps your practice is taking to keep them safe including PPE, eliminating the waiting room, separating sick and well children. Ask them what is getting in the way of getting preventive care and vaccines, then work to overcome their fears and think outside the box to accommodate them. Well visits by telehealth followed by car/parking lot immunization visits? Get creative and make sure you are doing everything possible to keep your patients up-to-date.
Does your practice have the desire, the tools, and the passion to lead your community when it comes to immunization rates? Your families and the ‘herd’ depend on it.
Office Practicum is a leading provider of pediatric-specific solutions. Our EHR, PM system, and billing services help pediatric practices improve clinical and financial outcomes. Contact us today to learn more.