Providers’ perceived vaccination behaviors at sick and follow-up visits may be related to time restrictions resulting from shorter appointments as well as providers’ varying degrees of comfort with offering vaccines during those visits. In addition, misunderstanding of vaccination contraindications has led to missed opportunities to vaccinate women and children [22] and this may apply to adults as well. Providers need to be aware of the true contraindications to vaccines. Mild acute illness is neither a contraindication nor a precaution to administering a vaccine [23]. Future projects may also focus on educating providers (at all levels of experience) regarding the safety and efficacy of administering vaccinations during illness-related visits and actual contraindications.
Also, to address time constraints during sick and follow-up visits, making the entire practice responsible for vaccination assessment and administration should be more widely employed to reduce the burden on the primary care provider. A successful model for increasing uptake involves using teamwork [16] among clinical and non-clinical staff. Successful implementation of an adult vaccination program may be improved by using a similar approach that will increase staff buy-in and accountability.
Conclusion
While care providers in this project generally perceived the reminder checklist at the point of care as helpful as a provider reminder, a patient engager, and a tool to determine vaccine eligibility, it was not effective in increasing Tdap or PPSV coverage among adult patients in the practice. Practice and workflow-related barriers to success of the intervention imply the need for careful consideration of the type of reminder system put in place in various practices. Hesitation to vaccinate during illness-related and follow-up visits denotes the need for further education of providers regarding true contraindications to particular vaccinations and further investigation of ways to make immunizing a collective responsibility shared by the patient, the office staff, and the primary and ancillary providers.
Corresponding author: Dyllan Walter, DNP, CRNP, North Hills Health Center, 212 Girard Ave., Glenside, PA 19038, dyllan79@yahoo.com.
Financial disclosures: None.