the medical home for Adult immunizations Sarah C. Nosal, MD, FAAFP President, NYS Academy of Family Physicians (NYSAFP) @NYSAFP_Prez @SCNosalMD

In thanks and with permission, Disclosures No relevant financial relationships to disclose. In thanks and with permission, Content has been copied and/or adapted from Adult Immunization CME that had been developed by Dr. Margot L. Savoy, MD, MPH, FAAFP, FABC, CPE Content has been copied and/or adapted from NYSAFP Policy and the work of Dr. Philip Kaplan, Past- President NYSAFP and Chair of Vaccine Committee which advises NSYAFP regarding vaccine policy Defining the PCMH The 2007 Joint Principles of the Patient-Centered Medical Home(3 page PDF)—as developed by the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association—are as follows: Physician-led practice: Patients have access to a personal physician who leads the care team within a medical practice. Whole-person orientation: The care team provides comprehensive care, including acute care, chronic care, preventive services, and end-of-life care, at all stages of life. Integrated and coordinated care: Practices take steps to ensure that patients receive the care and services they need from the medical neighborhood, in a culturally and linguistically appropriate manner. Focus on quality and safety: Practices use the quality improvement process and evidence-based medicine to continually improve patient outcomes. Access: Practices commit to enhancing patients’ access to care.

NYSAFP Policies

NYSAFP in support of: Single payer health care Universal purchase of all vaccines, flu vaccine, childhood vaccines, any vaccines A program of vaccines for adults analogous to VFC Universal reporting of all doses given to adults to the State Registry Thorough consideration of the unintended adverse consequences of vaccinating outside the medical home

The Medical Home

The Medical Home Physician-led practice Whole-person orientation Integrated and coordinated care Focus on quality and safety Access Physician-led practice: Patients have access to a personal physician who leads the care team within a medical practice. Whole-person orientation: The care team provides comprehensive care, including acute care, chronic care, preventive services, and end-of-life care, at all stages of life. Integrated and coordinated care: Practices take steps to ensure that patients receive the care and services they need from the medical neighborhood, in a culturally and linguistically appropriate manner. Focus on quality and safety: Practices use the quality improvement process and evidence-based medicine to continually improve patient outcomes. Access: Practices commit to enhancing patients’ access to care. The 2007 Joint Principles of the Patient-Centered Medical Home —as developed by the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association—are as follows

Influence

Who Most Influences Adults’ Decisions to Get Immunized?

Who Most Influences Adults’ Decisions to Get Immunized? Percentage Personal physician 69% Family member 19% Celebrity physician, public figure, other 7% None of the above 4% No answer 1% Source: National Foundation for Infectious Diseases. 2009 National Adult Immunization Consumer Survey. In: Landers SJ. Physicians asked to persuade adults to get immunized. American Medical News. 2009. Available at: http://amednews.com/article/20090803/profession/308039978/7/.

The Literature

Consensus in the Literature Known barriers… Medical Home based interventions… Lack of knowledge about immunizations Provide printed or web-based materials (CDC Vaccine Information Statements) Fear of vaccine safety Share honestly what is known and not known about risks and benefits; Clinician understanding/explanation of complex but straightforward multisource scientific evidence Limited access to immunization services Simultaneous administration of all missing vaccines Fear of vaccine related side-effects Vaccines pose less of a risk than the diseases they are meant to prevent Make vaccination a front-end priority, rather than an afterthought, and appropriately delegate authority (use of standing orders) Empower personnel to administer immunizations without a physician order www.aafp.org/immunization- child and adult standing order www.immunize.org/standingorders 2. Use widely accepted practice management resources ICD-10 codes tied to computerized algorithm/rule for vaccine eligibility (better than broad categories of chronic diseases in normal paper standing orders) 3. Implement reminder-recall systems Recall and reminder systems have resulted in increases of up to 20% in rates of vaccination against Hepatitis B Tetanus Influenza Pneumococcal disease

Consensus in the Literature Known barriers… Medical Home based interventions… Lack of physician recommendation Routine assessment of immunization status and engagement in Medical Home Physician and other health care provider with limited knowledge of vaccine indications and contraindications Maintenance of knowledge of published preventive care guidelines Fragmented adult care Vaccine registries-Immunization Information Systems Low perceived risk of contracting a disease Educate on need for herd immunity to protect children and grandchildren State (and City Registries) Eliminate “permission” to be included in registry Query and Submit Best Possible Scenario National Immunization Registry With support for interfaces/costs particularly for solo/small practice docs

Ultimate Goal

Goals to Improve Immunization Rates Immunization engagement in the medical home to enhance the delivery of comprehensive, integrated healthcare and health promotion services to improve health and well being

Thanks & Contact Info

In Thanks… Dr. Margot L. Savoy, MD, MPH, FAAFP, FABC, CPE Dr. Philip Kaplan, MD Dr. Jamie Loehr, MD healthisprimary.org

Contact Information Sarah C. Nosal, MD, FAAFP President, New York State Academy of Family Physicians Medical Director, Urban Horizons Family Health Center Chief Medical Information Officer, Institute for Family Health Email: SCNosalMD.AAFP@gmail.com twitter: @NYSAFP_Prez, @SCNosalMD Urban Horizons Family Health Center 50-98 East 168th Street Bronx, NY 10452 Office: 718.293.3900 Fax: 718.293.3980

Immunization Info Resources www.aafp.org/patient-care/public- health/immunizations.html www.immunize.org www.immunize.org/vis/ www.cdc.gov/vaccines/index.html www.cdc.gov/vaccines/hcp/conversations/provider- resources-safetysheets.html www.cdc.gov/vaccines/acip/index.html