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

2. 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.

3. NYSAFP Policies

4. 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

5. The Medical Home

6. 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

7. Influence

8. Who Most Influences Adults’ Decisions to Get Immunized?

9. 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 National Adult Immunization Consumer Survey. In: Landers SJ. Physicians asked to persuade adults to get immunized. American Medical News Available at:

10. The Literature

11. 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
child and adult standing order
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

12. 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

13. Ultimate Goal

14. 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

15. Thanks & Contact Info

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

17. 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
@SCNosalMD
Urban Horizons Family Health Center East 168th Street Bronx, NY 10452
Office: Fax:

19. Immunization Info Resources
health/immunizations.html
resources-safetysheets.html