Vaccination Strategies

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• Vaccination Strategies

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Center for Immunization and
Respiratory Diseases Centers for Disease Control
and Prevention
Revised May 2009
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Why Focus on Strategies to Increase Immunization?

• Immunization levels not optimal
• Cost-effectiveness of some strategies uncertain
• Sustainable systems needed

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AFIX

• Assessment
• Feedback
• Incentives
• eXchange

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Special Characteristics of AFIX

• Focuses on outcomes
• Focuses on providers
• Blend of advanced technology and personal
  interaction

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Assessment

• Evaluation of medical records to ascertain the
  immunization rate for a defined group
• Diagnosis of potential service delivery problems
• Assessment increases awareness

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Feedback

• Informing immunization providers about their
  performance
• Assessment with feedback creates the awareness
  necessary for behavior change

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How to Provide Feedback

• With feeling and precision
• Without judgment
• With confidentiality as appropriate

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Incentives

• Something that incites to action
• Vary by provider and stage of progress
• Opportunities for partnership and collaboration

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eXchange of Information

• Allows access to more experience than an
  individual can accumulate
• Motivates improvement
• Coordinates resources and efforts

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VFC/AFIX

• Incorporate AFIX activities during VFC site
  visits
• Combine VFC/AFIX site visits
• Reduces number of visits
• Extends reach of AFIX

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Comprehensive Clinic Assessment Software
Application (CoCASA)

• VFC and AFIX results
• Immediate assessment results
• Estimate of coverage levels
• Reasons for deficiencies
• Reports on patient subsets

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Strategies for High Immunization Levels

• Recordkeeping
• Recommendations and reinforcement
• Reminder and recall to patients
• Reminder and recall to providers
• Reduction of missed opportunities
• Reduction of barriers to immunization

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Records

• Must be available at the time of the visit
• Must be easy to read
• Must be accurate
• reflect current patient population
• reflect all vaccines given

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Immunization Registries

• Single data source for all providers
• Reliable immunization history
• Produce records for patient use
• Key to increasing immunization levels

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Recommendations and Reinforcement

• Recommend the vaccine
• powerful motivator
• patients likely to follow recommendation of the
  provider
• Reinforce the need to return
• verbal
• written
• link to calendar event

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Reminders and Recall to Patients

• Remindernotification that immunizations are due
  soon
• Recallnotification that immunizations are past
  due
• Content of message and technique of delivery vary
• Reminders and recall have been found to be
  effective

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Reminders and Recall to Providers

• Communication to healthcare providers that an
  individual clients immunizations are due soon or
  past due
• Examples
• computer-generated list
• stamped note in the chart
• Immunization Due clip on chart

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Missed Opportunity
A healthcare encounter in which a person is
eligible to receive vaccination but is not
vaccinated completely
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Reasons for Missed Opportunities

• Lack of simultaneous administration
• Unaware child needs additional vaccines
• Invalid contraindications
• Inappropriate clinic policies
• Reimbursement deficiencies

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Strategies for Reducing Missed Opportunities

• Standing orders
• Provider education with feedback
• Provider reminder and recall systems

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Reduction to Barriers to Immunization

• Physical barriers
• waiting time
• distance
• Psychological barriers
• unpleasant experience
• safety concerns

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CDC Vaccines and ImmunizationContact Information

• Telephone 800.CDC.INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/vaccines