In addition to countering vaccine hesitancy and increasing access, one easy way to increase vaccination rates is to reduce any missed opportunities to get people vaccinated and protected.
“Assessment refers to the evaluation of medical records to ascertain the immunization rate for a defined group of patients, as well as to provide targeted diagnosis for improvement. This step is essential because several studies have documented that most healthcare providers, while supportive of immunizations, do not have an accurate perception of their own practice’s immunization rates. Pediatricians in these studies greatly overestimated the proportion of fully immunized children in their practices. Assessment increases awareness of a provider’s actual situation and provides a basis for subsequent actions by provider staff.”The Need for Strategies to Increase Immunization Levels
These are situations in which a child or adult who is not fully vaccinated visits a clinic or health care provider and leaves without getting a vaccine that was due.
Missed Opportunities to Vaccinate
How do missed opportunities to vaccinate (MOV) happen?
“Missed vaccination opportunities have been shown to contribute to lower vaccination rates among children and adults. A missed vaccination opportunity occurs when a vaccine-eligible patient is seen for care but remains unvaccinated.”Wong et al on Missed Opportunities for Adolescent Vaccination, 2006-2011
It could be that their provider was temporarily out of a recommended vaccine, but a more likely scenario is that someone goes to the doctor while behind on a vaccine, and if they weren’t specifically there to get that vaccine, if the provider isn’t targeting missed opportunities for vaccination, then there is a good chance that they will leave without getting caught up.
Whatever the reason, we should work to use these opportunities to get children and adults vaccinated.
“t is important to vaccinate whenever possible, because you don’t know when a patient will be back in your office. Use sick-child and chronic care visits as a time to immunize. Be sure to check what vaccinations, if any, are due every time a patient is in the office. Always screen for contraindications.”Office Strategies for Improving Immunization Rates
To reduce missed opportunities to vaccinate, it can help to:
- get kids vaccinated on schedule, instead of spacing doses out, and make a detailed catch-up plan for anyone that is behind
- encourage new patients to bring all of their previous immunization records to their visit
- use an electronic health record system to forecast or automatically generate prompts when vaccines are due at well visits and sick visits
- manually review your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
- use standing orders and “nurse only” or “shots only” visits for vaccinations
- get patients caught up on their vaccines before they are discharged from the emergency room or hospital
- check the immunization records of others, including children, siblings, and parents, etc., that may have accompanied the patient to their visit
Working to reduce missed opportunities to vaccinate can help get everyone caught up and vaccinated and protected as quickly as possible, instead of making them wait until their next check up.
“The majority of vaccines are administered during well-child visits (eg, sports or camp physicals), and several surveys have shown that health care providers do routinely assess immunization status during such visits. However, acute care visits or sick visits in the patient-centered medical home are also an opportunity to deliver vaccines or to discuss upcoming vaccines. Assessing immunization status during sick and acute care visits is important.”Bernstein et al on Practical Approaches to Optimize Adolescent Immunization
This can help to increase vaccination rates.
“A 2014 analysis using data from recent Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) estimated the potential gains in coverage if the children who were in contact with health services received the doses of vaccine(s) for which they were due. For example, bridging the MOV gap could potentially improve Penta3/DTP3 coverage by as much as 10 percentage points, depending on the country (Table 1). At a sub-national level (e.g. poor performing districts or facilities) these coverage gains could be even greater, in some cases up to 30%.”Planning Guide to Reduce Missed Opportunities for Vaccination.
Even if most providers can’t expect to see a 30% or even 10% gain in vaccination rates from these efforts, a gain of just 1 to 3% would also be welcome.
More on Missed Opportunities to Vaccinate
- Strategies for Increasing Childhood Vaccination Rates
- We Know What Happens If We Stop Vaccinating
- Precautions vs Contraindications When Vaccinating Your Kids
- Vaccine Shortages
- Reducing Missed Opportunities to Vaccinate During Child Health Visits
- WHO – Missed Opportunities for Vaccination (MOV) Strategy
- WHO – Planning Guide to Reduce Missed Opportunities for Vaccination
- WHO – Intervention guidebook for implementing and monitoring activities to reduce missed opportunities for vaccination
- Missed Opportunities for Vaccination Assessment Report
- CDC – The Need for Strategies to Increase Immunization Levels
- CDC – The Comprehensive Clinic Assessment Software Application (CoCASA)
- AAP – Office Strategies for Improving Immunization Rates
- Reduce Missed Opportunities to Vaccinate
- Missed Opportunities for Rotavirus Vaccination
- Adolescent Immunizations: Missed Opportunities for Prevention
- Missed opportunities for adolescent vaccination, 2006-2011
- Factors Associated With Missed Opportunities for Influenza Vaccination: Review of Medical Records in a Diverse Sample of Primary Care Clinics, San Diego County, 2010-2011
- Pediatric Hospitalizations: Are We Missing an Opportunity to Immunize?
- The Need to Optimize Adolescent Immunization
- Practical Approaches to Optimize Adolescent Immunization
- Missed Opportunities for Influenza Vaccination Among Hospitalized Children With Influenza at a Tertiary Care Facility
- Missed Opportunities for Influenza Vaccination in Children With Chronic Medical Conditions
- Can vaccination coverage be improved by reducing missed opportunities for vaccination? Findings from assessments in Chad and Malawi using the new WHO methodology
- Prevalence and dynamics of missed opportunities for vaccination among children in Africa: applying systems thinking in a systematic review and meta-analysis of observational studies