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Missed Opportunities to Vaccinate

By / August 24, 2020 / catch-up immunization schedule, contraindications, countering vaccine hesitancy, missed opportunites to vaccinate, missed opportunities, precautions, standing orders, vaccination rates, vaccine shortages

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.

There are many reasons for missed opportunities for vaccination.

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 Imp​​roving 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.

While we often focus on countering vaccine hesitancy and vaccine mandates, etc., simply trying to reduce missed opportunities to vaccinate is an easy way to get more folks vaccinated and protected.

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

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