Low Vaccination Rates? Try The 4 Pillars

Healthy People 2020, the national health promotion and disease intervention initiative, set the goal influenza vaccination rate in the community at 70%. Despite this goal, reports show that vaccination rates are way under expectations at 44%.

Logistics, personal beliefs about vaccines, and seasonal changes in vaccine effectiveness are some of the obstacles that stand in the way of increasing the vaccination rate. Nationwide efforts, such as the Affordable Care Act mandating vaccinations be a part of basic care, have helped only slightly. To see dramatic increases, multi-strategy, evidence-based interventions are needed and recommended by the US Department of Health and Human Services.

The 4 Pillars^TM Practice Transformation Program (4P) addresses such needs. It is an evidence-based best practices toolkit based on decades of research aimed at increasing vaccination rates in primary care settings. The 4P are founded on:

1. Convenient vaccination services

2. Communication with patients about the importance of immunization and the availability of vaccines

3. Enhanced office systems to facilitate immunization

4. Motivation among coworkers through a competitive challenge and crowning of an office immunization champion

A team of researchers affiliated with the University of Pittsburgh and the Baylor College of Medicine published the effects of the 4P in the 2016 November issue of BMC Infectious Diseases. They analyzed 4P's effects in a randomized controlled cluster trial at 25 primary care practices based in the Houston and Pittsburgh areas.

A total of 70,549 adult patients were studied for a duration of 2 years. Vaccination rates increased in both the 4P arm and the control arm. The researchers found that 4P was not more effective than secular trends.

Missed opportunities are a known cause for low vaccination rates. The researchers found a higher rate of vaccination with sites that decreased missed opportunities. They employed mechanisms such as reviewing vaccination status at every visit and offering express vaccine service.

The 4P addresses missed opportunities and provides strategies to decrease it. In the midst of influenza season, the 4P can increase vaccination rates in the outpatient setting. It is one of many approaches that can help pharmacists increase vaccination. The most important thing is to have a plan and follow it!

Reference

• Lin CJ, Nowalk MP, Pavlik VN, et al. Using the 4 pillarsTM practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial. BMC Infectious Dis. 2016;16:623.