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Immunization Science

Missed Opportunities for Adult Immunization

The article

Missed opportunities for adult immunization in diverse primary care office settings. Nowalk MP, Zimmerman RK and Feghali J. Vaccine 2004;22(25-26):3457-3463.

Explanatory note: Immunization rates against pneumonia, influenza and tetanus of people 65 years of age and older are low in the United States. In addition, there are major economic and racial disparities in immunization coverage for older Americans.

The question

Are there missed opportunities to immunize adults more than 65 years of age?

The study

Researchers reviewed 810 medical records of patients in a variety of geographic, socioeconomic and practice settings, including rural, inner-city, Veterans’ Affairs (VA) and urban/suburban practices. They observed many different methods of recording immunizations. The study included patients 66 years of age or older that had an office visit during the study period. Approximately 9,000 visits were examined.

Researchers used the medical records to determine the number and type of visits, whether vaccines had been discussed, and whether vaccines were given or refused. They sought to determine influenza vaccination during 3 influenza seasons (October 1, 1998 to December 31, 2000) and pneumococcal and tetanus vaccinations over 5 years (January 1, 1995 to December 31, 2000).

Missed opportunities for immunization were defined as the total medical visits minus any visits in which vaccine was discussed or refused by the patient.

The findings

Missed opportunities to vaccinate against influenza occurred at 38% of visits, against pneumococcal disease at 47% of visits and against tetanus at nearly all visits (95%).

Only 24% received influenza immunization in all 3 seasons while 25% received no influenza vaccine in any of those seasons.

Refusal of vaccine receipt varied by site and by vaccine but occurred at rates of 9% or less.

Missed opportunities resulted from failure to discuss vaccination and to vaccinate at acute care visits, and from low frequency of preventive visits. Veteran Affairs records included a discussion of the vaccines more than at any of the other sites. Vaccination rates and missed opportunities also varied by clinic locations and socioeconomic status.

The relevance/bottom line

This study found that failure to discuss vaccines, to vaccinate at acute visits and to schedule preventive care visits are obstacles to achieving national adult immunization goals.

NNii’s comment

A minority of medical records indicated that physicians had discussed adult vaccines or vaccination status with their patients. In children, failure to review immunization status is also one of the most common reasons for missed opportunities to immunize.