Increasing immunization assessments and influenza vaccination at community-based adult services centers would benefit older adults at higher risk for severe infection.
“Medicare-Medicaid beneficiaries comprise a group of older adults, primarily those aged 65 and older, who frequently have concurrent or multiple chronic conditions that put them at much higher risk than younger adults for severe disease from acute conditions like community-acquired pneumonia or other respiratory diseases, including those caused by influenza, Streptococcus pneumoniae, and/or, as what we have seen recently with devastating results, COVID-19,” Tony Kuo, MD, MSHS explains. “Many of these diseases are preventable, or at least their complications can be lessened greatly, with vaccines. Unfortunately, access to vaccines, whether it’s due to cost, logistics, arranging a visit to the doctor, or just trying to contact hard-to-reach patients, has traditionally been challenging.”
As a result, opportunities to improve the promotion and delivery of vaccines in this population, such as those receiving services in community-based adult services (CBAS) centers, “remain a critical part of healthcare and public health,” Dr. Kuo says. There are more than 4,100 adult day service centers in the United States, according to the CDC.
For a study published in Vaccine, Dr. Kuo (corresponding and senior author), Maria-Teresa Cuddihy, MD, MPH, FACP (lead author), and colleagues aimed to determine why immunization assessments, followed by influenza vaccination, are not routinely conducted at CBAS centers caring for vulnerable beneficiaries in or near medically underserved areas. They performed an organizational assessment to determine modifiable factors that may hinder—or, conversely, enable—immunization assessment and influenza vaccination at 158 CBAS centers in Los Angeles County, California, using a 17-question survey. The survey examined gaps in communication with primary care providers, institutional policies for influenza vaccination, and vaccination policies for staff and clients, including whether increasing vaccinations was an interest/priority for the center.
Barriers Predicted Immunization Assessment & Influenza Vaccination
A total of 101 centers, or 66%, completed the survey. More than half of responding centers (58%) did not perform immunization assessments for influenza, although nearly three-quarters (71%) noted it would be feasible to do so if the assessments were incorporated as part of individualized/nursing care plans. The strongest indicators that influenced whether CBAS centers performed influenza vaccination assessments included center size, the presence of barriers to vaccination, and “the belief that it is the center’s responsibility to conduct immunization assessments and vaccinations,” according to the study results.
“Most barriers around vaccines may have more to do with having familiarity with vaccines, and in assessing or delivering vaccines, than with each of the individual barriers,” Dr. Cuddihy says. “Organizational experience and knowledge matter. CBAS centers that had incorporated immunization assessment and believed in providing vaccinations to their clientele reported less barriers in general, believed that vaccination of their clients is a part of their mission (responsibilities), and contacted primary care physicians to ensure better coordination of care (Table).”
Interest in and Strategies for Increasing Immunization Assessment & Influenza Vaccination
The results indicate that “there are potentially missed opportunities in the CBAS setting to address vaccine-preventable diseases by routinely assessing for, and providing, vaccinations for Medicare-Medicaid beneficiaries,” Dr. Kuo says.
Dr. Cuddihy indicates that while the study did identify barriers to influenza vaccination at CBAS centers, “they are generally not insurmountable,” and several centers have already expressed interest in, and are promoting, vaccination.
“For example, 60% of the centers routinely contacted clients’ primary care providers regarding influenza vaccination, and nearly 43% indicated interest in having an external vendor such as a retail pharmacy come on-site to administer vaccines, which probably can be done at no additional cost to the center,” she notes. “29% indicated it was not feasible to incorporate immunization assessment and vaccinations into a client’s intake process or nursing plan of care. These are all potential areas where centers could implement protocols to make these processes more routine, by contacting clients’ primary care providers about vaccinations, engaging external vendors, especially during influenza seasons, and making vaccine a part of the intake process or nursing plan of care.”
