Breaking down barriers to care

Lisa Stern, APRN
Lisa Stern, APRN

Writing in the June 10 edition of the New York Times, Dr. Pauline Chen explains the strangely low rates of shingles immunization among American adults. Citing a May report in the Annals of Internal Medicine, Chen reports that the vaccine, FDA-approved since 2006, has been administered to fewer than 10% of eligible adults. And half a million Americans continue to suffer from shingles each year. Considering the painful, unsightly, and often persistent sequelae of shingles, the vaccine's unpopularity seems especially baffling.

As study author Dr. Laura Hurley explains, "If a treatment isn't easy to administer, then sometimes it just falls to the bottom of the list of things for people to do." In the case of the shingles vaccine, financial barriers have made it unfeasible for many providers to stock it in their offices. As we all know from our experiences with patients (and our experiences as patients), compliance drops considerably when an extra step (e.g., going to the pharmacy to purchase the vaccine, going to a special immunization clinic) is added on.

We all have things like the shingles vaccine in our own clinical settings – services we ought to provide to patients but can't or don't for various practical reasons. In the reproductive health world, this is often long-acting reversible contraceptive (LARC) methods like the IUD and Implanon. Despite the enormous potential of LARC methods to reduce rates of unintended pregnancy and improve women's health, training barriers, expense, and persistent myths limit their use.

Given our commitment as a health-care community to evidence-based practice, our shared challenge is to identify areas of clinical practice where we need to make improvements to ensure our clients ready access to the treatments and diagnostics we know are best. Sometimes it may be inconvenient, sometimes it may be expensive, and sometimes it may require our utmost creativity and skill. But by identifying reasonable work-arounds, eliminating internal barriers, and/or lobbying for reform, we can achieve better outcomes for all of our clients.

I'd love to hear stories of your own struggles in the field. What steps have you taken – as a clinician, as a client, or as a citizen – to break down barriers to care? Join the conversation in the comments section below and be inspired.

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