When a patient presents for an office visit and is offered immunization, we have succeeded in eliminating perhaps the most important barrier — access. But our work is not done, as highlighted by many of the patient responses I receive when I ask patients if they’d like to get their annual flu shot.
These range from “Will it make me sick?” to “Do I really need it?” to “How much does it cost?” and “I got one last year.”
Patients often do not understand the concept of immunization. Many patients are reluctant to consent to vaccination. Many think the shot will give them influenza, and likewise cannot comprehend the need for annual immunization. The idea at the heart of vaccination – creating herd immunity so there are fewer vectors for disease transmission — is often lost to patients.
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It does not help that our current medical culture is predominately based on disease management rather than prevention. Many patients think medical intervention is unnecessary until they are symptomatic. Cost continues to be a barrier in all aspects of health care, and adult immunization is no exception.
Time constraints make it difficult to adequately educate patients about the benefits of vaccines in the office — a convincing conversation about immunization takes far more than 15 minutes. But there are several strategies that may help.
Providing patients with educational handouts on immunization at registration, prior to being called back for the provider visit, is helpful in shortening the time necessary to explain vaccines during the patient encounter. Questionnaires can also aid patients in determining their own risk for getting influenza, offering some autonomy in the decision making process.
Having medical assistants ask patients if they would like to be immunized during the initial intake can also be helpful. If a patient declines, the assistant can then further question the patient regarding their reasons for declining, and make a note of this. The provider can then understand the issues prior to the visit, enabling tailored discussions that specifically address the patient’s rationale for declining.
Remember that eliminating barriers to care is key, not only in disease management, but especially for disease prevention.
Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.
