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President's Column

ACP-ASIM launches new initiative to boost adult immunization rates

From the January 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

Too sick to be seen in the office, an elderly, female former smoker presents at the emergency room. She complains of fever, cough and pleuritic chest pain. She is in respiratory distress. The diagnosis? Bilateral pneumonia. She is immediately admitted and started on empiric IV antibiotics. From the sidelines, a third-year medical student watches intently, even though this is not her patient.

I was that medical student, and the patient was my grandmother. Despite the best efforts of the medical team treating her, she did not respond to treatment and subsequently died from pneumococcal pneumonia and its complications.

How many times have each of us endured the loss of a patient or loved one due to a disease that could have been prevented by a vaccine? Even when we can treat infections with our army of antibiotics, a patient's other medical problems can ultimately cause us to lose the battle. Our patients need an edge to ensure success. Vaccines can make a difference.

Preventing needless suffering

As internists, we provide the majority of primary care for adults in America. We have experienced first-hand, at the bedside, the needless suffering and loss of life that pneumonia and influenza inflict on the elderly. We also know all too well that pneumonia and influenza together are the fifth leading cause of death among seniors. Each year, pneumococcal disease alone causes 500,000 cases of pneumonia, 50,000 cases of bacteremia and 3,000 cases of meningitis.

Although these diseases can be prevented by a vaccine, 1997 statistics show that among adults age 65 and older, only 63% were vaccinated for influenza and only 43% were vaccinated for pneumococcal disease. In "Healthy People 2010," citing the 10-year health objectives for the nation, the U.S. Department of Health and Human Services insists we should aim for vaccination rates of 90% for seniors. This is a lofty goal, but one that is clearly worthy of internal medicine's best efforts.

Understanding the barriers to immunization can help internists overcome them. A primary barrier is patients' lack of knowledge about what immunizations they need. In addition, many misconceptions and fears about immunizations hinder the broader use of vaccinations. For example, too many patients worry about adverse reactions to vaccinations, or they worry that the vaccination will cause the very disease they are trying to avoid. Internists must work to dispel these myths and educate the public about the health benefits of appropriate vaccination.

Inadequate insurance coverage is another part of the problem. While Medicare Part B pays for both influenza and pneumococcal immunizations, many private insurance plans cover neither.

Managed care has also hindered vaccination rates. As we shorten office encounters to handle ever-increasing patient loads, preventive measures often take a back seat to immediate complaints.

The College's initiative

The College understands the challenges that practicing internists face when it comes to vaccinations. For this reason, the College is launching the ACP-ASIM Adult Immunization Initiative to provide strategies and tools to implement immunization programs in routine office practice, with an emphasis on office economics.

The College also understands its members' concerns about the economic disincentives that health insurers use to discourage the use of vaccinations. Many either do not cover adult immunizations at all, or if they do, they reimburse below the cost of providing the immunization.

Therefore, the College's Managed Care and Regulatory Affairs Department will use hard data to press health plans and insurers for rational reimbursement. We will show payers the positive economic impact of improved coverage for immunizations.

The College will also release the fourth edition of the "Guide for Adult Immunization" later this year. A short-format version of the book will also be available for easy reference.

And don't forget to check the College's Web site, which will soon provide information about treating high risk patients and links to other immunization resources, including CDC notices and alerts and specific vaccine information from the manufacturers.

In addition to influenza and pneumococcal vaccines, the College's Adult Immunization Initiative will also focus on vaccines for Hepatitis B, Lyme disease, tetanus, varicella and other vaccines frequently missed in childhood. Although less than 5% of adults are susceptible to infection from the chicken pox virus, adults are 25 times more likely to die from the disease than children, and it can have devastating effects during pregnancy.

Likewise, rubella can cause severe birth defects if contracted during pregnancy, and at least 12 million women of childbearing age are susceptible to the disease. Up to half of Americans over age 50 are not adequately immunized against tetanus and diptheria. One out of every 10 people who get diptheria will die from it, and 40 to 50 cases of tetanus still occur each year. An Institute of Medicine report, "Calling the Shots: Immunization Finance Policies and Practices," reported that 50,000 to 70,000 adults die each year from diseases that could have been prevented or mitigated by vaccines.

Vaccines are one of the greatest public health achievements of the 20th century. We still must take great strides to ensure that our patients receive this protection. ACP-ASIM is stepping forward to lead the profession in increasing adult immunization rates. Won't you join us?

Sandra Adamson Fryhofer, FACP

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