CCMS Medicine Summer 2017 - 16

www.CHESTERCMS.org

Achieving the ARARD Standard

Focus on Referral
BY WINSLOW W. MURDOCH, MD
MICHELE A. STEINER, MPH, RN

T

he standard for adult immunization practice
- Assess, Recommend, Administer or Refer
and Document - is a crucial pathway to
improving low adult vaccination rates in the U.S., a
Healthy People 2020 goal for improving the health
of the nation. However, executing this standard
in a traditional primary care office may be easier
said than done because of challenges that may arise
at every step in the process, beginning with the
assessment.
Vaccine schedules can be somewhat perplexing to even
the most experienced practitioner and highly skilled practice
managers who are accustomed to dealing with annual revisions
and are mindful to re-check the schedules every year. The 2017
schedule of recommended vaccines for adults includes eighteen
vaccines licensed for adults, two figures with vaccine indications
based on age, medical condition and other indications, two
pages of footnotes and a full-page table of precautions and
contraindications. It's not too difficult to embrace the schedule
and strongly recommend vaccines to your patients. It's certainly
worth the effort to protect the health of these patients, especially
those who may be most vulnerable.

Primary care practices traditionally have
been tasked as the community resource for
the provision of all vaccination services.
Unfortunately, over the last decade, many
practices are having an increasingly difficult
time financing, stocking, properly storing and
monitoring the numerous new and increasingly
expensive vaccines. And many commercial
insurers reimburse medical practices at, or
less than, the actual cost of procuring vaccines for smaller
practices. It is becoming much more difficult to expect that
your neighborhood primary care office can continue to be
comprehensive with this mission.
An investment in vaccination provision is already in place
at pharmacies, travel medicine clinics and health departments
for medication storage, their core business. According to a 2016
Chester County Immunization Landscape Survey conducted
by the Chester County Health Department, many primary
care providers already routinely refer adult patients to these
sites for vaccines they don't stock in the office. Notably, 16%
of survey respondents said they assess vaccine status at less
than half of patient visits or never. This amounts to many
missed opportunities for health promotion through adequate
vaccination.
In 2014, the Chester County Medical Society sponsored
a resolution on immunization accessibility with PAMED,
the state medical society, which offered encouraging news for
insured patients. Most commercial insurers are now covering
and paying for appropriate adult vaccines directly, at the time of
administration, when given by a pharmacist without an official
medical office visit. The patient can request an appropriate
vaccine directly to the pharmacist, or they can take prescriptions
to the pharmacist, many of whom are now specifically trained at
educating and administering these vaccines.

16 CHESTER COUNT Y Medicine | SUMMER 2017
http://chestercms.org/index.html
Table of Contents for the Digital Edition of CCMS Medicine Summer 2017
