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Updating Adult Vaccination Recommendations

Updating Adult Vaccination Recommendations

Research has shown that current vaccination rates for adults are low. “There are 14 different infectious agents for which vaccines are recommended for adults, but vaccination rates are low for a number of reasons,” says Carolyn B. Bridges, MD. “There is limited public awareness about the need for vaccines for adults besides influenza. Also, patients rely on recommendations about vaccines from their providers, but many providers don’t routinely assess vaccination status and follow with recommendations for the vaccines their patients need.” Each year, the Advisory Committee on Immuni­zation Practices (ACIP) reviews and updates its recommended immunization schedule for adults aged 19 and older. Each February, the schedule is updated on the CDC website (www.cdc.gov/vaccines). The schedule provides a brief summary of ACIP recommendations using figures and footnotes to describe which patients are recommended to receive each vaccine and a table that describes the primary contraindications and precautions for each vaccine. Strategies for Improvement A number of strategies can help incorporate adult vaccinations into clinical practice, including systems changes so that vaccines are routinely assessed and offered. Other strategies include using reminders for healthcare providers (HCPs), such as prompts in electronic health records, using protocols or standing orders for office staff, and sending reminders to patients about needed vaccines. According to Dr. Bridges, one of the most important elements in improving vaccination rates is making sure patients hear from their provider about which vaccines they need. The CDC has partnered with many organizations to update the Standards for Adult Immunization Practice. The standards are a call to action for providers to: – Assess vaccination needs among patients in every clinical...

How Surveys Mislead

Do you believe that traditional hospitals will be obsolete in the future? A recent survey found that 57% of those polled believed that would happen. The survey, sponsored by the Intel Corporation, involved 12,000 subjects from the United States and seven other countries around the world. Here are some other revelations from that survey: 84% said they would be willing to share their personal health information to advance and lower costs in the healthcare system. 70% said they were receptive to using toilet sensors, prescription bottle sensors, and swallowed health monitors. 53% said they would trust a test they personally administered as much or more than if that same test was performed by a doctor. My favorite response was that 30% of people would trust themselves to perform their own ultrasounds. That made me laugh. Ultrasonography is one of the most operator-dependent tests in use today. It is not easy to perform, nor is it easy to interpret. I then began to wonder about the credibility of this survey. Before I retired, I practiced in a typical small town in the northeastern United States. Some patients Googled me, and a few searched the Internet for information about their illnesses. But for the most part, it was a technologically unsophisticated population. I just can’t envision most of my patients wanting to share their personal health information, using toilet sensors, or trusting tests they did at home. Do their own ultrasounds? Not likely. Many of them did not even know what medications they were on. After rereading the article about the survey, it occurred to me that the sample may have...
Surveying the COPD Scene

Surveying the COPD Scene

In 2010, COPD surpassed stroke to become the third leading cause of death in the United States, affecting an estimated 24 million Americans. Studies indicate, however, that as many as half of those affected by COPD are undiagnosed, partially because symptoms of the disease come on slowly and worsen over time. As a result, many patients dismiss their symptoms and delay seeking diagnosis and treatment until their COPD reaches an advanced stage. In 2007, the National Heart, Lung, and Blood Institute (NHLBI) launched the COPD Learn More Breathe Better campaign, a program designed to raise awareness about COPD. To assess attitudes, knowledge, practices, and lifestyle habits related to COPD, the NHLBI also conducts a yearly survey among a nationally representative sample of U.S. adults. In 2013, the NHLBI’s annual survey included patients as well as primary care physicians (PCPs), obstetricians/gynecologists, and nurse practitioners (NPs). Results showed that there continues to be a lack of communication between patients and providers about COPD, according to James P. Kiley, PhD. “More Americans—smokers, in particular—are talking to their healthcare providers about the symptoms of COPD, which is a sign that awareness efforts are taking hold,” says Dr. Kiley. “That said, patients and providers can still do more.” Missed Opportunities The NHLBI survey found a dramatic increase in the numbers of current smokers who had discussed symptoms with their doctors, rising from 42% in 2009 to 67% in 2013. PCPs are also becoming more familiar with COPD evaluation methods and using them more frequently; in addition, NPs are catching up to PCPs in this regard (Table 1). At the same time, however, 26% of...
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