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The Vaccine Barriers: Time, Energy and Money

by Jeff A. Drasnin, MD, FAAP, pediatrics

About this time last year, I wrote a blog post about vaccines, focusing mostly on my work with families who choose to alternatively, selectively or not vaccinate their children at all. Today, I want to address that topic again and emphasize the importance of vaccination, but speak more broadly to physicians about the three barriers that stand in our way of administering vaccines: Time, energy and money.

Time

In primary care, there is a seasonality to our practices. Illness tends to drop in the summer and health maintenance visits accelerate. Whether you are a pediatrician, an internist or a family practitioner, part of these well visits turn to questions like: “Are you up to date on your vaccines?” I implore you, my colleagues, to set aside a little more time for this topic.

Discussing vaccines is not just a matter of following the template set out by your EMR or checking boxes off your list (if you are sadly still writing notes on paper). It is about education. It is about explaining to parents and patients the importance of vaccination and why it may have more impact than any other advance in medicine in the last century. I have found that families and patients who haven’t even come to my office for the purpose of vaccination will raise an eyebrow in interest when presented with a few facts, statistics or a “Did you know…?” Take the time to include this topic with every visit—it’s an investment worth making.

We as a generation don't fear disease anymore, we now fear the immunization itself. One of the reasons that we have a “vaccine controversy” and “vaccine indifference” in this country is because vaccines are so effective. If they weren’t, there’d be far less to argue about. You wouldn’t have the mother questioning how many vaccinations I’m recommending for their child, making me spend additional time assuring her of the benefits of said vaccination. But with everything we know about the positive effects of vaccination, why protect against something that we don’t fear? (I ask this question rhetorically.)

Vaccination programs in the United States and other developed countries have ground down the disease burden to a level of which many younger health care providers aren’t even aware of the seriousness of the diseases. As physicians, we only know how these diseases present based on what we learned in medical school—we don’t have first-hand experience, and neither do our families.

Energy

Working with families and patients who are skeptical of vaccines is a calling, a duty and, unfortunately, a lot of work. It takes a lot of energy. In my community, I bear this burden with pride. Taking the time to really review a patient’s chart and discuss vaccine options with someone who may be overdue (whether by patient or physician negligence) is a great deal of work. This can be done at health maintenance exams but also at ill visits—it’s actually recommended that vaccinations be given even with concurrent minor illnesses.

How many times do we miss opportunities to protect our patients? Okay, I’ll answer that question: A lot more often than you think! If you take the time to review your patient population and tally the number of “opportunities to vaccinate” that were missed (we have done this, and it’s a lot), you would be shocked. Every opportunity missed is a true failure on our part. Yes, improving is a challenge, but we must find the energy to do better.

Money

We can’t forget that vaccines are a business. Unfortunately, the cost to purchase and manage vaccines , and the challenges in securing appropriate reimbursement, can be a major issue – enough that some physicians have made the choice not to offer them. I get it and I don’t get it at the same time. For better or for worse, money makes our practices run. Without it, we cannot do the good work that we do. The way to fix the money side of vaccines is to spend the time and the energy to make it work. For example, independent practices can band together to gain better pricing from vaccine manufacturers, and providers can negotiate better reimbursement with insurers. You can use technology like bar coding to help manage inventory; even if you’re using a less sophisticated method to keep track of vaccines, accurate protocol can save dollars.

Don’t give up on standard of care when dollars get in the way. Fight through it to do the right thing for your patients.

Time. Energy. Money. None of us will ever have enough of these commodities. Invest what you can into vaccination and education. The historical return doesn’t lie.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

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