Blue Care Network Best Practices
Canton physician increases immunization rates by counseling patients
Making vaccines a priority and maintaining open dialogue with patients helps Sarah Lacy, M.D., maintain high immunization rates.
In fact, she has seen an increase in her office’s immunization rate over last year.
"We do several things to identify and reach out to patients who are missing vaccinations," says Dr. Lacy. She credits her nursing staff which reviews the Michigan Care Improvement Registry and the office’s vaccine report every quarter. Nurses proactively identify the specific vaccines each patient needs.
The staff also reviews patients who are overdue for yearly physicals. The office calls patients as a reminder.
Nurses follow-up by sending a letter to patients who cannot be reached by phone. "Not everyone knows the schedule for vaccines," said Dr. Lacy. "So we remind the patients to come in. That increases the numbers of physicals and increases the opportunities we have to talk with families."
The office makes sure new parents receive a printed card with the vaccine schedule so they know what to expect. Vaccines are discussed early so parents know what to expect at the next well visit.
Sick visits present another opportunity to review the vaccine report. The office uses electronic medical records.
Nurses can view an immunization page; the medical record flags the vaccines that are due. The EMR has been in the office since 2008. "The vaccine flag is the most recent update last year, so that may be part of the increase we’re seeing," said Dr. Lacy.
Dr. Lacy also maintains an open dialogue with parents. "At every physical I ask, 'How do you feel about vaccines?' People will ask what I do with my own kids. My kids are vaccinated, but I tell parents it's their decision. I don’t want them to feel I'm forcing them to vaccinate their children, but I feel it's my job to convince them that it's important," she said.
"We also talk about misinformation about potential dangers and side effects. Our vaccine system has been so successful that people have become complacent about vaccinations," said Dr. Lacy.
Dr. Lacy also points out that parents today may have never really seen anyone with the diseases we vaccinate against, so they don’t realize the dangers of not vaccinating.
If a parent with a young infant decides not to vaccinate, Dr. Lacy counsels them the child will be treated differently if he or she develops a fever.
"I may worry more about the child getting a blood infection," Dr. Lacy explains. "A two- or three-year-old who isn’t vaccinated is more likely to get blood work and a culture and has a higher risk of visiting the emergency room than a child who has been vaccinated. I worry more about serious consequences," Dr. Lacy added.
Dr. Lacy also give vaccines at sick visits if there is no fever, particularly if the patient hasn’t consistently been to the office for physicals.
Dialogue is key
Our biggest challenge is misinformation. "If parents have heard something negative, they tend to trust that information," said Dr. Lacy. "Some people who worry about vaccines may think that there's something I'm not telling them." If a patient comes in and has already decided against vaccines, Dr. Lacy stresses that the decision is the parent's to make. "But I keep bringing up the subject because it's important," she added.
Dr. Lacy suggests having several conversations with parents about vaccines. "I have some patients who come in for the two- or four-month visit, and they have heard some negative information about vaccines," says Dr. Lacy. "I give them my opinion and find out what their questions are. I respect their decision, but also let them know the right thing is to vaccinate the kids. If they choose not to, I don't dismiss them from my practice. Every future visit is an opportunity. Sometimes I have to build the trust with them a bit. You have to make the patients know that you are listening to their concerns."