Role Of The APRN In Increasing Adult Vaccinations

After reading the Wright and Anderson articles – discuss the role of the APRN in increasing adult vaccination rates. Given the culture of the United States , which tools discussed in the articles or that you reviewed on the CDC website do you think might be most useful in increasing the vaccination rates of adults? and Why?

Ensuring these individuals are fully vaccinated is imperative. The purpose of this study was to assess the immunization rates of adults ages �65 years managed by nurse practitioners (NPs) and compare the results with national immunization rates and Healthy People 2020 goals. Methods: A convenience sample of adults ages �65 years was obtained from two NP-managed clinics. The vaccine records of each subject were reviewed for documentation of having received five vaccines (tetanus, diphtheria, and pertus- sis; influenza; pneumococcal polysaccharide vaccine 23; pneumococcal conjugate vaccine 13; and herpes zoster vaccine). Conclusions: One hundred and fifty females (70.8%) and 62 males (29.2%) met inclusion criteria. NP-managed patients had higher immunization rates than the national averages across all five major vaccines. The herpes zoster vaccina- tion rates exceeded the recommendations from Healthy People 2020 whereas pneumococcal and influenza rates were below. Implications for practice: The stocking of vaccines within the NP-managed clinics, direct billing to Medicare for Part D vaccines, and previsit care planning likely contributed to the high vaccination rates. These high immunization rates in patients managed by NPs provide support for the important role that NPs play in the care of older adults.

Introduction

Forty-two million individuals in the United States are 65 years of age and older (U.S. Department of Health and Human Services, 2016). By 2030, this group of individ- uals is expected to almost double and reach nearly 72 million (U.S. Department of Health and Human Services, 2016). Less than 50% of those ages 65 and older report being up-to-date on preventative services, including vacci- nations (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010). The Centers for Disease Control and Prevention (CDC) es- timates that up to 49,000 individuals die annually from influenza and an additional 19,000 from pneumococcal

pneumonia, the majority of whom are older adults and are unvaccinated (Centers for Disease Control and Prevention, 2016). Numerous barriers exist to vaccinations in adults �65 years of age. Lack of insurance coverage for certain vaccines, limited knowledge regarding the importance of vaccines, and the failure of healthcare providers to recom- mend vaccines are just some of the potential causes for these low vaccination rates (U.S. Department of Health and Human Services: Centers for Medicare & Medicaid Services, 2016). Ensuring this group is fully vaccinated is imperative. Role Of The APRN In Increasing Adult Vaccinations

Vaccines have been around for hundreds of years. Despite widespread availability, mandated insurance

W. L. Wright et al. Immunization rates of adults ages 65 years and older

coverage, and extensive knowledge of benefits, many adults remain unvaccinated. Multiple chronic health con- ditions and an overall diminished response to vaccina- tions make older adults particularly vulnerable to infec- tious diseases (Klett-Tammen, Krause, von Lengerke, & Castell, 2016). To reduce this risk, the CDC recommends that individuals ages 65 years and older be routinely vac- cinated against tetanus, diphtheria, and pertussis (Tdap), pneumococcal disease (pneumococcal conjugate vaccine 13 [PCV13] and pneumococcal polysaccharide vaccine 23 [PPSV23]), herpes zoster vaccine (Zostavax), and in- fluenza (Kim, Bridges, Harriman, & Advisory Committee on Immunization Practices [ACIP], ACIP Adult Immuniza- tion Work Group, 2016). All healthcare providers play an important role in ensuring that this vulnerable population is fully immunized.

More than 222,000 nurse practitioners (NPs) work in the United States; two out of every three are employed in pri- mary care (American Association of Nurse Practitioners, 2016). Administering vaccinations is one of the most im- portant public health initiatives for NPs. Numerous studies have been conducted to assess outcomes in patients with hypertension, diabetes, and congestive heart failure when managed by NPs (Conlon, 2010; Wright, Romboli, DiT- ulio, Wogen, & Belletti, 2011). Results from these studies have shown NP outcomes to be similar to or better than those of physicians (Conlon, 2010; Wright et al., 2011). Few studies, however, have been conducted to assess the vaccination rates of adults ages 65 years and older when managed by NPs. The purpose of this study was to as- sess the immunization rates of five major vaccines (Tdap, PPSV23, PCV13, influenza, and herpes zoster) in patients ages 65 years and older managed within two NP-owned primary care offices and compare the results with national immunization rates and Healthy People 2020 objectives. The research questions were: (a) What are the immuniza- tion rates for five major vaccinations in adults 65 years and older managed within two NP-owned primary care clinics? (b) How do these rates compare with the national immu- nizations rates from the CDC? and (c) How do these rates compare with the immunization objectives, when avail- able, as issued by the Healthy People 2020? The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines were used to report the findings of this study (von Elm et al., 2016).

Review of literature

Importance of immunizations

Administration of recommended vaccines is one of the most cost-effective primary prevention strategies. It is esti- mated that for every $1 spent on vaccines, $16 is saved

on the treatment of acute and chronic diseases (Ozawa et al., 2016). According to the Michigan Primary Care Con- sortium, failing to immunize adults with recommended vaccinations costs the state approximately $500 million annually (Michigan Primary Care Consortium, 2012). In addition to the extensive cost-savings associated with im- munizations, vaccines have also been shown to reduce morbidity and mortality (Reed et al., 2014). Using data compiled from the 2013 to 2014 influenza season, the influenza vaccine alone prevented an estimated 549,317 cases of influenza and 49,938 hospitalizations for individ- uals ages 65 years and older (Reed et al., 2014). If all children and adults were vaccinated with the influenza vaccine to the level as recommended by Healthy People 2020, 5.9 million cases of influenza and 42,000 hospital- izations would be prevented (Reed et al., 2014). Ensuring that adults ages 65 years and older are fully immunized with all recommended vaccines is essential. Role Of The APRN In Increasing Adult Vaccinations