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How medical practices can create effective vaccination programs for the months ahead
The combined effectiveness of vaccinations, masking, social distancing, handwashing, and surface cleaning nearly eliminated flu as a significant health threat this year. Will that mean people will be less concerned about flu this coming season?
There has been considerable speculation that after what the country has gone through with the COVID-19 pandemic, the population could be vulnerable to a flu epidemic this winter because people haven’t been as concerned about getting their flu shots.
However, following the vaccine rollout for COVID-19, much of what was done could be extended to a flu vaccination program, helping a greater percentage of the population.
Family medicine practitioner Benjamin Caplan, M.D., founder and chief medical officer of CED Clinic in Boston, notes that this year, perhaps more than in seasons past, patients have come to expect ease of access, speedy intake, quick delivery, and efficient visit wrap-ups.
“Patients have experienced the efficiency of grand-scale vaccinations that were done well,” he says. “Medical practices that lag behind in making the system accessible and simple for patients will no longer be well tolerated. Also, the world culture is much more comfortable wearing masks in public, and people understand the great benefits. I think this added comfort with masks will likely lead to reduced prevalence of airborne infections, including influenza.”
Last year, the prevalence of influenza plummeted with the presence, and associated protections, of COVID-19 preventive measures. Caplan believes that could keep people from seeking flu shots this year.
“Many people have become accustomed to the benefits of quarantined living, including the reduced likelihood of infections,” Caplan says. “I suspect that people will not be interested in becoming vaccinated because they feel like they have less contact with others. Overall, people have the impression that they are safer from common infections, although as the culture comes back into closer quarters this impression will become a false sense of safety.”
That’s why medical practices need to continue to emphasize the benefits of vaccination, especially for those in higher-risk categories.
For example, patients with comorbid concerns — such as advancing age, obesity, diabetes, heart disease, respiratory illnesses, or those for whom a serious illness could pose life-threatening risk — need to know about the severity of getting the flu.
“They should understand the very real risk of morbidity and mortality,” Caplan says. “On the other hand, after the trials of COVID-19, people also need accurate information about the risks of (side) effects, potential long-term implications of vaccination, and all of the similar facts that have become part of the public dialogue, perhaps even to the point of understanding who manufactures the vaccines and how the vaccine functions.”
Saint Anthony Amofah, M.D., chief medical officer of the Community Health of South Florida and Health Choice Network in Miami, notes several things have to happen to achieve an efficient flu vaccination program, whether at the private or community health facility level.
“First, you have to make sure that the entire staff at the practice that is implementing the flu vaccine are vaccinated and invested in the positive benefits of flu vaccinations,” he says. “The people who are promoting the flu vaccine should really believe in it in order to effectively generate enthusiasm to tap into others who may be less invested. This is one way to maximize the impact and really make a difference.”
Secondly, he notes, a truly efficient and successful flu vaccination program will use more than one path for reaching the people who will benefit from the vaccinations.
“People get their information in different ways and through different platforms and mediums,” Amofah says. “E-blasts are great for getting your message out to your patients; reaching out to media through press releases and publicizing your program is important; mass texting is another way to reach patients; and mailouts detailing the availability and importance of the vaccine can help reach the elderly (patients) who may be less inclined to addressing information from tech platforms.”
William Lang, MD, a family physician for more than 30 years and chief medical director of WorldClinic, notes all practices should make the flu vaccination a part of routine care. “For anyone not doing an acute illness visit, once this season’s flu vaccine is available, part of the exit process from the clinic should be to receive a flu vaccine,” he says.
Lang notes physicians should make flu vaccination status part of the vital signs checklist, with the question “Have you had your flu vaccine yet?” as integral to the intake process as taking blood pressure.
“The key is to create a sense that the flu vaccine is just simply something that is needed,” he says. “Train staff in simple answers to flu vaccine concerns. Leave the big issues to providers but have approved FAQs that address the most common concerns — such as when someone says they are worried about getting the flu from the flu shot.”
Key to profits
Vaccination programs that are efficient and easy to use are inherently likely to gain traction and publicity. Caplan notes that if an efficient program can be linked to other services, from medical products and/or services sales or affiliate revenue streams such as advertising sales or data collection, it would be logical to expect increased profitability.
Amofah notes achieving profitability for a flu vaccination program really comes down to having many patients who have insurance coverage for the flu vaccine.
“At a community health center like ours, we really depend on insured patients who can thereby pay for the flu vaccine, in order to be able to also reach uninsured patients who are also critical to minimizing the spread of the flu,” he says. “To make a program profitable that also really positively impacts overall public health, you have to make it so efficient that it can reach the uninsured, as well. To get your margin, you want a mass effort for a mass turnout.”
Lang agrees that flu vaccines are typically not profit centers and because of that, many providers just choose to leave this to pharmacies. However, to make these visits profitable, he suggests seeing flu shots as a mechanism to reconnect with patients and identify other (perhaps more remunerative) services that are needed.
Tips of the trade
One way to increase the numbers of those being vaccinated for the flu is to make it as easy as possible for people. Amofah recommends setting up walk-in facilities so that patients are in and out in 15 minutes.
“It’s going to be crucial for practices to stress the importance of getting the flu shot because there is nothing more confusing for a health professional than having a patient coming in with flu symptoms and we have to wonder if this is COVID-19 or the flu,” Amofah says. “Getting the flu shot really helps medical professionals and patients avoid periods of confusion about the cause of their illness.”
Primary care practices should also consider making flu vaccine expectation a central theme in any late summer/early fall communications to patients. “Many patients go to pharmacies for flu shots because the pharmacies have made it a strategic priority to make it easy for patients,” Lang says. “Going to a typical primary care clinic is not easy. Differentiate yourself from the pharmacies. A flu vaccine visit can give the opportunity to identify other preventive issues that can be identified without initial provider involvement.”
By the time the U.S. gets to flu season, most of the COVID-19 vaccinations will be behind it, so public health and other medical agencies will be able to effectively market flu vaccinations. “Educating patients on the dangers of the flu is key to maintaining a successful flu vaccine program,” Lang says, “Vaccine and respiratory protection makes a difference.”