INCREASING IMMUNIZATION RATES AMONG AFRICAN-AMERICAN ADULTS: G. Intervention Strategies
This pattern of missed opportunities has contributed to continued under-utilization of vaccinations among adults despite initiatives to improve vaccination levels. In 1990, the National Coalition for Adult Immunization issued the Standards for Adult Immunization, endorsed by the National Foundation for Infectious Diseases, the CDC, the NMA, and other agencies. Beginning in 1994, national and state-based campaigns were initiated by the Health Care Financing Administration to increase influenza and pneumococcal coverage among Medicare beneficiaries. In 1994, the National Vaccine Advisory Committee recommended the following to improve adult immunization: 1) improve public and provider education; 2) institute major changes in clinical practice; 3) increase financial support by public and private insurers; 4) improve surveillance of vaccine-preventable diseases and vaccine production and delivery; and 5) provide support for research on vaccine-preventable diseases, new and improved vaccines, immunization practices, and international programs for adult immunization. The Department of Health and Human Services subsequently issued an Adult Immunization Action Plan outlining a proposal for collaboration among federal agencies, state and local agencies, health professional organizations, purchasers and providers of health-care, vaccine companies, and the public, to increase adult vaccination levels.
In 1997, utilization of vaccines among adults had improved but remained sub-optimal, and racial and ethnic disparities persisted. To further improve vaccination levels and eliminate disparities, scientifically based and culturally appropriate intervention strategies are needed. The independent, nonfederal Task Force on Community Preventive Services has completed a systematic review of 17 types of interventions designed to increase vaccination levels, and made recommendations for use of these interventions. Of those 17 interventions, the boxed information above represents the strongly recommended interventions relevant to adult populations. canadian pharmacy online
These provider-based interventions can be used to increase pneumococcal vaccination levels to the same standard or higher as those that have been achieved for the influenza vaccination by facilitating delivery of pneumococcal vaccination when patients visit their healthcare provider for an annual influenza vaccination.
Recommended interventions included vaccination requirements for college attendance and home visits by health care workers. There was insufficient evidence for the Task Force to recommend community-wide education alone; clinic based education only; client or family incentives; client-held medical records; or provider education alone. Further research is needed to assess the effectiveness of these interventions.
Planning for implementation of these Task Force recommendations in a specific community must take into account: observed problems; community preferences; community priorities; feasibility; activities currently being performed; current levels of vaccination coverage; causes of under immunization; and information regarding vaccine-preventable disease rates. These strongly recommended interventions are primarily provider-based. However, increasing community demand for vaccination may be a useful additional strategy. This is particularly true, if lack of knowledge among clients regarding the need for vaccination contributes to low coverage, and if increased knowledge will lead clients to demand vaccination from their providers who otherwise might not offer it. Enhancing access to vaccination services may also be useful to facilitate optimal timing of influenza vaccination, or for segments of the population with limited access to the health care system. This can be accomplished by offering vaccinations in non-traditional settings such as emergency departments, community centers, shopping malls, supermarkets, pharmacies and churches. Significant proportions of African Americans are church members and are likely to take the advice and recommendations of their clergy. buy prescription drugs online
