How to Give a Strong Recommendation to Adult Patients Who Require Vaccination

Mary C. Anderson, MD; Marie T. Brown, MD; Marie-Michele Léger, MPH, PA-C; Aparna Ramakrishnan, MA, MSW

Disclosures

April 16, 2015

Vaccination Status Assessment

All of the strategies discussed here can help improve vaccine assessment, though a combination may be needed to ensure that patients' vaccine needs are routinely assessed and opportunities to vaccinate are not missed.

Standing orders or protocols for nursing staff to assess and administer needed vaccines save time and reduce missed opportunities for vaccination. Examples of standing orders for vaccines can be found at the Immunization Action Coalition (IAC) website.

An intake questionnaire, completed by the patient at check-in, is another strategy that can help identify needed vaccines based on factors such as age, upcoming travel, lifestyle, occupation, or changes in medical conditions. Examples of intake questionnaires can also be found at the IAC website or the Centers for Disease Control and Prevention (CDC) website.

Reminders can help your practice stay on top of vaccines that are due soon or overdue. These can be generated by an electronic health record or immunization registries, or you can make a note of needed vaccines on a patient's vaccination chart.

In addition, reviewing patient data in your local immunization registry (or immunization information system) may help you identify vaccines the patient may have received elsewhere. For more information on immunization registries, visit the CDC Immunization Information Systems page.

Recommending Vaccination to Adults

After assessing immunization status, it is important to provide a strong, clear recommendation to the patient to get any necessary vaccines. Your recommendation is a critical factor in whether your patients receive the vaccines that they need. Research indicates that most adults believe that vaccines are important and are likely to receive them if recommended by their HCPs.[2,3]

Patients need to hear clearly that their HCP, whose advice about protecting their health is trusted, recommends that they receive a vaccine at this time and for an important reason.

Most providers would recognize that statements such as the following are not likely to be considered strong recommendations by patients:

Pneumococcal vaccine is recommended at age 65; do you want it? Patients generally don't want to get shots unless they feel that they really need them (some because they fear needles, some because they don't want to take unnecessary medications), and there is no clear indication in this statement of what the HCP recommends. Furthermore, this statement and question may send a message to the patient that the vaccine is not that important or necessary.

You might want to consider getting the pneumococcal vaccine. Adults have many things to consider and keep them busy. Without an explanation of why they should take the time to consider vaccination, or a clear indication that the HCP believes that it is important for them, they likely will not think about it after the visit. Furthermore, this statement does not send a clear message to the patient that the HCP actually recommends the vaccine.

I'm giving you the pneumococcal vaccine today because it is recommended at age 65. Although this strong statement may be effective with patients who have a long and trusting relationship with their HCP, it will most likely not be considered a recommendation because it is more of a directive and may seem too pushy to patients who want more information to make their own decisions about vaccination.

For some patients, a clear and strong recommendation from a trusted HCP is sufficient to make the decision to become vaccinated. "I strongly recommend that you receive the pneumococcal vaccine today because it can protect you from diseases caused by pneumococcal bacteria, including pneumonia. These diseases could be very serious for you now that you are older."

Others may need additional information before they are ready to make a decision. The following cases provide examples of evidence-based strategies and tips on strengthening vaccine recommendations with critical information that can help patients make informed decisions.

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