Role of the APRN in increasing adult vaccinations essay

RESEARCH – OUTCOMES

Comparison of immunization rates of adults ages 65 years and older managed within two nurse practitioner–owned clinics with national immunization rates Wendy L. Wright,MS, ANP-BC, FNP-BC, FAANP, FAAN (Adult/Family Nurse Practitioner, Owner—Wright & Associates Family Healthcare)1, Elise Morrell, MSN, FNP-C (Family Nurse Practitioner)2, Jennie Lee,MSN, FNP-BC (Physician)3, Norma Graciela Cuellar, PhD, RN, FAAN (Professor)4, & Patricia White, PhD, ANP-BC, FAANP (Professor of Practice)5

1Wright & Associates Family Healthcare, PLLC, Amherst, New Hampshire 2CVS MinuteClinic, Quincy, Massachusetts 3Division of Adolescent Medicine, Boston Children’s Hospital, Boston, Massachusetts 4Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama 5School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts

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Keywords Immunizations; vaccinations; vaccination rates;

nurse practitioner; nurse practitioner–managed

care; nurse practitioner–owned clinics; primary

care; 65 years and older; older adults.

Correspondence Wendy L. Wright, MS, ANP-BC, FNP-BC, FAANP,

FAAN, Wright & Associates Family Healthcare,

PLLC, 282 Route 101, Unit 9/10, Amherst, New

Hampshire 03031. Tel: 603-490-0154; Fax:

603-249-1107;

E-mail: [email protected]

Received: 21 December 2016;

accepted: 3 March 2017

doi: 10.1002/2327-6924.12459

Abstract

Background and purpose: Adults ages �65 years are at increased risk for infectious diseases. 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. Role of the APRN in increasing adult vaccinations essay

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.

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

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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 essay

Despite the well-documented benefits of vaccines, a 2014 study of randomly selected adults from the U.S. Cen- sus Bureau Database showed that only 71.5% of individu- als ages 65 years and older reported having received the influenza vaccine within the past year (Williams et al., 2016). Equally disappointing were the data regarding pneumococcal and herpes zoster vaccination rates. Only 61.3% of respondents ages 65 years and older reported having received a pneumococcal vaccination (PPSV23 or PCV13) and those receiving a Zostavax were 31.1% (Williams et al., 2016). These percentages were well be- low the targets of 90% for the influenza and pneumo- coccal vaccines and only slightly above the 30% for the Zostavax as set forth in Healthy People 2020 (U.S. Depart- ment of Health and Human Services, Office of Disease Pre- vention and Health Promotion, 2010). To improve upon these rates, healthcare providers must develop strategies to eliminate barriers to the recommended vaccinations, par- ticularly for those ages 65 years and older.

Barriers to immunizations for individuals 65 years of age and older

Clinicians, healthcare systems, and patients face numer- ous barriers to immunizations. When examining these barriers, it is helpful to separate them by potential cau- sation. From the provider/healthcare system perspective, the recommendations for vaccinations are frequently up- dated, making it difficult for healthcare providers to re- main up-to-date on the latest recommendations. As pri- mary care visits become shorter in length, the opportunity for the healthcare provider to recommend vaccinations and have meaningful conversations regarding the impor- tance of these vaccines may also be decreased (Tai-Seale, McGuire, & Zhang, 2007).

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While universal vaccine recommendations exist and in- surance coverage is mandated for all CDC recommended vaccines, the mechanism of billing and payment for these vaccines often varies for adults ages 65 years and older. For instance, the Centers for Medicare & Medicaid Ser- vices (CMS) reimburses practices under Medicare Part B for the two pneumococcal vaccines (PPSV23 and PCV13) as well as the influenza vaccine, while reimbursement for Tdap and the Zostavax are paid for under Medicare Part D (U.S. Department of Health and Human Services: Cen- ters for Medicare & Medicaid Services, 2016). Although CMS now allows primary, specialty, and urgent care prac- tices to bill for vaccines through Medicare Part D, patients must have purchased the Part D plan in order to be eli- gible for coverage (U.S. Department of Health and Human Services: Centers for Medicare & Medicaid Services, 2016). Many patients, particularly those taking few medications, may forgo this plan rendering insurance coverage for these important vaccines unavailable. Additionally, clinicians or practice managers must enroll in this unique Part D billing program established by CMS to enable billing for these vaccines (U.S. Department of Health and Human Services: Centers for Medicare & Medicaid Services, 2016). Practice managers may be unaware of this billing procedure or may not be interested in enrolling.

Vaccines that are not stocked within a facility require a referral to an outside agency or pharmacy to receive the Part D vaccines (Tdap and Zostavax). This requires extra time and diligence on behalf of the patient which can be a deterrent to obtaining the vaccine. Last, the cost of these vaccines is also significant. The PCV13 and Zostavaxs cost approximately $150.00–$175.00 per injection. For smaller practices, the financial burden to purchase and store these vaccines is significant and may be cost prohibitive.

Patients are often unaware of his or her current vaccina- tion status. Many patients admit to inadequate knowledge of which vaccines are needed and whether the vaccine has been previously received (Sevin, Romeo, Gagne, Brown, & Rodis, 2016). While best practice dictates that a vaccina- tion not documented should be assumed as not received and should be recommended to the patient, patients are often reticent to receive and providers often reluctant to administer the vaccination when the status is unknown (Sevin et al., 2016). Patients, particularly those on a fixed or reduced income, fear the costs of an uncovered or a partially covered vaccine (Sevin et al., 2016). If vaccines are not readily available through a healthcare provider or primary care office and the patient is forced to drive else- where for the vaccine, the patient may be less likely to re- ceive the vaccine. Lack of patient knowledge regarding the importance of vaccines also plays a significant role in the suboptimal adult vaccination rates (Sevin et al., 2016). If a patient is unaware of the risks associated with the failure

to receive the vaccine, the perceived side effects from the vaccine, such as injection site pain or redness, may out- weigh the benefits. Understanding barriers which exist to vaccines is essential to developing strategies to improve the immunization rates of all adults, especially those 65 years of age and older. Role of the APRN in increasing adult vaccinations essay

Method

Sample

Study participations were obtained from a convenience sample of all adults ages 65 years and older receiving care at two NP-owned primary care clinics located in south- ern New Hampshire. Subjects met inclusion criteria if they were current patients of Wright & Associates Family Healthcare (WAFHC), Amherst and Concord, and 65 years of age and older. Documentation of vaccine administration in the electronic health record (EHR) was required to be considered a positive vaccine recipient. Patient report of vaccine receipt without actual documentation of vaccine administration was considered as an unvaccinated subject.

Data collection

All participants included in this study had previously signed a consent form at WAFHC, Amherst and Con- cord, to allow the use of their EHR for research or qual- ity improvement projects. Following approval from the Simmons College Institutional Review Board (IRB), two Masters of Science graduate students enrolled in the Fam- ily Nurse Practitioner program at Simmons College were trained on the EHR system by the practice manager. The vaccination record and chart of each qualified subject was then systematically reviewed. Data on the receipt of five major vaccines (Tdap, PPSV23, PCV13, influenza, and Zostavax) were collected real-time from May to June of 2015. In addition, the age and gender of each subject were also recorded.

Data analysis

The IBM Statistical Package for the Social Sciences (SPSS) Version 24 was used to perform statistical analysis. Descriptive statistics such as mean and standard deviation (SD) were calculated for all continuous variables (age and vaccination status). Percentage and frequencies were cal- culated for the categorical variables such as gender. The re- lationship between categorical variables was analyzed us- ing a chi-square test with a p-value � .05 considered sta- tistically significant.

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Results

The vaccine records of 212 adults, ages 65 years and older, were evaluated: 150 females (70.8%) and 62 males (29.2%) (Table 1). Ages of the subjects ranged from 65 years to 101 years with a mean age of 71.3 years (SD 6.469) and a median age of 70 years. Of the 212 study par- ticipants, 70 subjects (33.0%) had received all five of the recommended vaccinations (Figure 1). Sixty-six subjects (31.1%) had received four of the recommended vaccines, 30 subjects (14.2%) received three, 22 subjects (10.4%) received two, and 15 subjects (7.1%) received one of the studied vaccines. Only nine participants (4.2%) had re- ceived none of the recommended vaccines. The mean number of vaccines received by adults ages 65 years or older at WAFHC was 3.6 with an SD of 1.432.

Tetanus, diphtheria, and pertussis

Of the study subjects, 81.1% of adults ages 65 years and older had received a Tdap within the previous 10 years or at age 65 years or older (Table 2). The percent- age of females having received a Tdap vaccination rate was 80.0% and males was 83.9%. The difference in the vaccine rates between females and males was not statistically sig- nificant (p = .512). Tdap vaccination rates for subjects ages 65–69 years were 88.3%, ages 70–75 years were 79.2%, and ages >75 were 62.5%. A statistically significant in- verse correlation (p = .004) was identified between Tdap vaccination status and various age groups. Vaccination

Table 1 Total subjects and gender

Gender Frequency Percent Valid percent Cumulative percent

Female 150 70.8 70.8 70.8

Male 62 29.2 29.2 100.0

Total 212 100.0 100.0

Figure 1 Percentage of subjects receiving vaccines.

rates of Tdap decreased as the age of the subjects increased: 88.3% in ages 65–69 years, 79.2% in ages 70–75 years, and 62.5% in those >75 years. Data collected from a 2014 national survey on vaccinations showed that 57.7% of adults ages 65 years and older had received a tetanus- toxoid-containing (Td) vaccine within the previous 10 years (Williams et al., 2016). The percentage of those 19 years of age and older having received a Tdap specifically within the previous 10 years was 20.1% (Williams et al., 2016). Data specific to the Tdap vaccine rates for those 65 years and older were not available (Williams et al., 2016). The results of this study demonstrated that 81.1% of sub- jects ages 65 years and older had received a Tdap vaccina- tion, far surpassing the national average of 20.1% (ages �19 years receiving Tdap) and 57.7% of those �65 years who had received a tetanus-toxoid-containing vac- cine (Td). Healthy People 2020 objectives were not avail- able for the Tdap vaccination in adults ages 65 years and older.

Pneumococcal conjugate vaccine 13

Of the study subjects, 52.8% of subjects had received the PCV13 vaccine at the time of data collection (Table 2). Fe- males had a PCV13 vaccination rate of 48.0% and males had a PCV13 vaccination rate of 64.5%. This difference between males and females was statistically significant (p = .028). PCV13 vaccination rates for subjects ages 65–69 years were 51.5%, ages 70–75 years were 58.4%, and >75 years were 43.8%. The differences between the age groups were not statistically significant (p = .348). In 2014, 61.3% of nationally surveyed adults 65 years of age and older had previously received at least one of the pneumococ- cal vaccines (Williams et al., 2016). National vaccination rates, specific to each individual pneumococcal vaccination (PPSV23 and PCV13), were not available (Williams et al., 2016). The pneumococcal vaccination rates from WAFHC far surpassed that of the national average of 61.3% yet re- mained below the 90% as recommended by Healthy Peo- ple 2020 (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010; Williams et al., 2016). Role of the APRN in increasing adult vaccinations essay

Pneumococcal polysaccharide vaccine 23

Of the study subjects, 76.4% of subjects had received the PPSV23 vaccine at the time of data collection (Table 2). Fe- males had a PPSV23 vaccination rate of 73.3% and males had a PPSV23 vaccination rate of 83.9%. This difference between males and females was not statistically signifi- cant (p = .10). PPSV23 vaccination rates for subjects ages 65–69 years were 74.8%, ages 70–75 years were 80.5%,

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Table 2 Vaccination rates at Wright & Associates Family Healthcare compared with national vaccination rates and vaccination objectives from Healthy People 2020

1National rates for Tdap not available; rate above reflects tetanus-toxoid-containing vaccine, not necessarily Tdap. 2Healthy People 2020 target not available for Tdap. 3National rates of PCV13 and PPSV23 reflect receipt of one pneumococcal vaccine; specific data not available on individual products. 4Healthy People 2020 target is for one pneumococcal vaccination; objectives not set for each individual vaccine.

and >75 years were 71.9%. The differences between age groups were not statistically significant (p = .537). In 2014, 61.3% of nationally surveyed adults ages 65 years and older had previously received at least one of the pneumo- coccal vaccines (Williams et al., 2016). National vaccina- tion rates, specific to each individual pneumococcal vacci- nation (PPSV23 and PCV13), were not available (Williams et al., 2016). The pneumococcal vaccination rates from WAFHC far surpassed that of the national average of 61.3% yet remained below the 90% as recommended by Healthy People 2020 (U.S. Department of Health and Hu- man Services, Office of Disease Prevention and Health Pro- motion, 2010; Williams et al., 2016).

Influenza

Of the study subjects, 77.8% of subjects had received the influenza vaccine during the 2014–2015 influenza sea- son (Table 2). Females had an influenza vaccination rate of 73.3% and males had an influenza vaccination rate of 88.7%. The difference between males and females was statistically significant (p = .014). Influenza vaccination rates for subjects ages 65–69 years were 76.7%, ages 70– 75 years were 81.8%, and >75 years were 71.9%. Age did

not appear to be a factor in obtaining the flu vaccine as the differences between groups were not statistically sig- nificant (p = .486). During the 2013–2014 influenza sea- son, 71.5% of national study participants ages �65 years reported having received an influenza vaccine (Williams et al., 2016). Data obtained from WAFHC revealed that 77.8% of patients �65 years had received the influenza vaccine during the previous flu season. This number was higher than the national average of 71.5% but below the 90% as recommended in Healthy People 2020 (U.S. De- partment of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010; Williams et al., 2016).

Herpes zoster vaccine

Of the study subjects, 70.3% of subjects had received the Zostavax at the time of data collection (Table 2). Females had a herpes zoster vaccination rate of 66.0% and males had a rate of 80.6%. This difference between males and females was statistically significant (p = .034). Herpes zoster vaccination rates for subjects ages 65– 69 years were 80.6%, ages 70–75 years were 59.7%, and >75 years were 62.5%. The differences between age

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groups were statistically significant (p = .006). Using data from a 2014 national immunization study, individuals ages �65 years who reported having received a herpes zoster vaccination were 31.1% (Williams et al., 2016). Of the study subjects at WAFHC, 70.3% of subjects had received the Zostavax at the time of data collection. These num- bers were well above the national average of 31.1% and the goal of 30% as set by Healthy People 2020 (U.S. De- partment of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010; Williams et al., 2016).

Discussion

The vaccination rates in adults ages �65 years managed by NPs at WAFHC were higher for all five vaccines than national vaccination rates. WAFHC maintained a supply of the Tdap vaccine within both clinics and was enrolled in the specialized Medicare billing site which allowed for Part D plan billing for vaccines. These factors may have accounted for the high percentage of vaccinated subjects. In this study, data were not collected regarding reasons for nonvaccine status, such as was the patient offered the vaccine but refused, was the patient allergic to a compo- nent in the vaccine, or was the patient not enrolled in a Medicare Part D plan. Lack of insurance coverage may have negatively affected the vaccination rates. Follow-up studies would be important to ascertain the reasons for not receiving a Tdap. The CDC issued a recommendation for Tdap administration to adults ages 65 years and older in June 2012; however, many of the patient’s previous providers may have been unaware of this recommenda- tion potentially lowering overall vaccination rates, partic- ularly for new patients to the clinic. Given that older adults are at the greatest risk for infectious diseases, finding ways to improve Tdap vaccination rates in the oldest age groups is imperative.

Prior to August 13, 2014, all adults ages 65 years and older were recommended to receive only one pneumococ- cal vaccine, PPSV23 (Tomczyk et al., 2014). On August 13, 2014, ACIP recommended that both the PCV13 and PPSV23 vaccines be administered routinely to all adults age 65 years and older with a sequential recommenda- tion of PCV13 first at age 65 years followed 6–12 months later by a PPSV23 (Tomczyk et al., 2014). Additionally, if subjects had previously received PPSV23, PCV13 should be administered 6–12 months after the initial PPSV23 (Tom- czyk et al., 2014). Of the subjects at WAFHC, 76.4% had received a PPSV23 and 52.8% had received a PCV13. The lower rates of PCV13 may have been related to the timing of data collection. Data were collected at WAFHC in May to June 2015, approximately 9–10 months following the revisions to the ACIP guidelines recommending the rou-

tine administration of PCV13. It was possible that patients had not been seen in the office during this time frame. A follow-up study to reassess the PCV13 vaccination rate given the elapsed time since guideline revision would be important.

WAFHC also maintained a supply of the Zostavax within both clinics and was enrolled in the CMS program which allowed for billing of Medicare Part D vaccines by primary care providers. These two factors may have accounted for the high vaccination rate. In this study, data were not col- lected regarding reasons for not having received the vac- cine such as was the patient offered the vaccine but re- fused or did the patient not have a Part D Medicare plan. Additionally, it was possible that some of the unvaccinated subjects in this study had medical conditions or were tak- ing medications, such as chemotherapeutic agents, which prevented the receipt of the Zostavax, a live virus vac- cine. Follow-up studies would be important to ascertain the reasons why each subject was unvaccinated, partic- ularly when looking for strategies to improve the herpes zoster vaccination rate.

Immunization rates for the influenza vaccine at WAFHC were higher than the national average. In addition, 100% of all influenza vaccine recipients managed at WAFHC re- ceived the high-dose influenza vaccine indicated for adult ages 65 years and older as opposed to the standard-dose influenza vaccine. A study conducted in 2012–2013 us- ing the Medicare population revealed a 22% reduction in influenza infections and hospitalizations when individuals ages 65 years and older received the high-dose influenza vaccine compared to the standard-dose influenza vaccine (Izurieta et al., 2015).

At both NP-managed clinics, a medical assistant care coordinator reviewed the chart of every patient prior to every office visit and documented for the NP the patient’s individualized preventative healthcare needs, including the need for any of the five major vaccines assessed in this study. This care planning provided additional, readily available information to be used during the office visit and enabled the NP to focus on all needed preventative services, including vaccines. Patients were encouraged by the NP to receive a vaccination if no documentation of previous receipt was available. Reminders were set by the NPs in all patient charts when a vaccine was due but was deferred during a visit because of illness or refusal. Reminder calls were conducted when influenza vaccines became available and were targeted specifically to adults ages �65 years. Studies have demonstrated that strategies such as these positively impact vaccination rates (Klett-Tammen et al., 2016; Turner et al., 2014). These strategies, employed for the past 10 years at WAFHC, may have significantly improved vaccination rates.

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Limitations

The small size of this convenience sample limited gen- eralizability to the population. No data were obtained re- garding race or socioeconomic status limiting ability to evaluate for the impact of race or socioeconomic status on immunization rates. Reasons for the lack of immunization receipt were not ascertained and limited ability to fully un- derstand barriers to vaccinations in this age group. In addi- tion, no rationale for the lower vaccination rates in women compared to men was explored. Patients were considered vaccine recipients if actual documentation of administra- tion was present within the EHR. Vaccination rates may have been higher than identified in the study if the pa- tient had received the vaccine at a previous facility yet WAFHC lacked this documentation. In addition, informa- tion regarding insurance and Medicare Part D enrollment was not collected limiting ability to understand if insur- ance played a role in the rates of Tdap and Zostavax.

Implications for NP practice

As the demand for primary care providers increases, NPs play an important role in meeting the healthcare needs of our nation. In 2015, more than 860 million visits were conducted with an NP; the majority occurred in a pri- mary care setting (American Association of Nurse Practi- tioners, 2016). The administration of vaccines has always been one of the most important primary prevention strate- gies conducted by an NP. While the objectives established by Healthy People 2020 were lofty, using strategies such as those employed within these two clinics and those rec- ommended by the National Adult Immunization Plan can help to achieve these vaccination goals (National Vaccine Program Office, 2016). Eliminating barriers to receiving vaccines such as stocking vaccines within the office, en- rolling in Medicare Part D billing programs, recommend- ing vaccines at every visit, setting reminders in the EHR, and previsit care planning for preventative care needs can make a significant positive impact on vaccination rates. This study provides further evidence that patients �65 years managed by NPs who implement vaccination strate- gies can significantly impact vaccination rates.

Conclusions

Adults ages 65 years and older managed by NPs in two primary care clinics had immunization rates that exceeded the national averages in all five of the major routine vac- cines (Tdap, PPSV23, PCV13, influenza, and herpes zoster) as recommended by ACIP. These findings support the im- portant role of NPs in meeting the vaccination needs of

some of our nation’s most vulnerable population, adults ages 65 years and older.

Role of the APRN in increasing adult vaccinations essay