Adult Immunization Quality Landscape Opportunities and Challenges
Pharmacy Quality Alliance's (PQA) 2022 Annual Meeting in Baltimore earlier this month featured speakers and educational sessions related to important topics in health care quality. Stakeholders from across the health care ecosystem engaged in robust discussions about issues and trends related to performance measure development and implementation, quality improvement and care transformation, social determinants of health (SDOH) and health equity, access and policy, and health information technology – across several therapeutic areas.
Potential for Improvement in Delivery Rates
During the Adult Immunization Quality Landscape Opportunities and Challenges panel, Donna Dugan, Ph.D., M.S., Senior Vice President at Discern Health, part of Real Chemistry, provided important information about the quality landscape for adult immunization, including the gap in evidence-based care and the potential for improvement across a number of immunizations recommended for adults in the U.S. She summarized some of the barriers to uptake, including low priority and awareness, out-of-pocket costs, adult interaction with the health care system, inconsistent data capture and exchange, and vaccine hesitancy. She also discussed some of the current trends in adult immunization that have been impacted by the pandemic, including the shift in immunization delivery settings from clinician offices to pharmacies and skilled nursing facilities, the amplification of the importance of adult immunization and heightened awareness of vaccine hesitancy, and the illumination of existing disparities in immunization rates among certain populations.
Shifting Delivery Settings as an Opportunity to Close Quality Gaps
As part of the panel on adult immunizations, Chad Worz, Pharm.D., BCGP, Executive Director and Chief Executive Officer of the American Society of Consultant Pharmacists (ASCP), provided the real-world immunization delivery perspective. He talked about immunization delivery by nurses and pharmacists in the pharmacy and long-term care settings, and the impact of COVID-19 on that delivery. He discussed several pharmacy and long-term care setting immunization barriers, including lack of access to patient history and Immunization Information Systems (IIS), lack of reimbursement, and staffing shortages. He highlighted several pharmacy/pharmacist-targeted initiatives and resources available to facilitate greater immunization delivery, including pilots and partnerships that focus on leveraging IIS-integrated technology to access patients’ immunization data at the point of service, health plan-pharmacy partnerships to improve vaccine rates, and training resources for pharmacy-based immunization delivery.
Continued Importance of Robust Performance Measurement for Monitoring and Improvement
Panelist Brett Kay, Director, Healthcare Quality at Johnson & Johnson Health Care Systems (JJHCS), stressed the continued importance of robust performance measurement for monitoring and improvement of adult immunization. He noted certain challenges with the current landscape, sharing that there is a breadth of measures for some immunizations, such as influenza and pneumococcal, but a more limited number for others. He also noted that the reliability and validity of data sources for vaccine quality measurement is a challenge overall, in addition to pharmacy-based immunization measure challenges such as attribution, data accuracy, variability of IIS requirements and use, and a lack of pharmacy-specific accountability programs and incentives. He stressed that, while these barriers exist, quality measure implementation and relative incentives continue to be a key driver of quality improvement and should continue to be pursued.
Focusing on the Future
With the goal of improving adult immunization rates, the panelists and audience members discussed the importance of joint accountability of physicians, nurses and pharmacists across practice, pharmacy, long-term care and other settings in the delivery of vaccines. They stressed that fit-for-purpose value-based programs and measures, which are inclusive of current and new vaccines as they are approved, are key to supporting and incentivizing adult immunization delivery.
