Immunization Q&A with Carolyn Bridges

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Dr. Carolyn Bridges, CDC
Dr. Carolyn Bridges, CDC

An internal medicine physician, Carolyn B. Bridges, MD, was in clinical practice before joining the Centers for Disease Control and Prevention (CDC) as an Epidemic Intelligence Service Officer in 1996. She has held a number of different positions at CDC working on influenza and other vaccine preventable diseases, and transitioned to her current position as the Associate Director of Adult Immunizations in 2011. Dr. Bridges’ career in public health has included research and policy on influenza prevention and control, vaccine effectiveness, vaccination coverage and improving coverage for recommended adult vaccines.

Q. It's National Immunization Awareness Month (NIAM). What are the CDC's main priorities around immunizations for the upcoming year and flu season?

Immunizations matter across the lifespan. Our goal — and the goal of NIAM — is to increase vaccine awareness so that more people stay up-to-date on their immunizations. It’s important that we all keep vaccinations in mind as we do other routine preventive health measures, similar to cancer screenings, exercise and eating right. So, we’re encouraging bundling preventive services for overall health and wellness. This flu season specifically, there is a focus on keeping pregnant women and older adults up-to-date on their immunizations for their own health and to prevent disease transmission to other family members.

Q: Do you anticipate anything new and different about this 2016 influenza season? Is there anything Medicare beneficiaries should start doing to prepare for it?

Our recommendations are the same for people with Medicare every influenza season — get a flu vaccine. The influenza vaccine is updated almost every year, including this year, and the protection wanes over time, so yearly immunizations are important. Since the best predictor of people getting vaccinated is having been vaccinated before, we encourage families to make it a habit for all members — children, adults and seniors. The good news is that it is easier to get immunized now, since vaccinations are offered in many places outside primary care offices such as the work place, pharmacies and grocery stores. We never know in advance how severe a flu season will be, but we do know that the best way to prepare is to get vaccinated.

Q: You spoke at the National Adult Influenza and Immunization Summit in May 2016. What were the main takeaways from that event?

The National Adult and Influenza Immunization Summit (NAIIS) is dedicated to improving awareness and use of recommended vaccines for all ages. Together with the National Vaccine Advisory Committee (NVAC), NAIIS published adult immunization practice standards—a framework for providers across the spectrum. The main action points are to assess immunization status in every patient encounter; recommend needed vaccines; vaccinate or refer to a provider who can; and document vaccines administered in vaccine registries. Many adults are not taking advantage of vaccines — one-third of older adults are not getting vaccinated for the flu, and 40 percent are not up-to-date on pneumococcal immunizations. At NAIIS, I spoke about the importance of provider recommendations, highlighting our recent studies that reveal many missed opportunities for providers like specialists and pharmacists to talk with people about vaccines. All providers — not just primary care — can help improve the low immunization rates among adults, and NAIIS is looking to better understand what is needed to help encourage routine vaccine assessments and recommendations.

Q. Tell us about your partnership with the QIO Program. Which immunization-related activities are you working on with the QIN-QIOs and other HHS organizations?

We’ve been working closely with Shiree Southerland, the Centers for Medicare & Medicaid Services’ Subject Matter Expert for the adult immunization work of the QIO Program. Our aims are clearly aligned, so we are coordinating efforts, making connections where relevant and framing things similarly to encourage implementation of the Standards for Adult Immunization Practice. Right now, the focus for both the CDC and the QIO Program is on encouraging the incorporation of vaccine needs assessment as part of routine patient care for adults. Also, flu vaccinations help reduce the risk of a cardiac event and prevent secondary complications from chronic heart disease, so immunizations tie in to the QIO Program’s work on preventing cardiovascular disease. We too want to work towards reducing racial and ethnic disparities in vaccination rates, so QIN-QIOs’ health equity work definitely ties in to immunizations. Telligen and the Flu Fighters! is a great example of immunization work within the Program.

Q. QIN-QIOs are tasked with improving shingles vaccinations rates among elderly adults (which are exceptionally low) as well as delivering pneumonia vaccinations to one million previously unimmunized Medicare beneficiaries nationwide by 2019. How can QIN-QIOs and other quality improvement professionals help primary care providers more proactively address immunization needs with patients?

One issue that was highlighted at NAIIS by Laura Hurley, MD, Assistant Professor of Medicine at the University of Colorado, is that providers are confused about the complexity of adult immunization payments. Many are not aware of which immunizations are included under Medicare Part B or Part D. QIN-QIOs can help educate providers and office staff about which vaccinations are covered under Medicare. Also, providing immunization services takes dedicated effort, so helping practices identify a champion and establish an efficient practice flow that includes vaccine assessment will ultimately result in improvements. But some providers simply can’t vaccinate patients due to staffing or other issues, so referral networks are vital. Unfortunately, if providers don’t carry the recommended vaccine themselves, they tend to not recommend it. So having a strong network of local providers, pharmacists — and even the health department— to refer patients to for vaccination services will result in better coverage.

Q. Anything else you would like QIO News readers to know?

Low vaccination rates in U.S. adults show that many people are not taking advantage of the benefits that vaccines have to offer, and that is what we are aiming to change. As a patient, you can ask questions and determine what is needed for your overall health. There are also a number of resources from the CDC that can aid in discussions about immunizations, including the CDC’s Adult Vaccine Quiz. Providers can also look for ways to streamline the vaccine needs assessment process, such as using a questionnaire at check-in, and QIN-QIOs can provide the right guidance to improve office workflow to incorporate the assessments for patients. Our hope is that vaccine needs assessments become a routine part of patient encounters and we reduce the burden of preventable illnesses.