Immunizations in high-risk adults overlooked.(Clinical Rounds)

WASHINGTON -- Using ancillary staff to obtain patient immunization and medication histories before the patient sees the physician could go a long way toward improving immunization rates among high-risk adults, Linda Hill, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Despite long-standing recommendations for annual influenza vaccine and one-time pneumococcal vaccination for adults aged 18-49 with chronic lung, cardiovascular, metabolic, and immunosuppressive conditions, overall coverage levels are only 20% for influenza vaccine and 8% for Pneumovax.

Rates are just slightly better for diabetic patients, at 27% and 15%.

The Healthy People 2010 goal is 60% for both vaccines, said Dr. Hill of the department of preventive and family medicine at the University of California, San Diego.

In an effort to determine what types of preventive health issues are addressed during a typical office visit, Dr. Hill and her associates audiotaped 37 visits of patients aged 20-50 years old who had chronic conditions.

The study patients were seen at three community health centers and one private practice between September 2003 and January 2005, according to Dr. Hill.

The average visit lasted about 13 minutes. About 5 minutes were spent taking the patient's history, half a minute on providing generic health information, another 1-2 minutes on evaluations such as explaining test results, and about a half minute on the physical exam. Only fractions of minutes each were spent offering health recommendations, such as "you should get more exercise"; discussing preventive services other than immunizations, ...