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More elderly and at-risk adults get their flu and pneumonia vaccinations when the shots are coordinated and given by nurses instead of doctors, according to a North American study.
Researchers, whose results appeared in the Annals of Family Medicine, said that the change was linked to a 44 percent increase in patients' chances of getting a flu shot and a more than doubling of their likelihood of getting vaccinated against pneumonia.
The U.S. Centers for Disease Control and Prevention recommends all adults and children get the flu shot every year. Adults older than 65 and those with certain chronic conditions are supposed to get the so-called pneumococcal vaccine, as are young children.
There's been a recent effort to get public health nurses and pharmacists involved in giving vaccines, although policies vary by state, said Jeffrey Johnson, who worked on the study. He said shifting responsibility to non-doctors might be especially helpful for people with chronic diseases.
"The family physician has all of the responsibility to look after the patient, and so somebody with diabetes, for example, comes in and their first concern is their blood sugar and their blood pressure, and pretty soon the time for the visit is up," said Johnson, from the University of Alberta in Edmonton, Canada.
"But for a nurse in the primary care setting, (vaccinations and other preventive care) might be the first thing they're responsible for. The evidence, we think, clearly shows that shifting the responsibility and the ability to the non-physician personnel... That works."
Johnson's research team analyzed 77 studies of the success of financial incentives, patient outreach and other strategies to improve vaccination rates for flu and pneumonia in particular.
The researchers found that changing who performs the vaccinations, especially putting them in the hands of trained nurses, was one of the most successful vaccination-promoting strategies, along with calls and texts to patients reminding them about the shots.
But even with the team-change strategy, typically less than half of all eligible people got their vaccines.
"In the end, the effectiveness of these things is still pretty modest," Johnson said."We need to think of ways to amplify the effect. An obvious one would be to combine the approaches."
That could mean making nurses responsible for giving the vaccines and also for reaching out to patients by phone to encourage them to come into the office.
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Just make it easier to get--if I have to get it at the doc's office, I'm not getting it. If I can get it at the grocery store, I'll get it. Simple.
The doctor's office is retail, like Macy's. The grocery store is discount, like Target. Either way, you get the same vaccine at a different price. American doctors are well trained, however, spending an average of 5 minutes per patient degrades this effect. Medicine is a blend of art and science. A doctor who spends a few mintues per patient is not going to achieve great results. A nurse who spends a few minutes more could likely achieve better results. It's sad, but true.
It's only going to get much, much worst. Welcome to the future of ACA.
Louisiana allows flu shots to be given in drug stores. Just about every such store in the city has a sign encouraging customers to get their shots while there. I think I'd trust a pharmacist for the job more than a grocery store manager.
This article makes it sound as if the physician is giving the immunization. Never in my life have I seen a doctor give a shot and I've been in healthcare for 25 years...of course the nurse makes a better vaccine advocate.
Doctors don't often give the injections, Gena- but they used to. I'm 65, and all my injections were given by doctors 'til I was in my 30s. The I suppose it was generally realized that it was a waste of time, that nurses or trained assistants could give them more efficiently- that a physician's office time was better spent in more productive ways.
I've had doctors give me shots in the past. Believe me, ask for the nurse to do it.
I got my first-ever flu shot this year. Why? 1. It was free (I'm uninsured). 2. It was two blocks from my house at a community center I could walk to, and it was a nice day for a walk. 3. It happened to be on a day I didn't have to work. 4. It was advertised in the newspaper and online.
If people have to take a day off from work, make an appointment, travel, and pay for the doctor visit, that's a major barrier. Even at the chain drug stores, if you don't have insurance, it's $20 or $25. But at least you can get it on evenings and weekends.
That's not necessarily so. In my case, at least, the vaccine itself is covered by insurance, there's no charge for the visit to administer it, since it only takes a few seconds, and there's no appointment necessary... I can just drop by whenever I feel like it, and in the last 10 years I've never had to wait more than a few minutes.
I know that may not be true for everyone, but you never know until you try, and you surely can't just assume it's going to be a major deal.
I believe Nurses are considered more sympathetic and trustworthy than Doctors. I realize this is usually incorrect, but people generally think that women are generally more trustworthy and sympathetic than men. Therefore, if a nurse tells them to get a shot, they're more likely to do it. Again, I don't think that Dr's are untrustworthy, or unsympathetic, but that's the perception. And I realize that there are excellent male nurses (I've had some myself) but still, the majority of nurses are women.
I think that is because the nurse often comes in, gets your vitals, and asks what you are there for to save the doctor time. Unfortunately doctors often come in, see you for a minute or two, and show you out the door. While I expect the doctor to write prescriptions, I do get more time to actually discuss anything with the nurse and most of the time the doc has in the room is not looking at me, listening to me, or hearing what I am really saying. Sad, but true. I would switch doctors if there were one covered by my insurance, but this is the only one in town.
The "Doctor" term is very nonspecific. People should just refer to MD's as physicians since other professions also have the "Dr." title. Anyways, pharmacists are extremely accessible in communities and it makes more sense for pharmacies to offer preventative care than having to get an appointment to see your physician.
In NY state, it is the law that every person who gets admitted to the hospital must be offered flu and pneumonia vaccines. As a nurse, I'm required to have myself and the patient sign a form proving I have done this. As a patient at the doctor's office, I have never in my life had a doctor offer or suggest a vaccine; this has always been the nurse. Generally vaccines are a "standing order" from a doctor and a nurse can simply give them if the patient fits the criteria. I have never heard of a doctor being directly involved with the patient in getting vaccines, so the result of this "study" seems like a no-brainer.
I work in a Community Health Care Center in a rural area. In our office, I as the medical assistant, offer the flu shot and then if refused, the physician offers it again and explains why it is important. This way, we are sure that every patient hears about and is offered a flu shot and any other immunizations that they may need (ie. TDAP, Pneumonia, ect). So, in my office and in others I am sure, we work together to make sure everyone is immunized. This time of year is great to make sure to get everyone up to date since we are already giving the flu vaccine. Also, in my office the flu vaccine is much cheaper than at the Big Box Stores. Although, if you have insurance you may not have any charge at all.
I disagree with this article. My doctor's office doesn't even like to give flu shots and recommends to patients to go to local pharmacies to get them. He even charges ALOT more for them than you can get them for at the pharmacies so he doesn't have to stock alot of it. Your health is YOUR responsibility - and your doctor could care less is you get one - more money for him if you don't when you have to make another appointment.
the decision to get a flu shot is not really so much about the reasons the academics and physicians offer. disease prevention, protection...the technical issues. what people want to know is more like...did you get one?
and that's a question you ask a nurse.
One item left out of the study is the ever growing number of people who no longer trust their Doctors to do what is in the patients best interest versus what is in the Doctors best "Financial" interest. A flu shot at an average Doctors office can run as high as $150. for the office will charge the cost of an "Office Visit" and then the cost of the Shot. I have gotten my Shot from the Pharmacist at Walgreens for the past two years and actually she was better at giving the shot than my Doctors "Trained" Nurses..and she was able to answer every question I had concerning the safety of the Vaccine whereas the Nurses had to "go check on that"... I see the day coming, or returning to, as in the 1700's and 1800's and early 1900's the local Pharmacist was the person, or best Authority on the subject, to go to for health related issues and treatments leaving the Doctors to deal with more serious matters.. Many Mothers, and families as a whole, I notice are taking a stronger interest in home diagnosing due to the high cost of Doctors and their Corporations, er Offices, along with Emergency Rooms, whose high and excessive costs are driving more and more people and patients to seek alternative resources for their health issues. Medicine is just becoming to expensive for the common people and is now the source for the Elite Rich and Goverment supported non-producers.
And then there is what happened to ME on October 22nd. I went to the doctor's office to have a nurse give me my annual flu shot. SHE convinced me that I also needed another pneumonia vaccine because I had not had one for 9 years. SHE told me I should have one every 5 years! I stupidly believed her and she gave me both that day. Within 8 hours I had a severe antibody reaction, as my body went all WW3 on that vaccine. Another screening nurse told me that unless I had a temperature of 103 or more, that some pain and swelling at the injection site was normal---her assuming it was the flu shot and not the pneumonia vaccine. Well, my fever did go up to 103 a few hours after that and AFTER my doctor's office was closed for the day. I ended up in ER for over 6 hours that night & was told to see a doctor for follow-up the next day. The result? The nurse was flat out wrong, period. I got the first one 9 years back because I was (then) working with kids all the time. I am only 46 years old and have NO health issues at this time that put me at risk and in need of a pneumonia vaccine until the age of 65! The ER doctors, and two of the doctors at our clinic told me I should never had at that vaccine. My arm swelled up like a grapefruit and was extremely painful and red from my should down to my elbow. It took 6 days until I no longer had ANY more fever, & for most of those 6 days it stayed in the 101.5 to 102.5 range. They gave me pain medications and even a dose of morphine when I was in ER. The doctor's office is paying our share of the costs after our insurance pays. They KNOW their nurse was in the wrong. It isn't always the doctors who mess up: it happens with nurses too! I will NEVER allow anybody to give me a vaccine I have not asked for again---not until I am convinced I really need it. I will never blindly trust a nurse or doctor, period.
It was probably the formaldehyde.
@Black, your body breaks lots of things down to formaldehyde, it's a common go between for many chemical reactions that you NEED in order to function. your statement is as nonsensical as blaming it on the carbon.
@Lisa, doctors and nurses despite their training are still human. and in a high stakes field like medicine simple human error can be the difference between life and death. don't let one bad nurse or doctor taint your view of the field as a whole.
@Lisa, just yet another reminder that WE need to be educated about what we put into our bodies. I believe that before you have any vaccine you should get the informaiton fact sheet, like the one you get with a prescription, and read it carefully, plus do your own research. The same as I do with any medication I take. I was talking with someone the other day at my work, she called because her doctor's office wanted to give her the shingles vaccine and she asked if it was covered by her insurance. Well yes it was but not until she was 50 or over. That was the approved age reccommendation for the vaccine, by the vaccine manufacturer, therefore that was the criteria her insurance company went by. She was 47, NOT 50! I know that is just a 3 year difference, but the has to be reasons the drug company set the age at 50. And apparently the doctors office does not even know this! Makes you wonder how youn they go and how many times this happens.....
@ James, I do not distrust the entire medical field or community, but this was a wake up call for me. I don't care how irked they may get with me, I WILL ask questions in the future and get second opinions. As it was, I did gently question the nurse and she double checked my records as to when I had had my first pneumo shot. But I believed her about needing it every 5 years. Moreover, my mother has IPD (early stages) and so I thought it wise in order to give her another layer of protection. I have never had a reaction of any kind to any vaccine in my entire life up until this point. This was not an allergic reaction---I have been told this & believe it, as I have seen many types & levels of allergic reaction in my life: I agree with you about the formaldehyde.
@Jessica, I read instructions and medications info sheet, both for myself and my pets. Unfortunately, the nurse gave me sheets on both vaccine after I got them and in my busy day I didn't sit down to read them this time. :-( Then I got so sick so quickly I was thinking straight. I reiterated to the another nurse on the phone that I had both vaccines & was reacting but she focussed on the flu shot. When I called 24 hours later to say I'd been to ER they scrambled to get me in. If they had seen me they day I called I probably would not have ended up in ER at all. Hindsight is 20/20. Lesson learned.
If this article has a point -- beyond the level of The Bleeding Obvious -- I have yet to find it.
As an RN with 3 state licenses I've never seen an MD give a flu shot, always a nurse. And it should always be a nurse at a drugstore or elsewhere and not some "trained personnel".
In my experience this is correct. I'm old and obstinate, never took these shots until a nurse cajoled me into it. Besides, she's cute.
The best way to avoid a flu is to keep your immune system healthy via a healthy lifestyle. Whatever strain of flu you are being vaccinated for has mutated by the time you get the shot and is of little or no value, possibly harmful. Elderly folks in many cases are unable to build up an immunity from the flu shot in any case. I'm not a conspiracy guy who denigrates the medical profession, they do a lot of good things, but flu shots are a waste of resources. People who think flooding every cell in your body with a toxic halide (fluoride) will protect your teeth are the same people who think flu shots are useful. Don't forget at certain points in history we were taught that radiation exposure, tobacco and DDT were OK. Americans want a quick fix for everything, anything but eat right, exercise and get a good nights sleep.
lovely, i am so sick of all this birth control and what FDA will and will not allow , how about all mendications are available without perscriptions. The drug companies would be richer then they are now and the compition for the lowest price would be un real.
I took a flu shot this year for the first time in years. I have not felt well since I got the shot, and a month after receiving it, I missed 1.5 weeks of work due to the flu. I will not get the vaccination again. I will wear a mask from now on, during the flu season.