Keith Reynolds 00:00:05 This is Primary Viewpoints with Patient Care Online, a podcast bringing you the most informative conversations with healthcare experts and leaders about what impacts primary care medicine today. My name is Keith Reynolds, and this episode we feature a discussion on immunizations between Patient Care Online editor Sidney Jennings and Doctor Steven Pifer, former president of the American Academy of Family Physicians.

Sydney Jennings 00:00:32 So, according to the US centers for Disease Control and Prevention, vaccination coverage among kindergarten students decreased from approximately 95% during the 2019 2020 school year to 93% during 2022 2023. How can primary care clinicians ensure more kindergarten aged children receive the recommended immunizations this year?

Dr. Steven P. Furr 00:00:54 I think part of that is the effect of the Covid and the fact that a lot of their kids didn't go in for their well-child visits, and they've kind of gotten out of that routine of going in for their yearly well-child visits. So one of the things that we've done is, you know, they don't come in for their well-child visits. A lot of times they're in for a sick visit if they're just in because they've got an earache or something else going on, they don't have high fever.

Dr. Steven P. Furr 00:01:15 We'll talk to them while they're there and say, hey, do you want to go in and get your immunizations while you're here and get it taken care of them, because you can always rely on them to come in for a, well, visit. So for us, if they're there for a visit, we try and get the vaccinations in and not just say, oh, why don't you come back for another visit? Let's get it while you're here.

Sydney Jennings 00:01:33 Great. And also, according to the CDC, there have been 203 reported cases of measles as of August 1st. In the US. The majority 86% of cases are among unvaccinated individuals. Upticks like this in measles cases appear to be more frequent. Now, do AAF do RFP members have thoughts on what might be causing the increase, and how can clinicians ensure patients are up to date on their measles vaccinations?

Dr. Steven P. Furr 00:02:01 Yeah, of course, as you mentioned, the reason for the increase is the number of people are unvaccinated, so they're just not getting their vaccination.

Dr. Steven P. Furr 00:02:06 And we're so dependent on that herd immunity. And people don't understand when you vaccinate yourself or your child, you not only protecting them, you're protecting all the people around you. In addition to that. So we have a large group of people that don't get vaccinated. Then other people are more exposed and you just got more virus available. So again, try and get people back in. You do. That's a vaccine they get. It's a measles, mumps, rubella vaccine all at once and all together. So again it's important to just make sure on all of our patients when they come in we try and check their immunization profile, see if they're up to date. If not, try and get them called up right there at their visit. And you know, and you know, we've been fortunate. We've lived in a time where vaccinations have been out and whole groups of diseases we don't see anymore. And people have forgotten how deadly those vaccines, those diseases were. You know, I grew up, my grandmother had polio.

Dr. Steven P. Furr 00:02:54 She had a weakened leg because of that. But we just forget how devastating those those diseases were. When I came along and was practicing, we had a infection called Haemophilus influenzae. Well, we've got a vaccine for that. We never see those cases anymore. We used to see kids with meningitis and horrible epiglottis. We never see that anymore due to the vaccinations.

Sydney Jennings 00:03:15 So there is still a lot of concern about the surge in vaccine hesitancy and misinformation that came along with the Covid pandemic. Do you feel as though the situation has improved as we move farther away from the from the public emergency?

Dr. Steven P. Furr 00:03:30 I think there's still a lot of misunderstanding because there's so much that has changed. There's additional vaccines, there's new vaccines, such RSV vaccine. I think to tell you the truth, people are really just kind of confused. They've kind of lost track. I mean, even for us as physicians, keeping up with the recommendations. And last year you had one recommendation for RSV. That's changed this year. So I think it's real important for for patients to get with their primary care doctor and let them help them understand what vaccines they need.

Dr. Steven P. Furr 00:03:59 And is it time to get a Covid vaccine update. So some of those vaccine hesitancy, I think a lack of a lot of us, just lack of understanding of what's really needed and the fact they can't get multiple vaccines at once, that it's no problem. You can get your flu and Covid vaccine, and even if you're due for it, your RSV vaccine all at the same time. So I think there is some vaccine hesitancy, but I think there's a lot of vaccine confusion that's going on, and that's among providers too, as the guidelines have changed. So you've got to make sure you keep up with that and have patients understand what they really need.

Sydney Jennings 00:04:32 True. So how should family physicians and other primary care clinicians continue to address vaccine hesitancy and misinformation among patients and families? You spoke to it a little bit.

Keith Reynolds 00:04:44 Yeah.

Dr. Steven P. Furr 00:04:44 And, you know, there was just a recent study that showed the main reason people don't get vaccinated because their doctor didn't suggest it to them. So often, you don't wait for the patient to come in and say, hey, I'm here to get this vaccine when they're there for a well visit.

Dr. Steven P. Furr 00:04:56 Are they there for sick visit? They're there to get their blood pressure checked or the diabetes checked. You look in their record and say, hey, you know, you're due for your Covid vaccine, you're due for your flu vaccine. Do you want to get that while you're here? And so often if you suggested, they'll agree to do it. And in fact, I'd probably say one fourth of my vaccinations are not done on the patient who's in the office, but it's their spouse who comes in with them so that the husband will be there for a visit, and the wife sitting there and say he's going to get his flu vaccine today, do you want to get yours? She said, yeah, I'm here. Let's go ahead and do it while we're here. So it's just a matter of asking if they want to get that done.

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Keith Reynolds 00:05:45 That's physicians practice.com.

Sydney Jennings 00:05:52 So shifting gears to adults, what do you feel are the most important changes in recommendations for adult vaccination as we head into the respiratory virus season?

Dr. Steven P. Furr 00:06:03 I think for many areas that there's not been a huge uptake in Covid Covid cases, people have forgotten they really do need to get a Covid vaccine and get a booster each year, and that's going to be the recommendation going forward. So we're going to kind of encourage them when they come in for their flu vaccine, also to get their Covid vaccine at the same time and make sure they get those taken care of. All the flu vaccines now are trivalent, so they're covered against three different strains at the same time. And the Covid vaccine should help protect against strains going forward. The other new recommendation is they should if they're 75 or older, they should get an RSV vaccine and that's the one time vaccine. At this stage, there's no recommendations to get subsequent vaccines. So if they've already had one, they won't need another one. They can get all three vaccines at once if they want to, or if they don't want to get them all the same day.

Dr. Steven P. Furr 00:06:48 You can give them to and then come back a day later or a week later if they want to, and get the other vaccines. Then the other recommendation for the RSV vaccine is that people in that age group between 60 and 75 or 60 or 74, who are at high risk, and those are people like people with diabetes who are immunocompromised, got chronic kidney disease, and particularly those who've got lung problems like COPD or asthma. Those people should probably go ahead and get an RSV vaccine even if they're not 75.

Sydney Jennings 00:07:15 So are there any particular challenges or new issues that primary care clinicians may encounter this upcoming respiratory virus season, and if so, how can they address them effectively?

Dr. Steven P. Furr 00:07:27 I think one of the biggest issues for us and that we've advocated for one, is particularly for adults. There's a split in how they can get vaccines. So some vaccines are covered in the Medicare Part B and that's like the flu and the Covid vaccines. However, some of the newer vaccines, such as the zoster vaccine and the RSV vaccine, are covered under Medicare Part D, so they have to go to the pharmacist to get that vaccine.

Dr. Steven P. Furr 00:07:51 We can't give that in the office because we don't get reimbursed for that. So it's very difficult. I'm there talking to a patient and I can give them the flu and the Covid vaccine, but I can't give them the RSV vaccine. So I've got to send them to the pharmacy to do that. They're much more likely to get the vaccine while they're there in the office. So one of the things as RFP we've been advocating for is that we need to have all approved vaccines, all ACIp approved vaccines covered under part B, we don't want to get them off part D, that's fine if they want to get them at the pharmacy. But we think a lot of these people with vaccine hesitancy are much more likely to get them in their primary care, their physician's office. So we would like to have all vaccines covered under part B. And the other thing to remember is not every Medicare person has part D coverage. There's thousands of Medicare patients who don't have part D coverage. Therefore, they can't afford to get some of these expensive vaccines that are $200 a shot.

Sydney Jennings 00:08:43 Wow. $200.

Keith Reynolds 00:08:45 Yes.

Dr. Steven P. Furr 00:08:46 Wow. And and that's and that's the reason we can't afford to stock some of these vaccines if we know we're not going to get reimbursed for them because they they're so expensive.

Sydney Jennings 00:08:54 Why are there any ways that like primary I mean, you mentioned advocating for Medicare Part D, but is there any other way that, like primary care clinicians can address those issues, or is that just the main one?

Keith Reynolds 00:09:08 Yeah, there.

Dr. Steven P. Furr 00:09:09 Are some companies that will do the billing for vaccines for you and stock them in the office. And you can get get around doing it that way. There's a complicated billing method on Medicare Part D to get around it, too, but it's fairly, fairly complicated. And the real solution is to get Congress to just go ahead and approve and get all vaccines that are recommended covered in a part B.

Sydney Jennings 00:09:28 Great. Well, thank you so much for joining me today.

Keith Reynolds 00:09:31 We enjoyed it.

Keith Reynolds 00:09:37 Again, that was Patient Care Online editor Sidney Jennings and Doctor Steven Pifer, former president of the American Academy of Family Physicians.

Keith Reynolds 00:09:44 My name is Keith Reynolds. And on behalf of the whole Patient Care Online team, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify. Also, if you'd like a digest of the best stories Patient Care Online publishes delivered straight to your email four days a week, subscribe to our newsletter at Patient Care Online. Com. Patient care online medical economics and physician's practice are all members of the life sciences family. Thank you.