Vaccine program targets low-income, uninsured

The primary benefit of vaccinating in the ED is that services provided in the ED reach minorities and the uninsured, who are very difficult to reach in other settings, says David Slobodkin, MD, MPH, FACEP, assistant professor of health policy and administration at the school of public health at the University of Illinois at Chicago and an ED physician at Freeport (IL) Memorial Hospital.

It is cost-effective to vaccinate when the patient is already being seen for a health care problem and where large numbers of people can be seen in the same location, he notes.

Poor, uninsured patients often are in need of vaccinations and lack access to primary care, says Jennifer Drew, MSPH, data manager/analyst for the pneumococcal vaccine intervention project at Grady Health Systems in Atlanta.

5% had received pneumococcal vaccine

When Grady started a vaccine program, more than 50% of ED patients had vaccine indications, and only 5% had received the pneumococcal vaccine.

"Furthermore, almost 50% of the patients did not have a primary care provider," Drew says. "Since many of these patients are using the ED as a primary care facility and have vaccine indications, the ED can offer a unique opportunity to improve the health of this population while also decreasing costs for an otherwise unreachable population."

Many ED staff tend to resist doing anything "extra" for patients with non-urgent or chronic chief complaints, even though these patients make up the majority of ED patients, Slobodkin says. "We use the excuse that we would need to take time from our real’ patients, even though that may not be true. The preventive intervention for the minor patient might be the most cost-effective thing that we could do in the ED."

In a large urban ED, a single public health nurse in the waiting room might be able to vaccinate dozens of people per shift, he notes.

A vaccine program was started at Jacobi Medical Center in Bronx, NY, in response to low immuniza -tion rates found during a measles epidemic in 1991. Sandra Cunningham, MD, FACEP, associate director of the pediatric ED at Jacobi, says Bronx was one of the hardest hit areas. "From further investigation, they found out that children in this community had one of the poorest immunization rates in the city," she says.

If immunization rates are adequate, and patients have good access to primary care, you may not need a program in the ED, Cunningham says. To determine your community’s immunization rates, contact your state department of health, she recommends.