Creating artificial barriers to vaccinations.

Achieving optimum outcomes is difficult enough without creating artificial barriers. Certainly none of us would ever admit to putting up any barrier that would prevent our residents from gaining access to important medical care; however, that it exactly what we have been doing by requiring signed consents for influenza and pneumococcal vaccinations in long-term care facilities. This is a serious issue—a nursing facility respiratory outbreak can easily infect almost two thirds of the residents resulting in complications in 20%. With estimates as high as 70% for vaccinations reducing the risk of hospitalization and death in seniors it is difficult to imagine why any barriers, let alone artificially created ones, would exist. The authors of “Factors Predictive of Increased Influenza and Pneumococcal Vaccination Coverage in Long-Term Care Facilities: The CMS-CDC Standing Orders Program Project” demonstrated requiring signed consents is in fact a major barrier for achieving higher vaccination rates. Similar results were documented in an earlier study published in the Journal of the American Geriatrics Society. With a target of 90% set by the Healthy People 2010 and rates at 66% for influenza coverage and 39% for pneumococcal coverage we clearly cannot afford to be creating artificial barriers. In a 2004 article in the Archives of Internal Medicine the title of the publication zeroed in on this very issue: “Is signed consent for influenza or pneumococcal polysaccharide vaccination required?” Their conclusion was that obtaining signed consent prior to administering vaccines represented an obstacle to achieving targeted goals for vaccinating individuals against influenza and pneumococcal disease. Further they found that signed consent is neither legally mandated (with the exception of the state of Maryland) nor a guarantee that the patient has been given signed consent. Quite the opposite of safe guarding one legally by requiring informed there is an argument that any action taken by health care providers that reduces rates of vaccination such as requiring signed consents may create a legal liability similar to that of withholding recommended effective low-risk treatment such as aspirin therapy for the prevention of a myocardial infarction. In addition, a previous Archives of Internal Medicine article highlighted the fact that one of the most fundamental and