Capacity of Primary Care Providers to Meet New Vaccination Recommendations

Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to understand:

1. The challenges facing primary care


2. The time and resources required to meet present and new vaccination recommendations


3. How to estimate primary care's capacity


Background:
Primary care exists in a high-velocity environment characterized by rapid technological advancement, aggressive regulation, cost-containment, and high customer expectations. It has
been estimated it would require the average practitioner an additional 7.4 hours per day to provide all recommended preventive services, including the present vaccination schedule. Add to this time the recent consideration to vaccinate all healthy children against influenza, and the fact that there are a number of new vaccines and newly eligible populations who are scheduled to
receive existing vaccines. While an exciting opportunity for controlling infectious diseases, meeting these expectations within the imposed fiscal and time constraints of the average practice
has proven so severe that the American College of Physicians has issued a warning that "primary care, the backbone of the nation's healthcare system, is at grave risk of collapse”.

Objectives:
Primary care providers in the state of California

Methods:
Individuals eligible to be vaccinated

Results:
Using direct workflow observations and parametric cost analysis of vaccination activities—including “express lane” and mass vaccination clinics—and coupling these data with a provider
survey, our group used Cobb-Douglass production functions to estimate the probability that primary care has the capacity to meet these new vaccination opportunities.

Conclusions:
There are distinct, highly predictable productivity and cost structures associated with vaccinating. If all primary care providers in the state of California were able to optimally provide vaccinations, there still would not be the capacity to meet present and future recommendations. A new model and research opportunities for primary care–community vaccinator collaborations are recommended.