Seeking efficiencies in immunization programs in British Columbia

Most physicians in British Columbia know immunization as a primary care service. Some are aware of the renewed focus on improving immunization programs in the province. This was initially stimulated by the National Immunization Strategy[1] in 2004, and federal funding for provincial and territorial immunization programs. The initial allotment of $400 million over 3 years has now ended, but assisted with launching varicella, pneumococcal, meningococcal C conjugate, and adolescent pertussis vaccine programs around the country. The renewed funding of $300 million announced earlier this year is earmarked for human papillomavirus vaccine. The total cost of vaccines to support BC immunization programs is projected to rise from $14 million in 2001–2002 to about $53 million in 2008–2009. Increased cost requires better management and efficiencies.

A number of process improvement initiatives are gaining ground on the backdrop of Immunize BC: A Strategic Framework for Immunization in BC.[2] This framework was announced in April by the Honourable George Abbott, Minister of Health. It highlights six priority actions: 
• Promote the immunization program to the public and health care professionals.
• Improve access to immunization services.
• Ensure an adequate supply of knowledgeable, trained service providers.
• Create an integrated immunization registry.
• Improve the vaccine inventory management system.
• Establish an immunization research agenda that includes the sociocultural aspects of vaccine delivery and uptake.

The coordination of actions in each of these areas is with the BC Immunization Subcommittee, a subcommittee of the Communicable Disease Policy Committee. It has representation from regional health authorities, the Ministry of Health, BC Centre for Disease Control, First Nations, and physicians (Dr Simon Dobson from pediatrics and Dr Michelle Linekin from family medicine).

There are two new initiatives in 2007 that physicians need to know about: vaccine-specific billing codes and better vaccine inventory management.

Vaccine-specific billing codes

The Medical Services Plan (MSP) now requires that vaccines given to those under 19 years old be billed using one of 17 vaccine-specific billing codes. [3] The codes include all publicly funded vaccines and will be amended if vaccines are added. Two tools are available to make recording easier. One is an immunization schedule for the patient chart. As each vaccine is given, the date, site of injection, and vaccine lot number are recorded. The schedule becomes a permanent record of immunization for the chart, from which the codes can be transcribed for electronic entry. The second tool is a pocket-sized card with the vaccine codes. Over the next 2 years, new information systems will flow these billing data into immunization registries. This is now done manually through submission of line-listed data to public health in most parts of BC where doctors immunize children. Data capture through billing codes has been done successfully for many years in Manitoba, allowing for both immunization coverage assessment and recognition of population vulnerabilities. [4-6]

Better vaccine inventory management

Vaccines are biologicals with short shelf lives and cold storage requirements. About $2 million is wasted each year in BC, from a total budget  of around $35 million. Most of this 6% waste is preventable. Regional health authorities and BCCDC are improving cold chain during transport and storage. Physicians can help by posting the vaccine storage and handling guidelines and ensuring that office staff have read them—available at BCCDC’s web site at www.bccdc.org/content.php?item=214. One staff member should be given primary responsibility for vaccine management. Vaccine refrigerators should be monitored with maximum-minimum thermometers, and temperatures should be checked and logged twice daily. Call your health department if you need advice on how to handle exposed vaccine. Store vaccine with the shortest expiry date at the front of the refrigerator so that it will be used first. Never store vaccine on fridge door shelves. Pack vaccines in cold chain carry bags with ice packs for transport to the office from the health unit. Return unused vaccine to your local health department—do not discard it. Some returned vaccines may have monetary value under contract credit policies, so throwing them away is literally throwing money in the trash. 

For more news, check our web site periodically at www.bccdc.org.

—Monika Naus, MD, MHSc
BC Centre for Disease Control

References

1.  Final Report: National Immunization Strategy. A Report from the F/P/T Advisory Committee on Population Health and Health Security (ACPHHS) to the Conference of F/P/T Deputy Ministers of Health. 2004. www.phac-aspc.gc.ca/publicat/nat_immunization_03/index.html (accessed 25 September 2007).
2.  Immunize BC: A Strategic Framework for Immunization in BC Ministry of Health. February 2007. www.health.gov.bc.ca/prevent/pdf/immunizebc.pdf (accessed 25 September 2007).
3.  Tools to assist with the new vaccine codes. Medical Services Plan, British Columbia. www.health.gov.bc.ca/msp/infoprac/physbilling/new_vaccine_codes.html (accessed 25 September 2007).
4. Communicable Disease Control Unit, Public Health Branch, Manitoba Health. Manitoba Immunization Report. Manitoba Immunization Monitoring System (MIMS). Annual Report 2004. www.gov.mb.ca/health/publichealth/cdc/surveillance/mims04.pdf (accessed 25 September 2007).
5.  Roberts JD, Poffenroth LA, Roos LL, et al. Monitoring childhood immunizations: A Canadian approach. Am J Public Health 1994;84:1666-1668.
6.  Gupta S, Roos LL, Walld R, et al. Delivering equitable care: Comparing preventive services in Manitoba. Am J Public Health. 2003;93:2086-2092.