Impact of a guideline-based best practice alert on pneumococcal vaccination rates in adults in a primary care setting

Abstract

Background Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used to investigate the impact of pneumococcal-specific best-practice alerts (BPAs) with and without workflow redesign compared to health maintenance notifications only, on pneumococcal vaccination rates in at-risk and high-risk adults, and on series completion in immunocompetent adults aged 65+ years. Methods This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis. Results In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) ( P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19–64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19–64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention). Conclusions A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19–64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates. Electronic supplementary material The online version of this article (10.1186/s12913-019-4263-2) contains supplementary material, which is available to authorized users.

Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time

“…A study evaluating measures to increase vaccination rates in both immunocompetent and immunocompromised patients in the USA (not restricted to incident as in our population) showed, that the measures they implemented (including notification systems for medical staff) did significantly increase vaccination rates in some groups studied; perhaps an area of research to further explore in Germany [ 19 ].…”

Do electronic reminders alter recorded diagnoses in primary care office-hours practices of health centers: A register-based study in a Finnish city

“…For example, when an electronic reminder suggests potentially useful vaccinations they are complied with very well. 21 Analogously, simple screening procedures, such as screening for colorectal cancer, are performed after an electronic reminder but a little less eagerly. 22 However, if there is a bigger decision to be made to guide long-term treatment of a patient, for example, deciding whether or not to start continuous preventive anticoagulation, the reminders are less eagerly complied with by PCPs.…”

Validation of the Brazilian Portuguese version of Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

“…The newly adapted instrument showed a mean EKAN sum score lower or similar when compared to other validation studies using the EKAN (4,6,9) . The lack of correspondence between objective (EKAN) and subjective (confidence rating on ability to provide evidence-based care) measures is a phenomenon that has been shown in other disciplines (1) , in nursing students (4,(6)(7) , and in practicing nurses (5) . The low knowledge scores yet high confidence is consistent in all the EKAN validation studies.…”

“…Evidence-based practice (EBP) is a significant global movement and is pertinent to all health professions. Research shows the relationship between best practice and patient outcomes (1)(2) . These results demonstrate the need to teach EBP in the academic setting.…”