Improving Influenza and Pneumococcal Vaccination Rates in Ambulatory Specialty Practices

Abstract

Background. Influenza and pneumococcal vaccinations are recommended for elderly and high-risk patients; however, rates of adherence are low. We sought to implement influenza and pneumococcal vaccine initiatives in 4 different ambulatory specialty practices, using 3 unique approaches.Methods. Four specialties with high-risk patient populations were selected for intervention: allergy (asthma), infectious disease (ID) (human immunodeficiency virus), pulmonary (chronic lung disease), and rheumatology (immunocompromised). Allergy and ID focused on influenza vaccination, and pulmonary and rheumatology focused on pneumococcal vaccination. We used 3 strategies for quality improvement: physician reminders, patient letters, and a nurse-driven model. Physicians were provided their performance data on a monthly basis and presented trended data on a quarterly basis at staff meetings.Results. All 4 specialties developed processes for improving vaccination rates with all showing some increase. Higher rates were achieved with pneumococcal vaccine than influenza. Pneumococcal vaccine rates showed steady improvement from year to year while influenza vaccine rates remained relatively constant. Allergy's influenza rate was 59% in 2011 and 64% in the 2014 flu season. Infectious disease influenza rates moved from 74% in the 2011 flu season to 86% for the 2014 season. Pneumococcal vaccine in pulmonary patients' rate was 52% at the start of intervention in February 2009 and 79% as of January 2015. Rheumatology rates rose from 50% in February 2009 to 87% in January 2015.Conclusions. Integrated routine workflow and performance data sharing can effectively engage specialists and staff in vaccine adherence improvement. Influenza vaccination may require other approaches to achieve the rates seen with pneumococcal vaccine.

Improving the vaccination status of liver transplant patients: Effectiveness of personally addressing patients and written recommendations to family physicians after 3 years

“…In contrast to the present study, Pennant et al documented significantly higher vaccination rates for pneumococci (after intervention: chronic lung disease: 79%, rheumatology disease: 87%), but especially for influenza (after intervention: allergy: 64%, infectious disease: 86%). However, the pre‐intervention vaccination rates were already well above the vaccination rates of our present study . In a study conducted by Sansom et al in a sexually transmitted disease clinic for men who have sexual relations with other men, a telephone reminder was ineffective regarding the proportion of patients who completed the basic immunization with the third dose of the hepatitis B vaccination (control group: 59.2% [n = 145], intervention group: 56.3% [n = 157]) or the second dose of the hepatitis A vaccination (control group: 62.9% [n = 154], intervention group: 58.1% [n = 162]).…”

Variations in Influenza and Pneumonia Immunizations for Medicare Beneficiaries Served by Rural Health Clinics

“…Disparities in immunization rates of Medicare beneficiaries between the African Americans and Whites are well documented in prior research (Pennant et al, 2015). Using national data from the Behavioral Risk Factor Surveillance System to perform a multilevel analysis of health care coverage, Anderson and Fullerton (2012) showed that the causal mechanisms of the gaps were attributable to racial residential segregation and poverty.…”

“…As noted by the American Lung Association (2014), immunizations for influenza and pneumonia among the elderly are imperative for health promotion. Research studies on multiple barriers to influenza and pneumonia immunization for adults have specified financial barriers (Gorshka-Ciebiada et al, 2015; Hebert et al, 2005; National Vaccine Advisory Committee, 2011), low health literacy (Sudore et al, 2006), ineffective reminder system (Johnson, Nichol, & Lipcznski, 2008; Multuck & Flower, 2008) and poor access to primary care services (Pennant et al, 2015). …”

Impact of Quality Improvement on Care of Chronic Obstructive Pulmonary Disease Patients in an Internal Medicine Resident Clinic

“…Several QI strategies in the literature have been described to improve the rates of pneumococcal vaccinations [ 23 , 24 , 25 ]. One study described a simple physician reminder document as sufficient to produce a significant improvement in pneumococcal vaccination in ambulatory rheumatology clinics.…”