Abstract
OBJECTIVE: To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate.
DESIGN: A prospective controlled trial.
SETTING: Department of Veterans Affairs ambulatory care clinic.
PATIENTS/PARTICIPANTS: There were 3,502 outpatients with scheduled visits divided into three clinic teams (A, B, or C).
INTERVENTIONS: During a 12-week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates.
MEASUREMENTS AND MAIN RESULTS: Team A nurses assessed more patients than team B nurses (39% vs 34%, p=.009). However, vaccination rates per total patient population were similar (22% vs 25%, p=.09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C (p<.001).
CONCLUSIONS: Nurse-initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse-initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1997;46 (RR-8):1–24.
Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis of randomized controlled trials. Arch Intern Med. 1994;154:2666–77.
Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination coverage levels among persons aged ≥65 years—United States, 1973–1993. MMWR. 1995;44:506–7, 513–5.
Gyorkos TW, Tannenbaum TN, Abrahamowicz M, et al. Evaluation of the effectiveness of immunization delivery methods. Can J Public Health. 1994;85:S14–30.
Fiebach N, Beckett W. Prevention of respiratory infections in adults: influenza and pneumococcal vaccines. Arch Intern Med. 1994;154:2545–57.
Herman CJ, Speroff T, Cebul RD. Improving compliance with immunization in the older adult: results of a randomized cohort study. J Am Geriatr Soc. 1994;42:1154–9.
Klein RS, Adachi N. An effective hospital-based pneumococcal immunization program. Arch Intern Med. 1986;146:327–9.
Siebers MJ, Hunt VB. Increasing the pneumococcal vaccination rate of elderly patients in a general internal medicine clinic. J Am Geriatr Soc. 1985;33:175–8.
Turner RC, Waivers LL, O’Brien K. The effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med. 1990;150:645–7.
Becker DM, Gomez EB, Kaiser DL, et al. Improving preventive care at a medical clinic: how can the patient help? Am J Prev Med. 1989;5:353–9.
Bloom HG, Bloom JS, Krasnoff L, Frank AD. Increased utilization of influenza and pneumococcal vaccines in an elderly hospitalized population. J Am Geriatr Soc. 1988;36:897–901.
Clancy CM, Gelfman D, Poses RM. A strategy to improve the utilization of pneumococcal vaccine. J Gen Intern Med. 1992;7:14–8.
Shea S, Dumouchel W, Bahamonde L. A meta-analysis of 16 randomize-controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3:399–409.
Cohen DI, Littenberg B, Wetzel C, Neuhauser DB. Improving physician compliance with preventive medicine guidelines. Med Care. 1982;20(10):1040–5.
Cheney C, Ramsdell JW. Effect of medical records’ checklists on implementation of periodic health measures. Am J Med. 1987;83:129–36.
Morton MR, Spruill WJ, Cooper JW. Pharmacist impact on pneumococcal vaccination rate. Am J Hosp Phar. 1988;45(1):73. Letter.
Balas EA, Boren SA, Brown GD, Ewigman BG, Mitchell JA, Perkoff GT. Effect of physician profiling on utilization: meta-analysis of randomized clinical trials. J Gen Intern Med. 1996;11:584–90.
LeBaron CW, Baughman AL, Dini EF, Maes E, Dietz V, Bernier R. Impact of measurement and feedback on vaccination coverage in public clinics, 1988–1994. JAMA. 1997;277(8):631–5.
Peabody JW, Luck J. How far down the managed care road? A comparison of primary care outpatient services in a Veterans Affairs medical center and a capitated multispecialty group practice. Arch Intern Med. 1998;158:2291–8.
Ratner ER, Fedson DS. Influenza and pneumococcal immunization in medical clinics, 1978–1980. Arch Intern Med. 1983;143:2066–9.
Grimshaw JM, Russel IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342(8883):1317–22.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rhew, D.C., Glassman, P.A. & Goetz, M.B. Improving pneumococcal vaccine rates. J GEN INTERN MED 14, 351–356 (1999). https://doi.org/10.1046/j.1525-1497.1999.00353.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1999.00353.x