Abstract
BackgroundAdult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates.MethodsThis prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n = 23; comparator group n = 20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations.ResultsVaccination rates increased after 12 months in intervention and comparator groups respectively for: a). influenza from 44.4 ± 16.7 to 51.3% ± 12.9% (by 6.9 percentage points, p = 0.001) and from 35.1 ± 19.1 to 41.3% ± 14.2%, (by 6.2 percentage points, p = 0.01); b). pneumococcal vaccinations in older adults from 62.8 ± 17.6 to 81.4% ± 16.6% (by 18.6 percentage points, for p < 0.0001) and from 55.9 ± 20.0 to 72.7% ± 18.4% (by 16.7 percentage points, p < 0.0001); and c). zoster from 37.1 ± 13.4 to 41.9% ± 13.1% (by 4.8 percentage points, p < 0.0001) and from 35.0 ± 18.7 to 42.3% ± 20.9% (7.3 percentage points, p = 0.001). Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7 ± 19.6 to 34.5% ± 19.0%, p = 0.3) and improved slightly in comparator group (24.3 ± 20.1 to 28.2% ± 20.0%, p = 0.003). Missed opportunities reduced after 12 months, most noticeably, for: a). for influenza from 57.7 to 48.6% (by 9.1 percentage points, p < 0.0001) and from 69.7 to 59.6% (by 10.1 percentage points, p < 0.0001); b). pneumococcal vaccinations in older adults from 18.1 to 11.5% (by 6.6 percentage points p < 0.0001) and from 24.6 to 20.4% (by 4.3 percentage points, p < 0.0001) in intervention and comparator groups respectively.ConclusionsMulticomponent interventions show promise in improving vaccination rates and reducing missed opportunities in older adults for pneumococcal and zoster vaccines and vaccination against influenza. Provider reminders remain the most effective strategy when delivered either as a component of these interventions or alone.
Highlights
Adult immunization rates are below Healthy People 2020 targets
Vaccination rates increased after 12 months in intervention and comparator groups respectively for: a). influenza from 44.4 ± 16.7 to 51.3% ± 12.9% and from 35.1 ± 19.1 to 41.3% ± 14.2%,; b). pneumococcal vaccinations in older adults from 62.8 ± 17.6 to 81.4% ± 16.6% and from 55.9 ± 20.0 to 72.7% ± 18.4%; and c). zoster from 37.1 ± 13.4 to 41.9% ± 13.1% and from 35.0 ± 18.7 to 42.3% ± 20.9%
Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7 ± 19.6 to 34.5% ± 19.0%, p = 0.3) and improved slightly in comparator group (24.3 ± 20.1 to 28.2% ± 20.0%, 3.8 percentage point increase, p = 0.003)
Summary
Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. Adult immunization rates remain well below Healthy People 2020 targets, [1] even though adults, on average, visit a primary care provider more than three times a year [2]. Primary care physicians provide more than 560 million office visits each year, putting them in the unique position to administer immunizations to patients of all ages [3]. Specialty care provides more than 230 million office visits, but, based on low immunization rates in specialty care, a large proportion of these visits are viewed as missed opportunities to provide adequate vaccination for adults [4]. We suggested that missed opportunities could represent a more accurate measure of provider and health care organization performance as compared to populationwide immunization rates because missed opportunities are clearly associated with a patient encounter
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