Prevention of pneumococcal disease in high risk adults: A pharmacist‐based assessment of adult immunization protocols in clinical practice

Abstract

BackgroundPneumococcal immunization rates in adults at high‐risk for pneumococcal disease fall below the Healthy People 2020 goal of 60%. Implementation of recommendations from the Advisory Committee on Immunization Practices (ACIP) provides an opportunity to improve patient care. We assessed whether pneumococcal immunization protocols (PIPs) exist for high‐risk adults across diverse clinical settings, determined protocol concordance with the 2012 ACIP recommendations, and identified tactics to improve ACIP recommendation implementation.MethodsWe conducted a multicenter, cross‐sectional survey of members of the American College of Clinical Pharmacy Practice‐Based Research Network, with practice responsibilities for high‐risk adult populations, from September 2014 to May 2015. Pediatric and travel vaccine practices were excluded. Objective survey measures evaluated the PIPs in three areas: (a) development, (b) maintenance, and (c) education. Subjective measures evaluated barriers to ACIP recommendation implementation.ResultsA total of 94 surveys representing 56 inpatient and 38 outpatient sites across 29 states were completed. Twenty‐five of the 45 inpatient PIPs (56%) were concordant with ACIP recommendations. Regular assessment for updates to and a formalized educational and accountability process was in place for 49 (91%) and 46 (85%) of the 54 inpatient PIPs evaluable in these categories, respectfully. Half of the outpatient sites did not have a standardized, written PIP in place. Of the 17 evaluable outpatient PIPs, 9 (53%) were concordant with ACIP recommendations. The most common perceived barriers to ACIP recommended immunization in adults were a lack of knowledge regarding national recommendations, a lack of accountability for recommendation implementation, and outdated PIPs.ConclusionOur study demonstrated that only 36% (34 out of 94) of the clinical sites had adopted the ACIP recommendations. While roughly half of the sites had PIPs in place, education of and accountability for immunizers was lacking, particularly in the outpatient setting. A system that enhances PIP prioritization, education, and accountability would likely address the gaps in adult pneumococcal immunization for high‐risk adults.