Adult Vaccination Rates Research Articles

Not Just for Kids: How to Improve Adult Vaccination Uptake in Canada

Vaccinations and booster shots aren’t just for kids. Adult vaccination rates urgently need a booster shot in Canada. Better and more regular uptake of vaccines during adulthood and retirement could improve the well-being of older Canadians and offset some of the challenges associated with an aging society. Despite clinical evidence showing the value of immunization against infectious diseases in the adult population, insufficient attention to lifetime immunization policies persists. This Commentary suggests creating formal approaches, based on applied behavioural design concepts, for improved adult immunization uptake. Influenza should be a pivot point. Even though the seasonal influenza vaccine suffers from relatively lower clinical efficacy than other vaccines, the related lack of confidence in its usefulness is exacerbated by doubts among healthcare workers. Still, the routine nature of the seasonal influenza shot does make it a pivotal part of adult immunization schedules. It should be used to prompt healthcare providers to review a patient’s overall immunization status, helping to develop databases to monitor and encourage other adult vaccines. This Commentary utilizes behavioural economic policy design issues and suggests major changes to the way Canadian provinces and territories monitor and ensure uptake of vaccines among adults. Alongside a digital strategy to create databases to monitor coverage of all adult vaccines, policies should build upon many patients’ preference to get their annual influenza shot at their local pharmacy by expanding pharmacists access to immunization databases, building greater links to primary care, and expanding pharmacists’ ability to set up immunization reminders for patients upon pharmacy visits, plus encouraging the use of digital apps. Going forward, the focus should shift to overcoming complacency with more use of automatic scheduling and reminders. Pharmacies, often a very convenient location for most urban-dwelling Canadians, could act as important parts of multidisciplinary primary care efforts to gather data on publicly funded adult vaccines – likely through digital platforms – and create reminders and prompts to overcome complacency as well.

A collaborative program to increase adult pneumococcal vaccination rates among a high-risk patient population receiving care at urgent care clinics

We report a project that utilized pharmacy students to increase pneumococcal vaccination rates in patients aged 19-64 years with high-risk medical conditions within urgent care clinics. The study also sought to better identify the number of patients previously vaccinated for pneumococcal disease. A total of 1,178 patients were considered eligible for pneumococcal vaccination during the study period, 287 (24.4%) of whom were determined to be previously vaccinated through chart assessment or patient interview. Of the remaining 891 patients, chart documentation of pneumococcal vaccination administered at the time of the urgent care visit was present for 96 patients (10.7%) in the intervention clinics compared with 6 patients in 2 control clinics who received the usual standard of care (P < .0001).

Evaluation of the Impact of an Innovative Immunization Practice Model Designed to Improve Population Health: Results of the Project IMPACT Immunizations Pilot

The goal of the initiative was to evaluate the impact of an innovative practice model on identification of unmet vaccination needs and vaccination rates. This was accomplished through a prospective, multisite, observational study in 8 community pharmacy practices with adults receiving an influenza vaccine with a documented vaccination forecast review from October 22, 2015 through March 22, 2016. When patients presented for influenza vaccinations, pharmacists utilized immunization information systems (IIS) data at the point of care to identify unmet vaccination needs, educate patients, and improve vaccination rates. The main outcome measures were the number of vaccination forecast reviews, patients educated, unmet vaccination needs identified and resolved, and vaccines administered. Pharmacists reviewed vaccination forecasts generated by clinical decision-support technology based on patient information documented in the IIS for 1080 patients receiving influenza vaccinations. The vaccination forecasts predicted there were 1566 additional vaccinations due at the time patients were receiving the influenza vaccine. Pharmacist assessments identified 36 contraindications and 196 potential duplications, leaving a net of 1334 unmet vaccination needs eligible for vaccination. In all, 447 of the 1334 unmet vaccinations needs were resolved during the 6-month study period, and the remainder of patients received information about their vaccination needs and recommendations to follow up for their vaccinations. Integration of streamlined principle-centered processes of care in immunization practices that allow pharmacists to utilize actionable point-of-care data resulted in identification of unmet vaccination needs, education of patients about their vaccination needs, a 41.4% increase in the number of vaccines administered, and significant improvements in routinely recommended adult vaccination rates.

Frequency and Consequences of Influenza Vaccination in Adults With Congenital Heart Disease

Immunization against influenza is a critical, but perhaps underappreciated prevention of morbidity and mortality in the cardiac population. The purpose of the present study is to examine influenza vaccination rates in adults with congenital heart disease (ACHD). A secondary purpose is to explore whether there is an association between demographic, medical, and behavioral variables and receipt of the influenza vaccination. Of the 183 consecutive ACHD patients who were contacted, 123 responded to our telephone survey. Mean age was 38.4 ± 14.7, with the most common type of lesion complexity being moderate (65.3%), followed by simple (21.0%) and severe (13.7%). Overall, 53 respondents reported undergoing influenza vaccination in the previous season. Fifty-two percent of all subjects claimed they were notified of the benefits of vaccination by their physician. Univariate analysis revealed that older age (p = 0.006), female gender (p = 0.027), perceived susceptibility to influenza illness (p <0.001), perceived severity of the influenza illness (p <0.001), perceived benefits of the influenza vaccination (p <0.001), side effects from previous immunization (p = 0.006), and physician recommendation (p = 0.008) were predictors of receipt of influenza vaccination. On multivariate analyses, however, only side effects from previous immunization was a predictor (odds ratio = 0.34 [95% confidence interval 0.13 to 0.91]), whereas physician recommendation was numerically, but not statistically, significant (odds ratio 2.01 [95% confidence interval 0.85 to 4.78]). Our study demonstrated that less than 50% of ACHD population receives influenza vaccination. We believe educating both the patients about the side effects of vaccination and the physicians about their role in counseling ACHD patients will increase the vaccination rates in this high-risk population.

Cost effectiveness of a practice-based intervention to improve vaccination rates in adults less than 65-years-old

ABSTRACT The cost-effectiveness of the 4 Pillars™ Practice Transformation Program to improve vaccination rates in adults <65-years-old is unknown. Two vaccines, influenza and Tdap (tetanus, diphtheria, acellular pertussis), were targeted for this age group. Cost-effectiveness of the intervention compared with control, with a primary outcome of cost per quality adjusted life year (QALY) gained, was estimated from societal and third party payer perspectives over a 10-year time horizon using a decision analysis model. Vaccination rates and intervention costs were derived from an intervention trial, and vaccine effectiveness, illness rates, and costs with/without vaccination were obtained from US databases and literature data. Future costs and effectiveness were discounted at 3%/year. The intervention cost was $1.78 per eligible patient/year. From the societal perspective, per patient total vaccination and illness costs with the intervention were $27.43 higher than control while gaining 0.00087 QALYs, costing $31,700/QALY gained. The intervention, extrapolated to the US population, could prevent 4.2 million cases, 87,489 hospitalizations, and 5,680 deaths due to influenza over 10 y in adults <65-years-old. In a probabilistic sensitivity analysis, the intervention was favored in 68.2% of model runs at a $50,000/QALY level and in 94.3% at $100,000/QALY. In a separate scenario analysis, the intervention became cost saving if influenza economic burden was >$2,099 per case (societal base case $846). Thus, the 4 Pillars Practice Transformation Program is an economically reasonable intervention to improve vaccination rates in adults <65-years-old, and could have a substantial public health impact.

Immunizing is not only a children's matter! : Why vaccinations are also important for adults

Vaccinations belong to the ten most effective public health achievements worldwide. While immunization programms for children are installed in Europe, vaccinations for adults are not established. However, adult vaccination is extremely meaningful: increasing age means ahigher susceptibility to infectious diseases, health problems and multimorbidity will increase. The burden of vaccine-preventable diseases is still high in Europe. Due to immunosenescence (older) adults are less protected against pathogens, antibody titers after vaccinations are lower and immunity lasts shorter. There is striking lack of data of adult vaccination rates and an international consensus regarding adult vaccination recommendations or guidelines are not available in Europe. In only six countries acomprehensive document describing recommended vaccinations for adults is available, among them Austria. The awareness of the importance of adult vaccination over the whole lifetime is not present to the necessary extent in Europe and has to be promoted.

With proper tools, pharmacists increase adult vaccination rates

With proper tools, pharmacists increase adult vaccination rates

Adult vaccination rates show modest, but far from optimal, gains

Adult vaccination rates show modest, but far from optimal, gains

Using a Mixed Methods Approach to Examine Practice Characteristics Associated With Implementation of an Adult Immunization Intervention Using the 4 Pillars Practice Transformation Program.

Adult immunization rates are consistently suboptimal, exacting significant human and financial burden of preventable disease. Practice-level interventions to improve immunization rates have produced mixed results. The context of change critically affects implementation of evidence-based interventions. We conducted a randomized controlled cluster trial of the 4 Pillars Practice Transformation Program to increase adult vaccination rates in primary care practices and used qualitative methods to test intervention effects and understand practice characteristics associated with implementation success. We conducted qualitative interviews with staff from 14 practices to assess implementation experiences. Thematic analysis of data pointed to the importance of quality improvement history, communication and practice leadership, Immunization Champion leadership effectiveness, and organizational flexibility. Practices were scored on these characteristics and grouped into four types: Low Implementers, Medium Implementers, High Implementers, and Public/University Practices. Intervention uptake and immunization rate changes were compared, and a significant increase in influenza vaccination rates (3.9 percentage points [PPs]; p = .038) was observed for High Implementers only. Significant increases in Tdap vaccination rates were observed for High Implementers (9.3 PP; p = 0.006) and the Public/University groups (6.5 PP; p = 0.012), but not other groups. Practice characteristics may be critical factors in predicting intervention success.

Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults

IntroductionRacial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors. MethodsWe contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior. ResultsThere were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge. ConclusionsRacial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.

The Korean Influenza National Immunization Program: History and Present Status.

The Korean influenza national immunization program was first established as an interim program in 1997, administering the influenza vaccine to low-income elderly adults. In 2005, the program assumed its present form of providing free influenza vaccination to adults aged ≥65 years. After turning over the influenza vaccination for elderly adults to the private sectors in 2015, the influenza vaccination coverage rate among this population increased to >80%. In addition, after the 2009 H1N1 influenza epidemic crisis, the vaccine was domestically produced. By reaching a 75% vaccination coverage rate in the target groups, it was possible to put an end to the influenza pandemic and fix the shortcomings of the system that existed at that time. The influenza vaccination program, provided free of cost, was extended to include infants aged <12 months in 2016 and ≤59 months in 2017 in order to reduce the influenza burden in these populations. However, the vaccine effectiveness remains low despite the high vaccination rates in elderly adults. Therefore, several areas, such as the adoption of quadrivalent influenza vaccine, adjuvanted influenza vaccine, and high-dose influenza vaccine and the expansion of vaccination target groups, still need to be addressed.

A Collaborative Program Using Student Pharmacists to Increase Adult Vaccination Rates for the At Risk Patient Population Attending Urgent Care Clinics

A Collaborative Program Using Student Pharmacists to Increase Adult Vaccination Rates for the At Risk Patient Population Attending Urgent Care Clinics

Implementation of Multi-Modal Intervention to Increase Adult Vaccination Rates in a Large Integrated Healthcare System

Implementation of Multi-Modal Intervention to Increase Adult Vaccination Rates in a Large Integrated Healthcare System

PIN95 - Effectiveness of Pharmacists-Led Provider-Focused Interventions to Improve Hpv Vaccination Rates in Adults in Malaysia

PIN95 - Effectiveness of Pharmacists-Led Provider-Focused Interventions to Improve Hpv Vaccination Rates in Adults in Malaysia

Using the 4 Pillars™ Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

IntroductionNational adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars™ Program, provider education, and one-on-one coaching of practice-based immunization champions. Methods25 primary care practices participated in a randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013–5/31/2014) and a pre-post study in Year 2 (6/1/2014–1/31/2015). Baseline year was 6/1/2012–5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year. ResultsThe cohort consisted of 70,549 patients ⩾18years who were seen in the practices ⩾1 time each year, with a baseline mean age=55years; 35% were men; 56% were non-white; 35% were Hispanic and 20% were on Medicare. Baseline vaccination rate averaged 35%. In the Year 1 RCCT, cumulative Tdap vaccination increased significantly in both intervention and control groups; in both cities, the percentage point increases in the intervention groups (7.7 PP in Pittsburgh and 9.9 PP in Houston) were significantly higher (P<0.001) than in the control groups (6.4 PP in Pittsburgh and 7.6 PP in Houston). In the Year 2 pre-post study, in both cities, active intervention groups increased rates significantly more (6.2 PP for both) than maintenance groups (2.2 PP in Pittsburgh and 4.1 PP in Houston; P<0.001). ConclusionsAn intervention that includes the 4 Pillars™ Practice Transformation Program, staff education and coaching is effective for increasing adult Tdap immunization rates within primary care practices.Clinical Trial Registry Name/Number: NCT01868334

APhA recognizes 2016’s Immunization Champions

Clinic, a walk-in clinic for patients aged 15 years and older, at a large Indian Health Service medical center in Phoenix. But providing only 10% of the vaccines given on campus, the clinic’s reach isn’t great enough for Van Lew. “We want vaccines addressed at every visit,” Van Lew said. Primary care alone, she noted, can’t cover all adult vaccines. Patients may have many specialty visits between less frequent primary care visits at the time immunizations are due. Van Lew aimed to standardize the approach to immunizations across the medical center campus. Through education campaigns, she has motivated nurses to embrace CDC recommendations to address immunizations at every visit. She successfully advocated for a protocol that would allow all nurses to offer routine vaccines anywhere on campus. In 2015, she provided 20 education sessions to more than 250 providers across specialties and professions to increase vaccine awareness, integrate vaccination into workflows, and devise better ways to use electronic health records and screening tools in this endeavor. Nationally, Van Lew has collaborated on research with CDC and the National Center for Immunization and Respiratory Diseases to better understand and improve adult vaccination rates. “I get involved in so many different arenas because there’s so many different ways we can impact vaccination rates—not just in the clinic.” In 2015, on Van Lew’s watch, more than 44,000 vaccines were administered to children and adults in her health system, substantially increasing immunization rates for zoster, human papillomavirus, tetanus, diphtheria, and pertussis.

A national examination of pharmacy-based immunization statutes and their association with influenza vaccinations and preventive health

BackgroundA series of state-level statute changes have allowed pharmacists to provide influenza vaccinations in community pharmacies. The study aim was to estimate the effects of pharmacy-based immunization statutes changes on per capita influenza vaccine prescriptions, adult vaccination rates, and the utilization of other preventive health services. MethodsA quasi-experimental study that compares vaccination outcomes over time before and after states allowed pharmacy-based immunization. Measures of per capita pharmacy prescriptions for influenza vaccines in each state came from a proprietary pharmacy prescription database. Data on adult vaccination rates and preventive health utilization were studied using multiple waves of the Behavioral Risk Factor Surveillance System (BRFSS). The primary outcomes were changes in per capita influenza vaccine pharmacy prescriptions, adult vaccination rates, and preventive health interventions following changes. ResultsBetween 2007 and 2013, the number of influenza vaccinations dispensed in community pharmacies increased from 3.2 to 20.9 million. After one year, adopting pharmacist immunization statutes increased per capita influenza vaccine prescriptions by an absolute difference (AD) of 2.6% (95% CI: 1.1–4.2). Adopting statutes did not lead to a significant absolute increase in adult vaccination rates (AD 0.9%, 95% CI: −0.3, 2.2). There also was no observed difference in adult vaccination rates among adults at high-risk of influenza complications (AD 0.8%, 95% CI: −0.2, 1.8) or among standard demographic subgroups. There also was no observed difference in the receipt of preventive health services, including routine physician office visits (AD −1.9%, 95% CI: −4.9, 1.1). ConclusionsPharmacists are providing millions of influenza vaccines as a consequence of immunization statutes, but we do not observe significant differences in adult influenza vaccination rates. The main gains from pharmacy-based immunization may be in providing a more convenient way to obtain an important health service.

E51 Vaccination Rates in Adults with Autoimmune Inflammatory Rheumatic Diseases and the Patients’ Perspective on their Infection Risk

E51 Vaccination Rates in Adults with Autoimmune Inflammatory Rheumatic Diseases and the Patients’ Perspective on their Infection Risk

Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center.

Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1% (2011-2012) and 9.4% (2012-2013) compared to an average 6.9% during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6% (95% CI 35-40.3%) and 56.1% (95% CI 40.9-73%) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.

Influenza update: Activity on the rise

Influenza update: Activity on the rise