KEYWORD1:
Adult; influenza; pneumococcal; registries; reminders

BACKGROUND:
Adult influenza and pneumococcal vaccination practice continues to be deficient and variant from recommended guidelines. Optimal methods of improvement are not well defined.

OBJECTIVE:
To assess effectiveness of alternative direct-to-patient reminder systems.

METHOD:
We retrospectively analyzed two registry directed strategies in a North Central Washington adult population: 1) a clinic based plan based on mailed reminders, and; 2) a health plan specific strategy of registry directed phone calls. The latter subset of patients was also independently included in the mailed reminder process, allowing for comparison of effectiveness. Vaccination rates were based on billing and claims data.

RESULT:
The clinic registry identified 21,461 patients indicated for influenza and/or pneumococcal vaccination according to CDC guidelines; 8,577 (40%) received a mailed reminder. Influenza vaccine was given to 43% of card recipients and 20% of non-recipients (p<0.0001; Fisher’s Exact test ). Of an identified subset of 486 health plan patients 189/345 (55%) receiving a phone call, 199/372 (54%) receiving a postcard, and 13/36 (36%) of non-recipients received influenza vaccine (Fisher's Exact test - p=0.0324). Pneumococcal vaccination (indicated for 19,035 registry patients) was administered to 273/7245 (3.8%) of mailed reminder recipients compared to 199/11790 (1.7%)of non-recipients; inappropriate pneumococcal re-vaccination occurred in 35 postcard recipients (0.48%) and 21 non-recipients (0.18%).

CONCLUSION:
Registry based mailed reminders and targeted phone calls are equally effective in increasing adult influenza vaccination rates but may result in inappropriate pneumococcal revaccination. Adult vaccination registries are an important tool in increasing compliance although their use needs further study.
LEARNINGOBJECTIVES:
1) Understand the treatment gap in adult influenza and pneumococcal immunization.
2) Appreciate the value of adult vaccine registries
3) Recognize the value of health plan/medical group collaboration