Monday, March 17, 2008

The effect of patient education on tetanus, diphtheria, and pertussis (Tdap) immunization rates in post-partum women

Janet Sullivan1, Benjamin Kinnear2, and Kristin Koehn1. (1) Child Health, University of Missouri - Columbia, DC058.00, One Hospital Drive, Columbia, MO, USA, (2) University of Missouri - Columbia Medical School, One Hospital Drive, Columbia, MO, USA

Learning Objectives for this Presentation:
By the end of this presentation, participants will be able to describe the effect of education on Tdap immunization rates in the immediate post-partum period, identify barriers to immunization, and to develop strategies to improve vaccination rates.

Pertussis cases in infants are increasing, likely secondary to exposure to underimmunized household contacts. Current Tdap recommendations include vaccination of all eligible adults including post-partum women. Rates of Tdap vaccination in post-partum women and the role of pediatricians in promoting vaccination in this group has not been previously described.

To examine the effects of inpatient education on Tdap administration and identify barriers to vaccination

We conducted a retrospective chart review of post-partum women who delivered over an 8 week period. Four weeks consisted of education by pediatricians regarding Tdap immunization recommendations in the immediate post-partum period. All women included in the study were contacted by telephone within 2 months of discharge for a follow up survey to determine if inpatient education affected Tdap immunization rates.

In total, 152 women completed our survey for this study. Overall, 21% of women were immunized with Tdap with the majority given in the post-partum period (81%). Seventy three percent of the post partum vaccinations were administered as inpatients following education and recommendations from pediatricians. Despite inpatient education, no immunizations were administered at OB follow up visits in eligible women. Patient-reported barriers to vaccination included loss of insurance, lack of primary care physicians, and lack of provider communication of Tdap guidelines to patient.

Despite recommendations for Tdap administration to post-partum mothers, vaccination rates in our population remained low. Inpatient education by pediatricians alone didn't improve vaccination rates. In addition, several barriers to immunization exist following hospital discharge. Future plans include development of a standardized immunization protocol (including rubella, Tdap, and influenza) to capture this population as inpatients.