Tuesday, March 18, 2008

Assessing Disparities in Adult Vaccination Using Multi-Modal Approaches in Primary Care Offices

Mary Patricia Nowalk1, Richard K. Zimmerman1, Melissa Tabbarah1, Martha Ann Terry2, Dwight E. Fox1, and Mahlon Raymund1. (1) Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 5th Avenue, Pittsburgh, PA, USA, (2) Department of Behavioral and Community Health Sciences, University of Pittsburgh, 130 DeSoto Street, 222 Parran Hall, Pittsburgh, PA, USA

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to describe a multimodal data collection method used to characterize medical practices to determine factors that may influence adult pneumococcal vaccination rates.

Racial disparities in invasive pneumococcal disease and pneumococcal polysaccharide vaccination (PPV) persist despite significant progress. One reason may be that minority patients receive primary care at practices with fewer resources, less efficient office systems, and different priorities.

To describe the recruitment of a diverse array of primary care practices in Pittsburgh, Pennsylvania serving white and minority patient populations, and the multimodal data collection process that included surveys of key office personnel, observations of practice operations and medical record reviews for determining PPV vaccination rates, and to report the results of the sampling strategy.

Practices were recruited and enrolled; surveys were completed by the head nurse, office manager and physicians. Medical records were reviewed for PPV vaccination status.

During 2005, 18 practices participated in the study, six with a predominantly minority patient population, nine with a predominantly white patient population and three with a racial distribution similar to the racial distribution of this locality. Eight were solo practices and 10 were multiprovider practices; they included federally qualified health centers, privately owned practices and faculty and University of Pittsburgh Medical Center community practices. Providers represented several racial and ethnic groups, as did office staffs. PPV rates determined from 2314 patients' medical records averaged 60.3 22.6% and ranged from 12% to 97%.

Recruitment of practices with attention to location, patient demographics, and provider types results in a diverse sample of practices and patients. Multimodal data collection from these practices should provide a rich data source for examining the complex interplay of factors affecting immunization disparities among older adults.