Effect of Concurrent Strategies on Adult Immunization Rates

Background:
Influenza and pneumococcal immunization is suboptimal in high risk adults .

Setting:
Kelsey-Seybold Clinic is a large group practice which provides primary and specialty care in the Houston area.

Population:
Adults at increased risk of influenza morbidity and mortality receiving primary care at KSC.

Project Description:
Influenza vaccine campaigns have become increasingly complex at KSC over the past 10 years, targeting health care workers, children, and adults with known risk factors as well as by age parameters. Interventions include pre-recorded telephone reminder messaging with the option to connect to an appointment desk, reminders on physician progress notes about needed vaccines, a focused campaign to immunize healthcare workers and overcome their misconceptions about influenza vaccination, and standing orders for immunization.
A retrospective electronic medical record search from was performed to assess immunization rates for influenza vaccine among adults and compared with nationally published rates. In 2007-2008, of adults over age 49, 61% received an influenza vaccination, compared to 45.9% in the 2006 National Immunization survey, below the Healthy People 2010 target goal of 90%. Fifty-one percent of adults aged 18-49 with diabetes, and 46% of those with diabetes, COPD, heart disease, renal disease, or asthma were vaccinated .

Results/Lessons Learned:
Immunizaton rates in this targeted group were substantially above those reported on the National Immunization Survey – Adults, 2006, though still well below the Healthy People 2010 goals. At present, KSC healthcare worker influenza immunization rates exceed 70%. Although it is difficult to determine which of the interventions contributed the most to the attainment of these rates, it is clear that there is a beneficial effect of healthcare worker immunization upon patient immunization rates, particularly when reminder strategies for both patients and physicians are in place and nurses are authorized to immunize under standing order protocols