Increasing Pneumococcal Vaccination Rates Among High Risk Adults Ages 5064: Implementation of the Tr

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Increasing Pneumococcal Vaccination Rates Among
High Risk Adults Ages 50-64 Implementation of
the Tracking, Recall, Outreach Model in a Private
Practice Setting

• Ruth Belflower
• Community Health Improvement Practicum
• April 17, 2006

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History of Invasive Pneumococcal Disease (IPD)
1881 S. pneumoniae isolated by Luis
Pasteur -Quickly became recognized as the most
common cause of lobar pneumonia and still Is
today -Before treatment was available the
fatality rate was 33 1936 antigen-specific
antiserum became available and mortality rate
dropped to 18 1941 Sulfadiazine treatment
decreased mortality rate further to 8 1975
first Pneumococcal Polysaccharide Vaccine (PPV)
became available in the US 1980 a second
PPV became available that targeted A
different strain of S. pneumoniae
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History of IPD Rates
CDC reported rates of IPD doubling from the
1970s To the 1980s in Charleston County,
S.C. attributed to increase in testing in the
1980s From 1985 thru 1989 IPD rates were 18.8
per 100,000 in Monroe Co. Different rate
ratios for extreme age groups and
blacks Two-thirds of cases were admitted to
the hospital Case-fatality rates were 15
overall Case-fatality rates were double in
the population with high risk conditions
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IPD Rates Today
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IPD Rates Today
Pre-Prevnar
Post-Prevnar 6 county average 67
47 Monroe average 54
31
30 decrease 43 decrease
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IPD Rates Today
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PPV Rates
National Immunization Rates 65 and
Over -Blacks 37 -Hispanics
31 -Caucasians 60 50 to 64 -1991 9 18
to 64 -2002 18 Rochester Immunization Rates
65 and Over -Blacks 42 -Caucasians
75 2010 Goal 90
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Improving Immunization Rates TRO Model
Update database With all new PPV Immunizations.
(Tracking)
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Improving Immunization Rates
Rosewald et al. -20 increase in complete
vaccinations for 18 to 30 month old children
from control group to intervention
group -Delay in immunization time decreased
by 63 days Balas et al. -Significant increase
in performance of 16 preventive care procedures
when Physicians were prompted -electronic or
paper made no difference -If physicians were
regularly prompted for fecal occult blood test,
flu vax, mammogram, pap smears, and tetanus
8333 could be saved yearly Szilagyi et al. -33
of 41 studies found patient reminder/recall
significantly increased immunization rates -6
of the 7 PPV studies showed 20 increase in PPV
rates -Effective in academic and private
settings -All types of reminders worked
well -prompting physicians increased vaccination
rates even more
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Improving Immunization Rates READII
Christine Long
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Community Partnerships
Christine Long, MPH University of
Rochester Center for Community Health 111
Westfall Rd., Rm. 854 Rochester, NY 14620 PH
585-753-5450 Christine_Long_at_urmc.rochester.edu
clong_at_monroecounty.gov Fax [phone]
Jefferson Family Medicine William Bayer,
M.D. Donna Williamson 924 Jefferson
Ave. Rochester, NY 14611 PH 585-463-3870 Donnaha
ir1_at_aol.com
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Results
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Discussion
Six Project Objectives Met 1. All Charts of 50
to 64 were reviewed for active/inactive
status 2. PPV status was obtained for all
active 50 to 64 years 3. High Risk status was
obtained for all active 50 to 64 years 4. PPV
baseline rates were determined 5. Alerts were
placed in all patient charts that need a
PPV 6. Phone calls were made to patients needing
to schedule appointments Learning Objectives
Met 1. Establishing community partnerships 2.
Engaging in community health
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Sustainability and Longevity
1 Project Objective not met Evaluation of the
Intervention Future Projects for
Students -Evaluation of PPV rates in Jefferson
Family Medicine after TRO implementation -Assess
ing Racial and Ethnic Disparities At
JFM -Implementing this intervention during
the Flu season at JFM or other practices -Using
this intervention in other practices for all
type of preventive care Sustained
Partnerships Center for Community
Health Jefferson Family Medicine
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Impact
Community -Hopefully to increase PPV rates at
Dr. Bayers practice, thus lessening the burden
of illness -Providing information to practice so
that TRO may be used in other ways -TRO
extending to other health care entities in the
community thus increasing preventive health
care in Rochester Personal -Reinforcing my
interest in a career in community health and
outreach -Feel good about helping the
community -Realizing the impact that changing
one variable may have on an intervention -impor
tance of building partnerships
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References
1. Swartz, MN. Attacking the Pneumococcus A
Hundred Years War. New Engl J Med. 2002
346722. 2. Sisk JE, Moskowitz JA, et. al.
Cost-effectiveness of Vaccination Against
Pneumococcal Bacteremia Among Elderly People.
JAMA. 19972781333-1339. 3. Breiman RF, Spika
JS, Navarro VJ, Darden PM, Darby CP.
Pneumococcal Bacteremia in Charleston County,
South Carolina a decade later. Arch Intern Med.
1990 1501401-1405. 4. Bennett NM, Buffington
J, LaForce FM. Pneumococcal Bacteremia in Monroe
County, New York. Am J Public Health. 1992
821513-1516. 5. CDC Rates 6. Random Digit Dial
Survey 2001 7. Center for Disease Control.
Improving Influenza, Pneumococcal Polysaccharide,
and Hepatitis Vaccination Among Adults Aged lt 65
Years at High Risk. MMWR Morb Mortal Wkly Rep.
2005 541-11. 8. Center for Disease Control.
Notice to Readers Assesing Vaccination Status at
Age 50 Years. MMWR Morb Mortal Wkly Rep.
199544561-563. 9. Butler JC, Breiman RF,
Campbell JF, Lipman HF, Broome CV, Facklam RR.
Pneumococcal polysaccharide vaccine efficacy an
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19932701826-1831. 10. Forrester HC, Jahnigen
DW, LaForce FM. Inefficacy of pneumococcal
vaccine in a high risk population. Am J Med.
198783425-430. 11.Farr BM, Johnston BL, Cobb
DK, et al. Preventing pneumococcal bacteremia in
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case-control study. Arch Intern MED.
19951552336-2340. 12. Szilagyi PG, Bordley C,
Vann JC, Chelminski A, Kraus RM, Margolis PA,
Rodewald LE. Effect of Patient Reminder/Recall
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20002841820-1827. 13. Balas EA, Weingarten S,
Garb CT, Blumenthal D, Boren SA, Brown GD.
Improving Preventive Care by Prompting
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4. Rodewald LE, Szilagyi PG, Huminston SG, Barth
R, Kraus R, Raubertas RF. A Randomized Study of
Tracking With Outreach and Provider Prompting to
Improve Immunization Coverage and Primary Care.
Peds. 199910331-38.