Daniel Fishbein, MD1, Bayo C. Willis, BS, MPH2, Dale M. Marioneaux, BS, MEd3, William M. Cassidy, MD3, Carolyn Bachino, MPH4, and Pascale M. Wortley, MD, MPH5. (1) Immunization Services Division/ Health Services Research and Evaluation Branch, CDC National Immunization Program, 1600 Clifton Rd. NE, MS E-52, Atlanta, GA 30333, 404-639-8797, DFishbein@cdc.gov, (2) Immunization Services Division/ Health Services Research and Evaluation Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE; MS-E52, Altanta, GA 30333, (3) Department of Medicine, Louisiana State University Health Sciences Center, 5825 Airline Hwy., Baton Rouge, LA 70805, (4) NCHSTP/GAP/OD, CDC, 1600 Clifton Rd. NE, Mailstop E-30, Atlanta, GA 30329, (5) NIP, CDC, 1600 Clifton Rd. NE, MS-E52, Atlanta, GA 30333
Context. Determine which vaccines are indicated for adults requires integration of health status with demographic and behavioral risk factors and previous immunization history. We developed and evaluated a low literacy patient self-assessment physician reminder tool (A/R) that determines if influenza, pneumococcal, MMR, tetanus, and hepatitis A/B vaccines are indicated. We provided this information to clinicians to remind them about indicated vaccines.
Methods. Group randomized studies in 3 family practice settings, 200 patients per site. Intervention patients, but not controls, completed the A/R. The A/R was attached to the patientsí medical record before the clinical encounter. Later, a chart audit was performed to determine which vaccines were indicated and administered according to the medical record.
Results. Agreement between A/R and audit regarding indications was good only for pneumococcal and MMR vaccines (kappa=0.65 and 0.85, respectively). For influenza (kappa=0.56), hepatitis A (kappa=0.31) and B (kappa=0.25) low agreement appeared due to indications on self assessment that were not found in the audit. After A/R, intervention groups received 1% to 15% more indicated vaccinations than controls. Significant increases occurred only in influenza (1 clinic), pneumococcal (1 clinic), and tetanus vaccinations (2 clinics).
Conclusions. Low agreement regarding indicated vaccines appeared due to lack of documentation in the medical record of vaccination indications associate with household contacts and behavioral risk factors. The relatively modest increase in immunization was attributed to the crowding caused by providing clinicians with information regarding six vaccines during clinical encounters. Standing orders may be necessary to further facilitate administration of indicated vaccines.
Keywords: Adult Health, Risk Factors
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 132nd Annual Meeting (November 6-10, 2004) of APHA