Open AccessImproving Pneumococcal Vaccine Rates
Author(s) -
Rhew David C.,
Glassman Peter A.,
Goetz Matthew Bidwell
Publication year - 1999
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.1999.00353.x
Subject(s) - medicine , vaccination , psychological intervention , ambulatory , veterans affairs , pneumococcal vaccine , family medicine , randomized controlled trial , population , emergency medicine , nursing , streptococcus pneumoniae , environmental health , biology , bacteria , immunology , genetics
OBJECTIVE: To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate. DESIGN: A prospective controlled trial. SETTING: Department of Veterans Affairs ambulatory care clinic. PATIENTS/PARTICIPANTS: There were 3,502 outpatients with scheduled visits divided into three clinic teams (A, B, or C). INTERVENTIONS: During a 12‐week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates. MEASUREMENTS AND MAIN RESULTS: Team A nurses assessed more patients than team B nurses (39% vs 34%, p = .009). However, vaccination rates per total patient population were similar (22% vs 25%, p = .09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C ( p < .001). CONCLUSIONS: Nurse‐initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse‐initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar.