Abstract
Purpose: Influenza and pneumococcal vaccines are underused. Systems approaches that
incorporate administrative and organizational strategies are more successful than
education of providers for improving vaccination rates. Little has been published
on the long-term success and durability of such efforts.
Methods: We performed a 10-year time-series study to examine the durability and success
of an ongoing, multifaceted, institution-wide influenza and pneumococcal vaccination
program. The program was first implemented at the Minneapolis Department of Veterans
Affairs (VA) Medical Center in 1987–88 following the demonstration that a clinic-based
standing order policy was much more successful than provider education for improving
vaccine delivery. The program ensures that vaccine is offered to all high-risk patients
followed up at the medical center, promotes convenient access for patients, and facilitates
efficient administration of vaccine. Specific elements include an annual mailing to
patients, standing orders for nurses, walk-in clinics, and the use of standardized,
preprinted documentation forms. Initially the program targeted high-risk outpatients
for influenza vaccination. It was extended to include inpatients in 1989–90. Pneumococcal
vaccinations were added to the program in 1994–95. Vaccination rates are estimated
each year from surveys mailed to randomly selected patients, and vaccine utilization
is monitored through pharmacy logs.
Results: The survey response rates have exceeded 75% each year. Influenza vaccination
rates for all high-risk patients followed up at the medical center have increased
from 58% following the 1987–88 vaccination season to 84% in 1996–97 (P < 0.001). Pneumococcal vaccination rates have also increased from 34% in 1994–95
to 63% in 1996–97 (P < 0.001). Vaccination rates are similar for inpatients and outpatients, but rates
for high-risk patients < 65 years of age remain lower than for the elderly: 69% versus
89% for influenza, 1996–97 (P < 0.001); 52% versus 66% for pneumococcal, 1996–97 (P = 0.05). For elderly patients followed up at the medical center, influenza (89% versus
67%, P < 0.0001) and pneumococcal (66% versus 43%, P < 0.0001) vaccination rates significantly exceeded those for the state of Minnesota
in 1996–97. The annual number of influenza vaccine doses dispensed has increased from
10,000 in 1987–88 to more than 22,000 in 1996–97; and more than 13,000 doses of pneumococcal
vaccine have been administered from 1994–95 through 1996–97.
Conclusion: This simple, multifaceted program that incorporates administrative and
organizational strategies to enhance influenza and pneumococcal vaccination rates
has been highly durable and successful over a 10-year peroid. Similar strategies if
implemented in other settings may enhance vaccination rates for the millions of high-risk
patients who have yet to be immunized.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
June 1,
1998
Received in revised form:
June 1,
1998
Received:
April 16,
1998
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
