IMPROVING COMPLIANCE WITH IMMUNIZATION IN THE OLDER ADULT - RESULTS OF A RANDOMIZED COHORT STUDY

OBJECTIVE: To compare three approaches for improving compliance with i nfluenza and pneumococcal vaccination of elderly patients. DESIGN: Ran domized controlled trial using three parallel group practices at a pub lic urban teaching hospital. SETTING: Public teaching hospital. SUBJEC TS: All patients 65 years of age and older (n = 1202) seen by resident physicians (n = 66) attending three ambulatory medical practices from October 1, 1989 to March 31, 1990. INTERVENTIONS: All three provider groups received intensive education in immunization standards. The con trol group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, th e prevention team, a flowsheet was used, patient education offered, an d staff had their tasks redefined to facilitate compliance; for vaccin ations, eg, nurses could vaccinate independent of MD initiative. MEASU REMENTS AND MAIN RESULTS: Medical records were reviewed for the 1202 p atients seen, including 756 patients seen during both the 1988-89 and 1989-90 influenza seasons, to determine documented offering and receip t of vaccinations. During the intervention period (1989-90), influenza vaccinations were offered significantly more frequently to prevention team patients (68.3%) than to patients in either the patient educatio n (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and hig h-risk co-morbidity and for physicians' level of training. Likewise, p neumococcal vaccinations were offered more frequently to previously un vaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjust ing for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either v accine. Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of phy sicians believing that they complied with influenza and pneumococcal v accination guidelines, respectively. CONCLUSIONS: The results of this trial provide strong support for organizational changes that involve n onphysician personnel to enhance vaccination rates among older adults.