Kl. Nichol, 10-YEAR DURABILITY AND SUCCESS OF AN ORGANIZED PROGRAM TO INCREASE INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES AMONG, HIGH-RISK ADULTS, The American journal of medicine, 105(5), 1998, pp. 385-392
PURPOSE: Influenza and pneumococcal vaccines are underused. Systems ap
proaches that incorporate administrative and organizational strategies
are more successful than education of providers for improving vaccina
tion rates. Little has been published on the long-term success and dur
ability of such efforts. METHODS: We performed a 10-year time-series s
tudy 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 Vetera
ns Affairs (VA) Medical Center in 1987-88 following the demonstration
that a clinic-based, standing order policy was much more successful th
an provider education for improving vaccine delivery. The program ensu
res that vaccine is offered to all high-risk patients followed up at t
he medical center, promotes convenient access for patients, and facili
tates efficient administration of vaccine. Specific elements include a
n annual mailing to patients, standing orders for nurses, walk-in clin
ics, and the use of standardized, preprinted documentation forms. Init
ially the program targeted high-risk outpatients for influenza vaccina
tion. It was extended to include inpatients in 1989-90. Pneumococcal v
accinations were added to the program in 1994-95. Vaccination rates ar
e estimated each year from surveys mailed to randomly selected patient
s, and vaccine utilization is monitored through pharmacy logs. RESULTS
: The survey response rates have exceeded 75% each year. Influenza vac
cination rates for all high-risk patients followed up at the medical c
enter have increased from 58% following the 1987-88 vaccination season
to 84% in 1996-97 (P < 0.001). Pneumococcal vaccination rates have al
so increased from 34% in 1994-95 to 63% in 1996-97 (P < 0.001). Vaccin
ation 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 pneumo
coccal (66% versus 43%, P < 0.0001) vaccination rates significantly ex
ceeded 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 pneu
mococcal vaccine have been administered from 1994-95 through 1996-97.
CONCLUSION: This simple, multifaceted program that incorporates admini
strative and organizational strategies to enhance influenza and pneumo
coccal vaccination rates has been highly durable and successful over a
10-year period. Similar strategies if implemented in other settings m
ay enhance vaccination rates for the millions of high-risk patients wh
o have yet to be immunized. (C) 1998 by Excerpta Medica, Inc.