10-YEAR DURABILITY AND SUCCESS OF AN ORGANIZED PROGRAM TO INCREASE INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES AMONG, HIGH-RISK ADULTS

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.