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Pathway Fails to Increase Vaccination Rate

Kate Traynor

Including a prompt in clinical pathways reminding physicians to offer the pneumococcal vaccine to hospitalized seniors does not improve vaccination rates, say researchers.

A study reported in the Feb. 1 American Journal of Medicine found that inclusion of a reminder notice in new pneumonia care pathways at several Connecticut hospitals produced a 1.3 percent vaccination rate. This figure was statistically unchanged from the vaccination rate, 1.1 percent, that preceded introduction of the pathways.

According to the research team, the pneumonia care pathways improved several unspecified processes in patient care, making the unchanged vaccination rate a disappointing exception.

The pathways were created by 26 acute care hospitals that participated in the Connecticut Pneumonia Pathway Project, a quality improvement effort. Fifteen of these pathways, the research team determined, contained a prompt for the prescriber to ask patients 65 years or older whether they wanted vaccination against pneumococcal disease.

The researchers calculated baseline pneumococcal vaccination rates for the 15 hospitals and a comparison facility by examining records for 612 patients age 65 or older who were discharged between April 1, 1995, and March 31, 1996, and had had a diagnosis of pneumonia. The pathways’ influence on vaccination rates was determined by checking the records of 596 seniors discharged during the first half of 1997 after having pneumonia.

The research team did not determine whether any of the seniors received the pneumococcal vaccine before hospitalization. But the researchers said it was unlikely that the vaccination rate for these seniors differed from the state's average of 43 percent.

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) recommended last March (PDF) that long-term care facilities use standing orders to increase pneumococcal vaccination rates among adults. ACIP also urged that other facilities, including hospitals, adopt such standing orders.

None of the hospitals participating in the pathway project used standing orders for pneumococcal vaccination.

According to a 1996 survey of Medicare beneficiaries (PDF), 57 percent of those who had not been vaccinated against pneumococcal disease said they did not know they needed the vaccine. Thirteen percent of the respondents said their physician had not recommended the vaccine. Eleven percent said they did not think about or simply missed receiving the vaccine.