Improving compliance with immunization in the older adult: results of a randomized cohort study.
OBJECTIVE
To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients.


METHODS
Randomized controlled trial using three parallel group practices at a public urban teaching hospital.


METHODS
Public teaching hospital.


METHODS
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.


METHODS
All three provider groups received intensive education in immunization standards. The control group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, the prevention team, a flowsheet was used, patient education offered, and staff had their tasks redefined to facilitate compliance; for vaccinations, eg, nurses could vaccinate independent of MD initiative.


RESULTS
Medical records were reviewed for the 1202 patients seen, including 756 patients seen during both the 1988-89 and 1989-90 influenza seasons, to determine documented offering and receipt 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 education (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and high-risk co-morbidity and for physicians' level of training. Likewise, pneumococcal vaccinations were offered more frequently to previously unvaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjusting for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either vaccine. Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of physicians believing that they complied with influenza and pneumococcal vaccination guidelines, respectively.


CONCLUSIONS
The results of this trial provide strong support for organizational changes that involve non-physician personnel to enhance vaccination rates among older adults.
Department of Medicine, University Hospitals of Cleveland, OH.
C J
CJ
Herman
T
T
Speroff
R D
RD
Cebul
D000368:Aged; D001428:Bacterial Vaccines; D015331:Cohort Studies; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006801:Humans; D007252:Influenza Vaccines; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000193:education* / Q000523:psychology; D015999:Multivariate Analysis; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D009820:Ohio; D010348:Patient Care Team / Q000458:organization & administration; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D013296:Streptococcus pneumoniae / Q000276:immunology*
D001428:Bacterial Vaccines; D007252:Influenza Vaccines