Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders.
OBJECTIVE
To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate.


METHODS
A prospective controlled trial.


METHODS
Department of Veterans Affairs ambulatory care clinic.


METHODS
There were 3, 502 outpatients with scheduled visits divided into three clinic teams (A, B, or C).


METHODS
During a 12-week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates.


RESULTS
Team A nurses assessed more patients than team B nurses (39% vs 34%, p =.009). However, vaccination rates per total patient population were similar (22% vs 25%, p =.09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C (p <.001).


CONCLUSIONS
Nurse-initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse-initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar.
Rhew
D C
DC
Department of Medicine, UCLA, Los Angeles, CA, USA.
Glassman
P A
PA
Goetz
M B
MB
D000554:Ambulatory Care Facilities; D001428:Bacterial Vaccines / Q000008:administration & dosage*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D009726:Nurses; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control*; D011446:Prospective Studies; D017010:Reminder Systems; D013296:Streptococcus pneumoniae; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines