title: Changing practices in the use of pneumococcal vaccine.
abstract: OBJECTIVE
  An important issue facing primary care practices is how to best improve preventive services to patients. We sought to determine if an intervention designed by a continuous quality improvement (CQI) process (reminder sticker and patient education sign in each examining room) or a patient education intervention (sign only) could increase the rate of pneumococcal vaccination.
  
  
  METHODS
  These two interventions were administered over a 6-month period in a controlled, prospective study design in a family practice residency program clinic. The study targeted patients ages 65 and older and patients ages 2-64 with diabetes mellitus who had never received the pneumococcal vaccine. The main outcome measure was the vaccination rate in the targeted population.
  
  
  RESULTS
  A total of 1,647 patient encounters involving 778 patients were documented during the study period. Overall, the reminder and sign module had higher percentages of pneumococcal vaccination in this target population (20% versus 11% for sign only, versus 7% control). Chi-square analysis revealed a statistically significant difference for this group, compared with placebo, but not for the sign-only group.
  
  
  CONCLUSIONS
  An intervention designed from a CQI process to impact the office patterns of primary care physicians can produce measurable changes in pneumococcal vaccination rates.
authors.affiliation: Mountain Area Health Education Center Family Medicine Residency Program, Asheville, NC, USA. robynl@mtn.ncahec.org
authors.forename: R A
authors.initials: RA
authors.lastname: Latessa
authors.forename: D M
authors.initials: DM
authors.lastname: Cummings
authors.forename: S H
authors.initials: SH
authors.lastname: Lilley
authors.forename: S L
authors.initials: SL
authors.lastname: Morrissey
mesh_terms: D000293:Adolescent; D000368:Aged; D001428:Bacterial Vaccines; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D010819:Physician's Role; D011008:Pneumococcal Infections / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D011787:Quality of Health Care; D017010:Reminder Systems; D017749:Total Quality Management; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D001428:Bacterial Vaccines