title: Promoting pneumococcal immunizations among rural Medicare beneficiaries using multiple strategies.
abstract: BACKGROUND
  Vaccine-preventable diseases among adults are major contributing causes of morbidity and mortality in the United States. However, adult immunizations continue to be underutilized in both urban and rural areas.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a community-wide education campaign and mailed reminders promoting pneumococcal immunizations to rural Medicare beneficiaries.
  
  
  METHODS
  We implemented a community-wide education campaign, and mailed reminders were sent to Medicare beneficiaries in 1 media market in Montana to increase pneumococcal immunizations. In a second distinct media market, mailed reminders only were sent to beneficiaries.
  
  
  RESULTS
  The proportion of respondents aged 65 years and older aware of pneumococcal immunizations increased significantly from baseline to follow-up among respondents both in the education-plus-reminder (63% to 78%, P = 0.04) and the reminder-only (64% to 74%, P = 0.05) markets. Overall from 1998 to 1999, there was a 3.7-percentage-point increase in pneumococcal immunization claims for Medicare beneficiaries in the education-plus-reminder market and a 1.5-percentage-point increase in the reminder-only market. Medicare beneficiaries sent reminders in the education-plus-reminder market compared to those in the reminder-only market were more likely to have a claim for pneumococcal immunization in 1999 (odds ratio 1.18, 95% confidence interval 1.08 to 1.28). The results suggest that these quality improvement strategies (community education plus reminders and reminders alone) modestly increased pneumococcal immunization awareness and pneumococcal immunization among rural adults. Mailed reminder exposure was associated with an increased prevalence of pneumococcal immunizations between 1998 and 1999 and was augmented somewhat by the education campaign.
authors.affiliation: Montana Department of Public Health and Human Services, Cogswell Building, C-317, PO Box 202951, Helena, MT 59620-2951, USA. tharwell@state.mt.us
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Johnson
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
authors.forename: Peg M
authors.initials: PM
authors.lastname: Donahue
authors.forename: M'liss A
authors.initials: MA
authors.lastname: Weisner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McInerney
authors.forename: Greg S
authors.initials: GS
authors.lastname: Holzman
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
mesh_terms: D000368:Aged; D003146:Communications Media; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D009009:Montana; D010043:Outcome and Process Assessment, Health Care; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011177:Postal Service; D015397:Program Evaluation; D017010:Reminder Systems; D019035:Rural Health Services / Q000458:organization & administration*; D040241:Social Marketing
chemical_list: D022242:Pneumococcal Vaccines