Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers.
OBJECTIVE
To increase adult immunizations at inner-city health centers serving primarily minority patients.


METHODS
A before-after trial with a concurrent control.


METHODS
Five inner-city health centers.


METHODS
All adult patients at the health centers eligible for influenza and pneumococcal vaccines.


METHODS
Four intervention sites chose from a menu of culturally appropriate interventions based on the unique features of their respective health centers.


METHODS
Immunization and demographic data from medical records of a random sample of 568 patients aged 50 and older who had been patients at their health centers since 2000.


RESULTS
The preintervention influenza vaccination rate of 27.1% increased to 48.9% (P<.001) in intervention sites in Year 4, whereas the concurrent control rate remained low (19.7%). The pneumococcal polysaccharide vaccine (PPV) rate in subjects aged 65 and older increased from 48.3% to 81.3% (P<.001) in intervention sites in Year 4. Increase in PPV in the concurrent control was not significant. In logistic regression analysis, the likelihood of influenza vaccination was significantly associated with the intervention (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.77-2.41) and with age of 65 and older (OR=2.0, 95% CI=1.62-2.48) but not with race. Likelihood of receiving the pneumococcal vaccination was also associated with older age and, to a lesser degree, with intervention.


CONCLUSIONS
Culturally appropriate, evidence-based interventions selected by intervention sites resulted in increased adult vaccinations in disadvantaged, racially diverse, inner-city populations over 2 to 4 years.
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA. tnowalk@pitt.edu
Mary Patricia
MP
Nowalk
Richard K
RK
Zimmerman
Chyongchiou Jeng
CJ
Lin
Mahlon
M
Raymund
Melissa
M
Tabbarah
Stephen A
SA
Wilson
Ann
A
McGaffey
J Todd
JT
Wahrenberger
Bruce
B
Block
David G
DG
Hall
Dwight E
DE
Fox
Edmund M
EM
Ricci
D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data*; D018864:Cultural Diversity; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008913:Minority Groups; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D014505:Urban Population / Q000145:classification*
D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines