INCREASING PNEUMOCOCCAL IMMUNIZATIONS AMONG YOUNGER ADULTS AT HIGH RISK OF PNEUMOCOCCAL INFECTION USING THE 4 PILLARS™ IMMUNIZATION TOOLKIT

Purpose: To increase pneumococcal vaccination rates among adults 19-64 years considered to be at high risk of pneumococcal disease because of the presence of one or more chronic medical conditions.

Methods: The 4 Pillars™ Immunization Toolkit (Toolkit) is a compilation of evidence-based strategies, resources, and step-by-step guidance for making office systems changes to increase adult vaccination and was the foundation of the intervention.  The intervention took place in 18 primary care practices in Pittsburgh, PA.  Baseline year was 6/1/2012-5/31/2013. In a randomized controlled cluster trial in Year 1 (6/1/2013-5/31/2014), 10 sites received the intervention and in a pre-post study in Year 2 (6/1/2014-1/31/2015), the control sites and 4 Year 1 intervention sites received the intervention and the remaining 6 sites were in maintenance.  The analytical dataset included patients with at least one office visit in each year. Patients were 19-64 years and classified as high risk based upon ICD9 codes and were grouped into those with diabetes, lung disease, heart disease, and others.  Pneumococcal polysaccharide vaccine (PPSV) vaccination rates among all eligible patients at the end of baseline and at the end of the 2-year intervention are reported.

Result: 4,737 high risk patients were identified with a mean age at baseline of 52 years; 8.2% were non-white and 54.2% were women, 65.4% were commercially insured, 42.2% had diabetes, 11.3% had lung disease and 12.8% had heart disease.  43.1% (2042/4737) high risk patients had received the 23-valent PPSV at the end of baseline.  Among remaining 2695 eligible patients, 596 (22.1%) received the vaccine during the study period for a final cumulative vaccination rate of 55.7%. Patients with diabetes were more frequently vaccinated with PPSV at the end of baseline (52.1%) and at the end of the intervention (66.2%) than patients with chronic lung or chronic heart disease.  In logistic regression, high risk individuals were more likely to be vaccinated if they were older, commercially insured and had diabetes.

Conclusion: At the end of two years, PPSV vaccination rates among high risk adults under age 65 years were close to the national goal of 60%. Patients with diabetes were more likely to receive PPSV than those with other high risk conditions.