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Using the 4 Pillars™ to Increase Vaccination among High-risk Adults: Who Benefits?
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Nov 2017
Source: Am J Manag Care. 23(11):651-655.
Details:
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Alternative Title:Am J Manag Care
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Personal Author:
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Description:Objective:
Compare changes in vaccination rates (pneumococcal polysaccharide (PPSV), influenza, and tetanus, diphtheria and pertussis (Tdap) vaccines) among high-risk adults following an intervention (6/1/2013–1/31/2015) using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program).
Study Design:
Post hoc analysis of data from a randomized controlled cluster trial.
Methods:
Eighteen primary care practices received staff education, guidance for using the 4 Pillars™ Program and support of a practice immunization champion. Paired t-tests were used to compare vaccination rates were compared separately for those with diabetes, chronic lung or chronic heart disease or other high-risk conditions. Student’s t-tests were used to compare across high-risk conditions. Generalized estimating equation modeling was used to determine likelihood of vaccination.
Results:
Based on ICD9 codes, 4,737 patients 18–64 years old were identified as having diabetes (n=1,999), chronic heart disease (n=658), chronic lung disease (n=1,682) or another high-risk condition (n=764). PPSV vaccination increased 12.2 percentage points (PP), Tdap vaccination increased 11.4 PP and influenza vaccination increased 4.8 PP. In regression analyses, patients with diabetes (OR=2.2, 95%CI=1.80–2.73), chronic lung disease (OR=1.50, 95% CI=1.21–1.87) or chronic heart disease (OR=1.32, 95% CI=1.02–1.71) were more likely to receive PPSV than those without the respective high-risk condition. Those with diabetes (OR=1.14, 95% CI=1.01–1.28) or chronic lung disease (OR=1.14, 95% CI=1.01–1.30) were more likely to receive influenza vaccination than those without the respective condition.; likelihood of Tdap vaccination was not significantly associated with any of the chronic conditions tested.
Conclusions:
An intervention including the 4 Pillars™ Program was associated with significant increases in vaccination of high-risk adults. Overall uptake of recommended vaccines for those with high-risk conditions remained below national goals.
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Source:
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Pubmed ID:29182350
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Pubmed Central ID:PMC6166239
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