Using the 4 Pillars™ to Increase Vaccination among High-risk Adults: Who Benefits?

Details

• Alternative Title:
  Am J Manag Care
• Personal Author:
  Nowalk, Mary Patricia ; Moehling, Krissy K. ; Zhang, Song ; Raviotta, Jonathan M. ; Zimmerman, Richard K. ; Lin, Chyongchiou J.
• 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.
  
  
• Subjects:
  Adolescent Adult Adult Vaccination Article Communication Diphtheria-Tetanus-acellular Pertussis Vaccines Female Health Promotion High-risk Adults Humans Influenza Vaccines Male Middle Aged Motivation Pneumococcal Vaccine Pneumococcal Vaccines Primary Care Primary Health Care Risk Factors Young Adult

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• Source:
  Am J Manag Care. 23(11):651-655.
• Pubmed ID:
  29182350
• Pubmed Central ID:
  PMC6166239
• Document Type:
  Journal Article
• Funding:
  U01 IP000662/IP/NCIRD CDC HHS/United States ; UL1 RR024153/RR/NCRR NIH HHS/United States ; UL1 TR000005/TR/NCATS NIH HHS/United States
• Volume:
  23
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:edb3e80aa969ef90044c7c0f2064851aabedbb83965367d9ba3a18d7a454f69b
• Download URL:
  https://stacks.cdc.gov/view/cdc/59510/cdc_59510_DS1.pdf
• File Type:
  [PDF - 71.05 KB ]