QI Efforts Can Produce Real Increases in Influenza, Pneumococcal Immunization Rates

A recent meta-analysis in the Annals of Family Medicine suggests that assigning vaccination responsibilities to non-physician office staff and having clinicians remind patients of needed immunizations may help improve influenza and pneumococcal vaccination rates.

Canadian researchers at the University of Alberta, Edmonton, analyzed 106 studies -- nearly 80 percent of which were performed in the United States -- to map out an effective way to increase immunization rates. The researchers concluded that any of a variety of quality improvement interventions could produce modest increases in vaccination rates, and they observed that three -- team change, patient outreach and clinician reminders -- are effective for improving rates of both influenza and pneumococcal vaccinations.

"We found that interventions involving team change were effective, especially where nurses had been assigned responsibilities for administering vaccine," the researchers wrote. "Configuring additional personnel so that they are able to relieve physicians of vaccinations seems important to successful team change.

"Additionally, patient outreach may better increase vaccinations to the extent that direct personal contact is achieved. A previous review has similarly reported that reminders involving person-to-person telephone contact were most effective."

Researchers noted that clinician reminders and vaccination education were linked with greater increases in pneumococcal vaccination rates, while audit and feedback appeared more effective for influenza vaccination rates.

"Awareness and support may be less common for pneumococcal than for influenza vaccinations, making pneumococcal vaccinations relatively low-hanging fruit," researchers wrote.

The analysis also noted that few of the interventions improved vaccination rates enough to meet policy targets in North America. And because most of the studies focused on older adults or high-risk non-elderly patients, the researchers cautioned physicians and policymakers to temper expectations of quality improvement when using these interventions.

However, the researchers had advice for physicians in community practice. "Our results suggest that shifting vaccine administration from physicians to members of the primary care team with clear responsibilities for chronic and preventive care and activating patients through personal outreach may stand the best chance of improving vaccination rates in community dwelling adults."