Enhancing immunization rates at family medicine clinics in Milwaukee, WI
Yacoob Z, Cook C, Kram J (co-presenter), Klumph M (co-presenter), Stanley M, Baumgardner D, Kotovicz F, Hunter P. Enhancing immunization rates at family medicine clinics in Milwaukee, WI. Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.
Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.
Context: Many of the Healthy People 2020 goals focus on increasing immunization rates especially among high risk populations. With 2020 less than 2-years away many of our immunization rates still remain suboptimal in part due to a lack of patient education and counseling.
Objective: Our study aimed to collect and compare rates of age appropriate and co-morbidity specific vaccines as well as patient demographic data. Study Design: Quasi-experimental; pre/post-test design. Setting: Two academic primary care clinics (FCC and FPC); Milwaukee, WI.
Participants: Patients seen by either a 2nd or 3rd year family medicine resident between Jul-Sept/17 or Nov/17-Jan/18.
Intervention: Three lectures were developed and delivered to clinic nurses and medical assistants.
Results: Patients overall (N=1689): 60.7% female, 45.4% African American, 10.1% refugees, and 62.3% insured by Medicaid. Adults ≥65 years had higher rates of PPSV23 both pre- (83.3%; n=90) and post-intervention (92.1%; n=76) in comparison to national rates (63.6%). Differing rates of PPSV23 were seen for those suffering from heart/lung disease (pre/post: 50.0%/52.5%) and diabetes (pre/post: 68.6%/76.4%) (p<0.001). Also, differing rates for Hepatitis B vaccination were seen among those with liver disease (pre/post: 34.2%/33.3%) and diabetes (pre/post: 25.7%/24.0%) (p<0.001). Adult Tdap rates improved slightly pre- (82.4%; n=562) to post-intervention (86.1%; n=540) (p=0.09). The following patient groups had higher rates of missed opportunities: Medicare (p<0.001), Caucasians (p<0.001), FPC patients (p=0.043). Furthermore, more individuals were up-to-date on adult Tdap (p<0.001) and Hepatitis B (p<0.001) at FCC.
Conclusion: Immunization rates at our two primary care clinics were higher than national averages. However, these rates differed between clinics and patient co-morbidities. For the vast majority of vaccines, the intervention did not have much of an impact; thus, implying the need to refocus vaccination educational efforts on other healthcare providers, like resident physicians.