Increasing the Pneumococcal Vaccination Rate of Elderly Patients in a General Internal Medicine Clinic

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Abstract
To improve the pneumococcal vaccination status of an elderly patients group, those over 64 yr of age were identified and in a randomly chosen study group (N = 163), 91 elderly patients (56%) received the pneumococcal vaccine. Factors associated with a higher rate of pneumococcal vaccination included receiving the previous year''s influenza vaccine, a medical problem list attached to the patient''s chart, active clinic status (i.e., seen in the year before the study began), and more than 2 problems listed in the computer record. Letters encouraging pneumococcal vaccination were then sent to patients who had not been vaccinated. Twenty of 72 patients (28%) who received the latter were vaccinated during the next year; 8% of control patients (3 of 39) who did not receive the latter were vaccinated. The 95% confidence limit for the relative difference between the study and control group is 6 to 53%. The relative difference was also significant for influenza vaccination between the intervention group and the portion of the control group that had not been vaccinated at the first chart review. Factors associated with pneumococcal vaccination rate following the mailing of the reminder letter were active clinic status and being up to date for either influenza or tetanus vaccination. The incidence of complete vaccination (pneumococcal, influenza, and tetanus) did not improve significantly in the study population. Pneumococcal vaccination prevalence increases significantly when patients are sent letters encouraging vaccination.

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