Background: Adult patient populations are not effectively vaccinated in United States, which contributes to increased rates of hospitalization, cost of medical care and disease complications. Though physicians’ understanding of vaccination measures should be comprehensive, many studies have indicated that adult patients are not receiving their vaccinations as they should. One study during a pertussis outbreak in California indicated that only 53% of vaccination providers had asked their patients about the pertussis vaccine in response to the outbreak. Another study in Turkey found that only 27% and 9.8% of patients received the influenza and pneumococcal vaccines after their PCP visit, respectively. The aim of our quality improvement study was to assess the effect of pocket card education on increasing physician awareness and vaccination rates in our continuity care clinic.
Methods: An IRB-approved non-randomized case-control study was designed to evaluate the effect of pocket card education on resident physicians at our continuity clinic for the vaccination of adult patients with the Zoster and Tdap/Td vaccines. Pocket sized vaccination cards containing the CDC recommended schedules for Zoster and Tdap/Td vaccines were made and distributed to twenty-one participating resident physicians with a brief verbal overview and tutorial. Using two web based sample size calculators, given a confidence level of 95%, confidence interval of 5, and a city population of 200,000, an adequate sample size of 383 was determined. Charts were reviewed and the vaccination rate of adult patients from August 2014 to November 2014 was collected. The first two consecutive months consisted of the control group and the latter two consecutive months consisted of the experimental group.
Results: The total number of patients evaluated in this study was 747, which consisted of 408 patients in the control group and 339 patients in the experimental group. In the control group, 2 Zoster (0.5%) and 13 Tdap/Td vaccines (3.2%) were administered prior to our intervention that resulted in a total number of 15 (3.7%) vaccines. After distributing the pocket cards and educating the physicians, the vaccination rate increased to 6 Zoster (1.8%) and 21 Tdap/Td (6.2%) vaccines with a total number of 29 (8%) vaccines. Using the Fischer’s Exact Test and Chi-square Test, the calculated p-values for the total number of vaccinations administered were 0.0158 and 0.0176 respectively. P-values for the individual vaccines were not statistically significant.
Conclusions: Our study concluded that pocket cards are an effective way of educating health care providers to offer the appropriate vaccines to patients thus improving the rates of vaccination. We saw a statistically significant increase in vaccination rates as a whole after our experimental intervention, speculating that continued efforts will indeed lead to improved rates of hospitalization, healthcare cost and burden, and improved morbidity and mortality.