Pneumococcal vaccination in pennsylvania nursing homes: factors associated with vaccination level.

OBJECTIVES

To determine the levels of knowledge and beliefs about pneumococcal disease and the pneumococcal polysaccharide vaccine (PPV), the level of PPV use, PPV-related practices, and factors associated with PPV use in Pennsylvania's nursing homes.

DESIGN/SETTING: A 68-item, cross-sectional survey of Nursing Directors at a random sample of PA nursing homes (291) was conducted between April and June 1999. Survey results and facility characteristics were used to describe vaccination practices, estimate the vaccination level and determine through bivariate analysis, associations between vaccination level and facility characteristics and practices.

RESULTS

Respondents are knowledgeable about PPV and recommendations for its use but less knowledgeable about financial reimbursement. Pneumonia is believed to be a serious threat to nursing home residents; PPV is thought to be important, effective, cost-effective, and safe for use in nursing homes. The estimated PPV rate is 49%, and vaccination practices are variable. Factors associated with higher vaccination level include: knowledge of financial reimbursement, strong belief in the importance of vaccinating residents and the effectiveness of the vaccine, practices related to policies, assessment, consent and orders, and organizational factors of size, ownership, average length of stay, and identification of a staff "vaccine advocate."

CONCLUSION

Staff members are knowledgeable about the vaccine and believe it should be used in nursing homes. Efforts aimed at improving vaccination rates should concentrate on examples of effective vaccination programs and practices rather than basic information about the vaccine. Development of institutional policies, which guide vaccination practice and institutionalize the use of automated patient management systems that prompt staff to assess vaccination status and order vaccination, could have considerable impact in meeting the recommendation for vaccination of nursing home residents.