Northwell Health, Great Neck, NY, USA.
Northwell Health, New Hyde Park, NY, USA.
J Prim Care Community Health. 2021 Jan-Dec;12:21501319211060986. doi: 10.1177/21501319211060986.
Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low.
This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations.
In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort.
The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.
尽管肺炎球菌疫苗已经广泛供应，且疾病控制与预防中心 (CDC) 也建议接种疫苗，但年龄在 65 岁以下、患有慢性疾病和免疫功能低下的成年人的免疫接种率仍然很低。
这项干预性（队列）研究旨在通过三管齐下的方法提高患有肺炎球菌病风险增加的患者的肺炎球菌疫苗接种率。这包括：（1）临床医生教育网络研讨会；（2）针对即将预约的患者，由注册护士进行的就诊前咨询，以解决疫苗接种状况；（3）修改后的就诊前跨学科团队会议，让临床医生和注册护士共同回顾哪些患者在就诊时适合接种疫苗，以及哪些患者可能需要重新参与并进一步接受动机访谈。在完成 10 周的干预措施后，研究组织者审查了已完成肺炎球菌疫苗接种的患者比例。
在这项为期 10 周的快速循环计划中，共有 482 名患者符合接种条件。在干预阶段，共联系了 370 名患者，其中 38%的患者在就诊前咨询时适合接种疫苗，5%的患者已接种过疫苗，18%的患者不适合接种，38%的患者在就诊前无法联系。这一举措使该队列的疫苗接种率提高了 43%。
疫苗接种率的显著提高支持在非初级保健专业中使用多学科方法进行就诊前规划框架，并支持其他疫苗接种工作，尤其是在 COVID-19 等新兴疾病方面。未来的研究方向包括远程医疗咨询与当天接种预约的疗效、在实践现场内设置注册护士、以及利用其他辅助人员（如医疗办公室助理）让患者参与就诊前计划。
