Pacheco Curtis S, Baxter Joseph A, Steigelman Daniel
Department of Internal Medicine, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.
Department of Allergy and Immunology, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Lackland, TX 78236, USA.
Mil Med. 2024 May 18;189(5-6):e1289-e1293. doi: 10.1093/milmed/usae112.
Vaccinations are an essential aspect of preventive medicine. In October 2021, the pneumococcal conjugate vaccine-20 (PCV-20) and PCV-15 were authorized for use in adults by the U.S. FDA. In 2022, the Advisory Committee on Immunization Practices (ACIP) subsequently published updated pneumococcal vaccination recommendations that incorporate both PCV-20 and PCV-15. Pneumococcal vaccination is effective in reducing pneumococcal disease, particularly in high-risk patient groups such as those with chronic lung disease; however, the updated dosing schedule for pneumococcal vaccinations can be quite confusing, especially if patients have previously received "older" vaccinations, such as pneumococcal polysaccharide vaccine-23 or PCV-13. The purpose of this quality improvement project was to increase providers' knowledge of current ACIP pneumococcal vaccination recommendations, including indications and dosing schedule, and to improve pneumococcal vaccination rates among eligible adults and children.
Focused education sessions were presented to primary care and subspecialty residents, fellows, and staff at Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center regarding current ACIP pneumococcal vaccination recommendations. Sessions included information about PCV-15 and PCV-20 vaccines, indications for vaccination, and dosing schedules. Subjective knowledge of updated ACIP pneumococcal vaccination recommendations was assessed among primary care and subspecialty residents, fellows, and staff via an anonymous survey both pre- and post-intervention. Number of PCV-20 vaccinations given and estimated vaccination rates of patients aged 19 to 64 years with asthma were assessed pre- and post-intervention over a 6 month time span.
Of surveyed providers, only 9% discussed vaccinations at every visit and 11% did not discuss vaccinations at all. There was a statistically significant increase in providers' knowledge of pneumococcal vaccination guidelines for children post-intervention (P = .01) but no statistically significant increase in knowledge for guidelines for adults, for patients that have received prior pneumococcal vaccines, or in overall confidence in recommending pneumococcal vaccines. There was a 17% increase in the number of PCV-20 vaccinations given post-intervention (198 pre-intervention, 232 post-intervention). The estimated PCV-20 vaccination rate for adults aged 19 to 64 years with asthma increased from 14.9% pre-intervention to 19.5% post-intervention (P = .33).
There is a significant knowledge gap regarding ACIP pneumococcal vaccination recommendations among military providers and a low pneumococcal vaccination rate for adults aged 19 to 64 years with asthma at Joint Base-San Antonio MTFs. Focused education sessions were effective in increasing providers' knowledge of updated pneumococcal vaccination recommendations, confidence in recommending vaccines, total number of pneumococcal vaccinations given, and estimated pneumococcal vaccination rate for adults with asthma. The validity of conclusions drawn from our data were limited because of discordant numbers of survey respondents as well as potentially inaccurate estimates of pneumococcal vaccination rates pre- and post-intervention. Despite this, the results warrant continued education of pneumococcal vaccines, indications, and dosing schedules.
疫苗接种是预防医学的重要组成部分。2021年10月，20价肺炎球菌结合疫苗（PCV-20）和15价肺炎球菌结合疫苗（PCV-15）获美国食品药品监督管理局批准用于成人。2022年，免疫实践咨询委员会（ACIP）随后发布了更新后的肺炎球菌疫苗接种建议，其中纳入了PCV-20和PCV-15。肺炎球菌疫苗接种可有效降低肺炎球菌疾病的发生，尤其是在慢性肺病等高危患者群体中；然而，肺炎球菌疫苗接种的更新后的给药方案可能会相当令人困惑，特别是如果患者此前接种过“旧”疫苗，如23价肺炎球菌多糖疫苗或PCV-13。本质量改进项目的目的是提高医疗服务提供者对当前ACIP肺炎球菌疫苗接种建议（包括适应证和给药方案）的认识，并提高符合条件的成人和儿童的肺炎球菌疫苗接种率。
针对布鲁克陆军医疗中心和威尔福德·霍尔门诊手术中心的初级保健和亚专科住院医师、研究员及工作人员，就当前ACIP肺炎球菌疫苗接种建议举办了专题教育课程。课程内容包括PCV-15和PCV-20疫苗的信息、疫苗接种适应证及给药方案。通过干预前后的匿名调查，评估初级保健和亚专科住院医师、研究员及工作人员对更新后的ACIP肺炎球菌疫苗接种建议的主观认识。在6个月的时间跨度内，干预前后评估PCV-20疫苗接种数量以及19至64岁哮喘患者的估计疫苗接种率。
在接受调查的医疗服务提供者中，只有9%的人每次就诊时都讨论疫苗接种，11%的人根本不讨论疫苗接种。干预后，医疗服务提供者对儿童肺炎球菌疫苗接种指南的认识有统计学意义的显著提高（P = 0.01），但对于成人指南、曾接种过肺炎球菌疫苗的患者的指南，以及在推荐肺炎球菌疫苗的总体信心方面，认识没有统计学意义的显著提高。干预后PCV-20疫苗接种数量增加了17%（干预前198剂，干预后232剂）。19至64岁哮喘成人的PCV-20估计疫苗接种率从干预前的14.9%升至干预后的19.5%（P = 0.33）。
军事医疗服务提供者对ACIP肺炎球菌疫苗接种建议存在显著的知识差距，在圣安东尼奥联合基地军事医疗设施中，19至64岁哮喘成人的肺炎球菌疫苗接种率较低。专题教育课程有效地提高了医疗服务提供者对更新后的肺炎球菌疫苗接种建议的认识、推荐疫苗的信心、肺炎球菌疫苗接种总数，以及哮喘成人的估计肺炎球菌疫苗接种率。由于调查受访者数量不一致以及干预前后肺炎球菌疫苗接种率可能存在不准确的估计，从我们的数据得出的结论的有效性受到限制。尽管如此，这些结果仍表明有必要继续开展关于肺炎球菌疫苗、适应证及给药方案的教育。
