Factors Affecting Influenza and Pneumococcal Vaccination Acceptance Among Emergency Department Patients

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Factors Affecting Influenza and Pneumococcal
Vaccination Acceptance Among Emergency Department
Patients

• Diane Rimple, MD
• May 11, 2004

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Acknowledgements

• Daniel Fishbein, MD
• Meghan Brett, MD

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Prevention in EDs

• EDs as a source of primary care
• Number without health insurance is increasing
• Those who seek care in EDs are more likely to be
  underinsured
• The underinsured are less likely to receive
  preventive health care

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Patient Barriers to Vaccination

• Knowledge
• Attitudes
• Behavior

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System Barriers to Vaccination

• Knowledge
• Attitudes
• Behavior

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Purpose of Study

• Identify and eliminate barriers
• Determine acceptance rates
• Evaluate the cost

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Location of Study
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UNM Background

• Only teaching hospital and Level 1 Trauma Center
  in New Mexico
• 60,000 visits per year
• 13 of patients are insured
• Large Latino and Native American populations

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Eliminating the Barriers

• We tried to eliminate as many as possible
• Awareness
• Language
• Opportunity
• Cost

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Description of Intervention

• Timing three weeks in Dec. 2003
• Assessment and vaccination by medical students
• trained to give vaccinations
• taught the indications and contraindications
• paid to work four hour shifts

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Description of Intervention

• All patients asked if they were interested in
  talking about vaccination
• Screened by medical students for risks for these
  diseases using CDC Assessment-reminder form

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Description of Intervention

• Vaccinated if
• Fulfilled ACIP criteria
• Not already up-to date
• No contraindications
• Agreed
• Process occurred prior to being seen for their
  chief complaint
• Did not interfere with their care

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Results

• Between Dec 1 and Dec 21, 4254 patients were seen
  in the UNM ED.
• 916 (21.5) were under 18 years old
• 163 (4.9) were triaged as critical
• 931 (29.3) presented outside the study times
• Leaving 2244 eligible patients

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Results

• 684 patients were interviewed
• 524 had ACIP indication for influenza or
  pneumococcal vaccine
• 220 influenza only (15 UTD)
• 63 pneumococcal only (5 UTD)
• 241 both vaccines (14 UTD for both)

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Proportion of High Risk Patients,By Age Group
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Proportion of Vaccinated High Risk Patients at
Baseline
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Proportion of High Risk Patients Vaccinated
during Study
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Post Intervention Influenza Vaccination Coverage
Age Group and Patient Attitude
2010 Targets
Under 50 50 to 64 65 and older
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Pneumococcal Vaccine Coverageby Age Group and
Pre-interview Belief
2010 Targets
Under 50 50 to 64 65 and older
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Language Patients Preferred and Vaccination
Influenza Pneumococcal
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Insurance Status and Vaccination
Influenza Pneumococcal
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Insurance Status and Vaccination
Influenza Pneumococcal
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Conclusions

• The Need
• 524 of 684 (77) patients presenting to the ED
  for other complaints qualified for the vaccines

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Conclusions

• Knowledge Barriers
• Many at risk people did not know that they were
  at risk.
• Language, in our community, was NOT a barrier
  Spanish speaking patients had equal (low) rates
  of vaccination coming into our project.

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Conclusions

• Patient Attitude Barriers
• Once they were informed that they were at risk,
  the vast majority of them agreed to immunization

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Conclusions

• Patient Behavior Barriers
• When vaccination was offered, rates rose from
  well below to well above the recommended levels.
• We found that language did not seem to be a
  barrier ALL patients had low rates prior to the
  project.

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Conclusions

• System Behavior Barriers
• Our program was designed to be supplemental to
  the standard ED care.
• This would be difficult to accomplish with
  regular ED staffing.
• Medical students provided inexpensive, eager and
  reliable manpower, but needed training and back
  up.

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Conclusions

• System Knowledge and Attitude Barriers
• These were minimal at our institution general
  agreement that
• Vaccinations are needed
• With help, the ED is a great place to give them

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Conclusions

• Patient Barrier Cost
• The only significant predictor of vaccination
  status prior to the study was insurance status.

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Conclusions

• Start up required time and involvement at the
  faculty level.
• Success depended on familiarity
• Sustainability will depend on
• Support from administration
• Demonstrating ability
• Cost effectiveness