Culturally appropriate interventions raise flu and pneumonia vaccine rates at inner-city health centers
Research Activities, January 2009, No. 341
Annual influenza vaccination of 90 percent of the elderly is a main goal of the Government's Healthy People 2010 initiative. Hispanics and blacks over age 65 receive influenza vaccine at a lower rate (45 percent and 48 percent, respectively) than do whites in the same age group (69 percent).
To reduce the racial disparities and find ways to increase overall annual flu vaccination, researchers at the University of Pittsburgh undertook a 4-year trial of patients over age 50 years using proven, culturally appropriate interventions at four inner-city health centers. They compared these centers with another center that received no intervention (the control center). The intervention centers all served predominantly minority and economically disadvantaged populations. The menu of evidence-based interventions included educational sessions for all clinical staff; standing orders for nurses to screen adults for needed vaccinations; vaccination reminders on the front of charts; hanging immunization posters in each examination room and the waiting room; playing immunization videos in the waiting room; mailing reminders to all eligible adults; establishing walk-in flu vaccine clinic hours; and a vaccination promotion contest.
Over the course of the study there were significant increases in the percentage of patients seen at the intervention centers who received annual influenza vaccination, when compared with the control site. Over the 4-year trial, annual flu vaccination rates increased from 27 percent to 49 percent at the intervention sites, while the control site patients continued to have low rates of vaccination (20 percent). Intervention health care centers also increased their use of pneumonia vaccine from 48 percent to 81 percent in patients over the age of 65 years.
No racial disparities were observed at health centers using the interventions, and increases in vaccination rates were observed among white and Hispanic patients. Among the factors contributing to the rise in vaccination rates was input from staff and welcoming multiple viewpoints, including from minority staff on the feasibility of various strategies. The researchers note that only patients seen at the health centers for the entire period of the study were included, so the impact on transient patients could not be determined.
The study was funded in part by the Agency for Healthcare Research and Quality (HS10864). More details are in "Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers," by Mary Patricia Nowalk, Ph.D., R.D., Richard K. Zimmerman, M.D., M.P.H., Chyongchiou Jeng Lin, Ph.D., and others, in the July 2008 Journal of the American Geriatrics Society, pp. 1177-1182.