Pre-Visit Planning Could Significantly Improve Pneumococcal Vaccination Rates

Reema Dbouk, MD

Credit: LinkedIn

Pre-visit planning showed potential to improve the uptake of pneumococcal vaccination among senior age adults in internal medicine clinic settings, according to new data presented at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, MA, this week.

A team of investigators from the Emory University School of Medicine, led by internist Reema Dbouk, MD, found significantly improved pneumococcal vaccination rates across older adults aged ≥65 years old when applying 2 different methods of intervention informed by pre-visit strategies. The findings suggest a promising and time-efficient role for internal medicine care teams in assuring higher-risk adults are more protected against pneumococcal disease.

Dbouk and colleagues noted that—despite the availability of both 15-valent and 20-valent pneumococcal conjugate vaccine (Prevnar 15, Prevnar 20) for the prevention of pneumococcal disease—vaccination rates were stagnant near 65% among the US population from 2019 – 2021. Notably, vaccination rates are even poorer among minority populations.

“US coverage is only 54% for non-Hispanic (Black persons) and 46% for Hispanic (persons),” investigators wrote. “As of December 2022 in the US, approximately 4.4% of Medicare beneficiaries aged 65 years and older received Prevnar 15 or Prevnar 20.”

Pre-visit planning, they reasoned, has been shown to historically benefit vaccination rates among targeted populations receiving care in ambulatory settings. The team sought to improve pneumococcal vaccination in eligible patients aged ≥65 years old seen in their clinic by 10% overall, and by 15% in minority groups.

The assessed intervention included medical assistants reviewing the vaccination status of patients scheduled for care in the following day and pending vaccination orders when indicated. Providers then reviewed the pending vaccination orders during the patient visit, confirmed patient eligibility, and offered the vaccination to the patient. Once the patient agreed to vaccination, the order was signed and the dose was administered before the end of the care visit.

Dbouk and colleagues ensured medical assistants were comfortable and confident in managing the pre-visit planning by survey, generating an empathy map based on the results that helped inform an instructional resource on how to pre-visit plan pneumococcal vaccinations.

Intervention 1 included a pre-visit planning for 1 physician and medical assistant team, while intervention 2 included pre-visit planning for 3 physician and medical assistant teams. Their baseline data was pneumococcal vaccination rates by provider of patients aged ≥65 years old seen in clinic August – October 2022 (intervention 1) and November 2022 – January 2023 (intervention 2).

The team observed that both interventions were significantly beneficial for improving pneumococcal vaccination uptake in each of overall, Black and White patients aged ≥65 years old. They additionally noted intervention 2 was associated with improved vaccination uptake among Asian patients.

Indeed, investigators concluded the strategy may help to primarily improve vaccination uptake, while also aiding outcomes including the clinic workflow and care team preparation for individual patients.

“Pre-visit planning is a tool that has potential to improve pneumococcal vaccination uptake in the ambulatory setting, and offload sole responsibility for addressing preventive health measures from providers,” they concluded.

References

1. ^{Dbouk R, Gray K, Moore MA. Increasing Pneumococcal Vaccination Rates Using Pre-Visit Planning in Patients Age 65 and Older in an Academic Internal Medicine Clinic. Poster presenter at: American College of Physicians Internal Medicine 2024 Meeting. Boston, MA. April 18 – 20, 2024.}
2. ^{Kunzmann K. William Schaffner, MD: Pneumococcal Vaccine Guidelines. HCPLive. Published August 14, 2019. https://www.hcplive.com/view/william-schaffner-md-pneumococcal-vaccine-guidelines}