Improving the rates of pertussis vaccination in the retail clinic setting through provider education

Abstract

Problem: Pertussis is an emerging public health risk with the infant population posing greatest risk of morbidity and mortality. Over the past two decades, the incidence of pertussis has been increasing in the United States, making it the most common preventable childhood illness by vaccine. Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC), the rates of vaccination against pertussis remain low, with only 56 percent of adolescents and 5.9 percent of adults having obtained the Tdap vaccine. The National Foundation for Infectious Diseases posited that many providers are unaware of the ACIP guidelines for adolescents and adults or have personal reservations about vaccination, therefore, are less likely to recommend routine vaccinations. Retail clinics present an opportunity to reach target patient populations through convenience and affordability; every patient visit is an opportunity to address patients' vaccination status. There is evidence that education can be an effective tool to increase immunization frequency, both for providers and patients when combined with other strategies such as making vaccinations affordable and convenient.

Purpose: The purpose of this capstone project was to determine ifan electronic educational intervention in the provider's weekly newsletter increased the number ofTdap vaccinations in a clinical retail setting.

Methods: The educational intervention and retrospective chart review was conducted over a ten week period from February to April 2013 across twelve states. Data were collected four weeks prior to the first educational intervention, two weeks following the first educational intervention, two weeks following the second educational intervention, and four weeks following the second intervention. The rate of Tdap vaccination per visits was analyzed across each of the five twoweek periods.

Results: Twelve states were selected to participate in this project. On average, each state had an average of6,583 visits per two-week period, with 5.7 Tdap vaccines being given. Using Friedman's ANOYA, there was a difference in the rates ofTdap vaccinations (x2 (4) = 11.25, P < 0.05. Wilcoxon signed-rank tests were used to follow up on this finding. A Bonferroni correction was applied so all effects are reported at the 0.005 level. None of the tested pairs were statistically significant at the 0.005 level.

Conclusion: Despite a lack of statistical significance, the project demonstrated the importance of using an electronic educational intervention as a plausible method to educate providers in clinical retail settings on standards of practice. Individually, some of the states demonstrated changes in trends, which indicates the clinical significance of the intervention. Educating providers on best standards for routine vaccinations is a necessary strategy in order to promote adherence to national guidelines.