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Factors Affecting Influenza and Pneumococcal Vaccination Acceptance Among Emergency Department Patients

Factors Affecting Influenza and Pneumococcal Vaccination Acceptance Among Emergency Department Patients Diane Rimple, MD May 11, 2004 Acknowledgements Daniel Fishbein, MD Meghan Brett, MD Prevention in EDs EDs as a source of primary care: Number without health insurance is increasing

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Factors Affecting Influenza and Pneumococcal Vaccination Acceptance Among Emergency Department Patients

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  1. Factors Affecting Influenza and Pneumococcal Vaccination Acceptance Among Emergency Department Patients Diane Rimple, MD May 11, 2004

  2. Acknowledgements • Daniel Fishbein, MD • Meghan Brett, MD

  3. 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

  4. Patient Barriers to Vaccination • Knowledge • Attitudes • Behavior

  5. System Barriers to Vaccination • Knowledge • Attitudes • Behavior

  6. Purpose of Study • Identify and eliminate barriers • Determine acceptance rates • Evaluate the cost

  7. Location of Study

  8. 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

  9. Eliminating the Barriers We tried to eliminate as many as possible: • Awareness • Language • Opportunity • Cost

  10. 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”

  11. 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”

  12. 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

  13. 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

  14. 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)

  15. Proportion of High Risk Patients,By Age Group

  16. Proportion of Vaccinated High Risk Patients at Baseline

  17. Proportion of High Risk Patients Vaccinated during Study

  18. Post Intervention Influenza Vaccination Coverage Age Group and Patient Attitude 2010 Targets Under 50 50 to 64 65 and older

  19. Pneumococcal Vaccine Coverageby Age Group and Pre-interview Belief 2010 Targets Under 50 50 to 64 65 and older

  20. Language Patients Preferred and Vaccination Influenza Pneumococcal

  21. Insurance Status and Vaccination Influenza Pneumococcal

  22. Insurance Status and Vaccination Influenza Pneumococcal

  23. Conclusions The Need: • 524 of 684 (77%) patients presenting to the ED for other complaints qualified for the vaccines

  24. 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.

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

  26. 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.

  27. 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.

  28. 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

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

  30. 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

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