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Using the 4 Pillars to increase vaccination among high-risk adults: who benefits?
Am J Manag Care. 2017 Nov; 23(11):651-655.AJ

Abstract

OBJECTIVES

To compare changes in vaccination rates (pneumococcal polysaccharide vaccine [PPSV]; tetanus, diphtheria, and pertussis [Tdap] vaccine; and influenza vaccine) among high-risk adults following an intervention (June 1, 2013, to January 31, 2015) that used the 4 Pillars Practice Transformation Program (4 Pillars Program).

STUDY DESIGN

Post hoc analysis of data from a randomized controlled cluster trial.

METHODS

Eighteen primary care practices received staff education, guidance for using the 4 Pillars Program, and support for a practice immunization champion. Paired t tests were used to compare vaccination rates separately for those with diabetes, chronic lung or chronic heart disease, or other high-risk conditions. Student's t tests were used to compare vaccination rates across high-risk conditions. Generalized estimating equation modeling was used to determine the likelihood of vaccination.

RESULTS

Based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, 4737 patients aged 18 to 64 years were identified as having diabetes (n = 1999), chronic heart disease (n = 658), chronic lung disease (n = 1682), or another high-risk condition (n = 764). PPSV uptake increased by 12.2 percentage points (PP), Tdap vaccination increased by 11.4 PP, and influenza vaccination increased by 4.8 PP. In regression analyses, patients with diabetes (odds ratio [OR], 2.2; 95% CI, 1.80-2.73), chronic lung disease (OR, 1.50; 95% CI, 1.21-1.87), or chronic heart disease (OR, 1.32; 95% CI, 1.02-1.71) were more likely to receive PPSV than those without the respective high-risk condition. Those with diabetes (OR, 1.14; 95% CI, 1.01-1.28) or chronic lung disease (OR, 1.14; 95% CI, 1.01-1.30) were more likely to receive an influenza vaccine than those without the respective condition. The likelihood of Tdap vaccination was not significantly associated with any of the chronic conditions tested.

CONCLUSIONS

An intervention including the 4 Pillars Program was associated with significant increases in vaccination of high-risk adults. However, the overall uptake of recommended vaccines for those with high-risk conditions remained below national goals.

Authors+Show Affiliations

University of Pittsburgh School of Medicine, 4420 Bayard St, Ste 520, Pittsburgh, PA 15260. E-mail: tnowalk@pitt.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29182350

Citation

Nowalk, Mary Patricia, et al. "Using the 4 Pillars to Increase Vaccination Among High-risk Adults: Who Benefits?" The American Journal of Managed Care, vol. 23, no. 11, 2017, pp. 651-655.
Nowalk MP, Moehling KK, Zhang S, et al. Using the 4 Pillars to increase vaccination among high-risk adults: who benefits? Am J Manag Care. 2017;23(11):651-655.
Nowalk, M. P., Moehling, K. K., Zhang, S., Raviotta, J. M., Zimmerman, R. K., & Lin, C. J. (2017). Using the 4 Pillars to increase vaccination among high-risk adults: who benefits? The American Journal of Managed Care, 23(11), 651-655.
Nowalk MP, et al. Using the 4 Pillars to Increase Vaccination Among High-risk Adults: Who Benefits. Am J Manag Care. 2017;23(11):651-655. PubMed PMID: 29182350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using the 4 Pillars to increase vaccination among high-risk adults: who benefits? AU - Nowalk,Mary Patricia, AU - Moehling,Krissy K, AU - Zhang,Song, AU - Raviotta,Jonathan M, AU - Zimmerman,Richard K, AU - Lin,Chyongchiou J, PY - 2017/11/29/entrez PY - 2017/11/29/pubmed PY - 2018/7/26/medline SP - 651 EP - 655 JF - The American journal of managed care JO - Am J Manag Care VL - 23 IS - 11 N2 - OBJECTIVES: To compare changes in vaccination rates (pneumococcal polysaccharide vaccine [PPSV]; tetanus, diphtheria, and pertussis [Tdap] vaccine; and influenza vaccine) among high-risk adults following an intervention (June 1, 2013, to January 31, 2015) that used the 4 Pillars Practice Transformation Program (4 Pillars Program). STUDY DESIGN: Post hoc analysis of data from a randomized controlled cluster trial. METHODS: Eighteen primary care practices received staff education, guidance for using the 4 Pillars Program, and support for a practice immunization champion. Paired t tests were used to compare vaccination rates separately for those with diabetes, chronic lung or chronic heart disease, or other high-risk conditions. Student's t tests were used to compare vaccination rates across high-risk conditions. Generalized estimating equation modeling was used to determine the likelihood of vaccination. RESULTS: Based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, 4737 patients aged 18 to 64 years were identified as having diabetes (n = 1999), chronic heart disease (n = 658), chronic lung disease (n = 1682), or another high-risk condition (n = 764). PPSV uptake increased by 12.2 percentage points (PP), Tdap vaccination increased by 11.4 PP, and influenza vaccination increased by 4.8 PP. In regression analyses, patients with diabetes (odds ratio [OR], 2.2; 95% CI, 1.80-2.73), chronic lung disease (OR, 1.50; 95% CI, 1.21-1.87), or chronic heart disease (OR, 1.32; 95% CI, 1.02-1.71) were more likely to receive PPSV than those without the respective high-risk condition. Those with diabetes (OR, 1.14; 95% CI, 1.01-1.28) or chronic lung disease (OR, 1.14; 95% CI, 1.01-1.30) were more likely to receive an influenza vaccine than those without the respective condition. The likelihood of Tdap vaccination was not significantly associated with any of the chronic conditions tested. CONCLUSIONS: An intervention including the 4 Pillars Program was associated with significant increases in vaccination of high-risk adults. However, the overall uptake of recommended vaccines for those with high-risk conditions remained below national goals. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/29182350/Using_the_4_Pillars_to_increase_vaccination_among_high_risk_adults:_who_benefits L2 - https://www.ajmc.com/pubMed.php?pii=87314 DB - PRIME DP - Unbound Medicine ER -