CHICAGO — Telephone outreach is relatively inexpensive and successful at raising pneumococcal vaccination rates, Dr. Adrienne Mims said at the annual meeting of the American Geriatrics Society.
Dr. Mims presented data from an outpatient study conducted in five managed care clinics that compared a telephone intervention with a control condition. A total of 2,395 healthy patients over the age of 65 years and 3,711 patients aged 18 years and older with diabetes, coronary artery disease, or congestive heart failure were randomized to either the telephone-intervention group or the control group.
These populations are targeted for universal immunization, according to practice guidelines. There were 3,053 patients in each of arm of the study, which was funded by the Centers for Disease Control and Prevention.
Patients in the intervention arm were sent a letter explaining the study and received up to four calls during daytime and evening hours from outreach nurses who explained the shot was free, available at a nurse visit, and could be scheduled if desired. The nurses also asked why the patient had not been immunized, then gave information tailored to the reason mentioned by the participant. Most commonly, patients said “they didn't know or the doctor didn't tell me,” said Dr. Mims of Kaiser Permanente, Atlanta.
At the 6-month follow-up, 489 patients (16%) in the intervention group were vaccinated, compared with 211 (7%) in the control group. Overall, patients who received the telephone intervention were 2.3 times more likely to be vaccinated than were patients in the control group, reported Dr. Mims and associates.
The elderly were more likely to be vaccinated than were younger, chronically ill patients (17% vs. 16%), but immunization rates improved significantly in both populations. Most patients received their pneumococcal vaccine within 3 months of the outreach.
The cost of the phone calls was $41,520, or $147 per additional patient vaccinated, compared with the cost of an office visit or of hospitalization for treating pneumococcal disease, which averages about $5,000.
Kaiser Permanente in Atlanta had previously tried several initiatives to improve pneumococcal immunization rates, such as patient outreach letters and clinic posters. Those efforts significantly improved immunization rates, to 60% in seniors and about 40%–45% in younger, chronically ill patients. But the target set by the Healthy People 2010 initiative of the Department of Health and Human Services is 90%.