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Pneumococcal vaccination in nursing homes: does policy change practice?

M Kate Dunn1, Sumi Misra, Ralf Habermann

  • 1Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine and Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA.

Journal of the American Medical Directors Association
|July 12, 2003
PubMed
Summary

A Tennessee regulation requiring pneumococcal vaccination documentation for nursing home residents 65+ saw modest improvements in immunization rates. Facilities finding the policy useful reported greater increases in vaccination coverage.

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Area of Science:

  • Public Health Policy
  • Geriatric Medicine
  • Infectious Disease Prevention

Background:

  • Nursing home residents are at high risk for pneumococcal disease.
  • A Tennessee regulation mandated pneumococcal vaccination documentation for residents aged 65 and older.
  • Understanding the impact of such policies is crucial for improving vaccination rates in vulnerable populations.

Purpose of the Study:

  • To evaluate the effect of a new Tennessee Department of Health regulation on pneumococcal vaccination rates in nursing homes.
  • To identify factors associated with improved pneumococcal immunization among elderly nursing home residents.
  • To assess the perceived usefulness of the policy by facility staff.

Main Methods:

  • A cross-sectional descriptive study was conducted.

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  • A mailed, self-administered survey was used to collect data from Tennessee nursing homes.
  • 304 nursing homes meeting specific criteria were targeted for the survey.

    • Main Results:

    • Pneumococcal immunization rates increased from 32% to 42% between 1998 and 1999, coinciding with the policy implementation.
    • Facilities with higher immunization rates (>=75%) were larger, urban, had computerized records, standing orders, and high influenza rates.
    • Only 23% of homes found the policy helpful, and 38% reported at least a 5% increase in rates; however, those finding it useful showed greater improvement.

    Conclusions:

    • The regulation was associated with modest improvements in pneumococcal vaccination rates.
    • Facility size, urban location, and robust record-keeping practices were linked to higher immunization rates.
    • The policy's perceived usefulness correlated with greater improvements in vaccination coverage.