Date of Award

5-15-2011

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Carole A. Pepa

Abstract

Despite recent advances in healthcare, Streptococcus pneumonia-associated infections contribute to significant morbidity and mortality in older adults. Because of the pneumococcal vaccine’s efficacy for preventing invasive disease, guidelines for vaccinating older adults have been developed; yet, the nation has not met immunization goals. The purpose of this EBP project was to determine if a telephone reminder, as compared to provider recommendation, would increase pneumococcal vaccination rates. The Iowa model and Kotter’s eight stages of change guided this project within a multi-provider office in Northwest Indiana. Within the practice, Medicare patients scheduled from September 1 to November 10, 2010 received a phone call reminding them of vaccine coverage and advising them to ask their provider about vaccine benefits. Following the visit, immunized patients were queried to determine the trigger for vaccine acceptance. During the 10-week project, 133 patients were immunized: a 6-fold increase in administration; a rate increase of 9.13 percentage points. A final chart audit, which included those immunized plus those whose records were updated during the project, revealed that 61.76% of patients were up-to-date, a 28.31 percentage point increase. Chi-square analyses were used to determine effectiveness of the telephone reminder and to evaluate variables of interest. Eighty percent of patients immunized during a physician visit reported the telephone reminder as trigger (X2 = 14.400, p = .000); but the phone call was less effective for patients seen by the NPs. Regardless of provider or patient age and gender, Blacks and Hispanics were less likely to be immunized than Whites (p = .000). These findings support incorporating telephone reminders into practices with limited patient education activities, but additional investigation is needed to identify effective strategies for increasing immunization rates in minority populations.

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