Implications on Vaccine Compliance Rates in an Internal Medicine Outpatient Clinic with the Implementation of a Pharmacist Driven Vaccination Assessment: Phase 2

Purpose: To determine if a pharmacist driven immunization assessment influences compliance with the CDC immunization recommendations for hepatitis A, hepatitis B, influenza, tetanus/diphtheria/pertussis (TDaP), human papillomavirus (HPV) and pneumococcal disease at a community teaching hospital internal medicine (IM) clinic.

Methods: Phase 1 of the study included a baseline retrospective chart review of patients seen in the clinic during a 4 week period in 2009.  Phase 2 of the study included an identical chart review 15 months after initiation of a pharmacist driven screening assessment. Rates were compared to determine efficacy of the assessment at increasing immunization compliance. The chart reviews included baseline demographics and patient specific indications for the various vaccines.  Compliance was defined as having an indication for the vaccine and receiving at this visit or previously within the appropriate time frame. 

Results: A total of 194 and 209 IM patients were eligible to be included in phase 1 and phase 2 of the study, respectively. Overall compliance with the CDC immunization recommendations was generally low but significantly improved from 2009 compared to 2010 (21% vs. 29.8%, p<0.001).  Vaccinations rates increased significantly for influenza, hepatitis B, and TDaP (Table 1).  Although rates decreased slightly for pneumococcal, hepatitis A, and HPV, these differences were not significant.  

Vaccine	IM 2009	IM 2010	P-value
Influenza	21.7%	44.8%	<0.001
Pneumococcal	38.5%	33.3%	0.35
Hepatitis A	36%	20.5%	0.25
Hepatitis B	9.4%	36.1%	0.005
TDaP	5.2%	14%	0.004
HPV	41.7%	25%	0.67

Conclusion: Compliance with the CDC immunization recommendations improved with implementation of a pharmacist driven assessment; however, rates are still low signifying a need for additional pharmacist intervention.