Identifying missed opportunities for the pneumococcal conjugate vaccine (PCV13) in outpatient Veterans 65 years and older

Introduction: Most pneumococcal deaths in the United States occur in adults. The most effective way to prevent pneumococcal disease is vaccination. The recommendation for use of the pneumococcal conjugate vaccine (PCV13) in adults 65 years and older is recent, and the dosing schedule of PCV13 and the pneumococcal polysaccharide vaccine (PPSV23) can be complex in this population. PCV13 administration rates have not been assessed since the recommendations were expanded to include patients 65 years and older.

Objectives: Assess the rate of PCV13 immunization in patients 65 years of age and older and identify barriers that contribute to missed opportunities for PCV13 in this population.

Study Design: A retrospective chart review of 150 outpatient Veterans age 65 years or older who did not receive PCV13 immunization at a scheduled Primary Care appointment during March 2015.

Methods: Computerized patient records were used to determine if a patient has received PCV13.  If a patient has not received the PCV13, investigators will review electronic medical records and record any documented reason for a patient not receiving the PCV13 which will include: patient declined PCV13, medication not available for administration in clinic, vaccine not offered at appointment, not recommended to give due to timing of last PPSV23, contraindication to PCV13, or other reason.

Results: The rate of PCV13 immunizations administered at Primary Care appointments during the study period was only 37% (89 out of 239 PCV13 eligible patients). The remaining 150 patient records will be reviewed further to identify opportunities for provider education and process improvement.

Conclusions: Current results demonstrate a low rate of PCV13 immunization in outpatient Veterans 65 years and older. Upon completion of this study, barriers to patients not receiving PCV13 will be identified. Current project completion goal is March 7, 2016.