Improving Physician Coverage of Pneumococcal Vaccine: A Randomized Trial of a Telephone Intervention

Abstract

Improved pneumococcal vaccine (PPV) immunization for seniors is a national goal of the Medicare program. This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations. Medicare fee-for-service claims data were used to select New York primary care physicians with high volume (n = 732) or African-American serving (n = 329) practices. All practices received mailed feedback on their 1999 Medicare practice specific PPV coverage rates, along with educational materials and offers of assistance. Practices were also randomized to receive telephone calls directing attention to the mailing and further promoting improvements in PPV coverage or no active follow-up. Physicians randomized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only, and 27% vs. 17% (p = 0.01) of high volume physicians and 34% vs. 22% (p = .052) of African American serving physicians achieved at least a 5% increase in their cumulative PPV claims coverage. This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization. However, improved methods may be needed to induce a large percentage of physicians to change.

Determinants of Pneumococcal Vaccinationi among Patients with Chronic Obstructive Pulomonary Disease in Spain

“…Some strategies that have proved useful in improving vaccination coverages and should therefore be assessed, include: monitoring the vaccination status of persons with chronic diseases; increasing and improving information on the risks of pneumococcal disease and the benefits of the vaccine for patient and health professional alike; enhancing the use of regular (postal or telephone) reminders in the case of high-risk subjects; and continuing to insist on raising the general practitioners' awareness as to the vital importance of their advice vis-à-vis risk groups. 10,35,67 In addition, it has been shown that making use of the annual influenza vaccination campaigns to detect and vaccinate as yet unvaccinated high-risk subjects against pneumococcus is an effective strategy for increasing pneumococcal vaccination coverages. 39,41,42 Accordingly, the conclusions to be drawn from this study are: that pneumococcal vaccination coverages among Spanish COPD patients are low; and that strategies to improve these must be implemented as a matter of urgency.…”

Overcoming Barriers to Pneumococcal Vaccination in Patients With Pneumonia

“…Other studies have observed a similar weak effect of physician education and chart reminders to improve vaccination rates. [14][15][16][17] Even if physicians gain requisite knowledge of vaccination indications through educational interventions, that knowledge often does not translate into improved clinical practices. 18 A more active physician educational interaction through the Delphi survey improved understanding and acceptance of pneumococcal vaccination.…”

Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis

“…These are summarised in Appendix 16, Figure 21. Most of these involved social comparison in both arms, with feedback on behaviour 20,[70][71][72][73][74][75][76][77] or without feedback 18 (n = 10), and typically they were studies that tested some other combination of BCTs in the intervention arm, but had A&F offered as part of usual care in both arms. One study tested a combination of BCTs in the intervention arm, but had credible source in both arms as part of usual care.…”

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