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Agency for Healthcare Research Quality

Outcomes/Effectiveness Research

Clinician recommendations for pneumonia vaccination play a key role in vaccination rates

Despite the availability of antibiotics, the case-fatality rate for pneumonia caused by pneumococcal bacteria is 5 to 36 percent in adults and 18 to 60 percent in the elderly. Pneumococcal polysaccharide vaccine (PPV) is recommended for elderly people and those aged 2 through 64 years with high-risk conditions such as chronic cardiac disease and diabetes. Despite these recommendations, PPV vaccination rates remain low, especially among ethnic minorities. For instance, in 2004, 34 percent of Hispanics and 39 percent of blacks received PPV compared with 61 percent of whites. Clinicians can increase pneumonia vaccination rates and reduce racial disparities in PPV vaccination by recommending the vaccine to eligible patients, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10864).

Attitudes about vaccination and a clinician's recommendation for vaccination are the most powerful predictors of PPV status, note the researchers who conducted the study. They surveyed a random sample of diverse patients from three inner-city health centers in 2003 about their vaccination status and their attitudes and beliefs about the pneumonia vaccine. Of a predominantly elderly, low-income group of 300 patients, 59 percent said they had been vaccinated, 9 percent intended to be vaccinated within 6 months, and 32 percent had no intention of being vaccinated.

Individuals who had a complete physical exam 1 to 2 years ago or more than 2 years ago were 84 percent and 90 percent, respectively, less likely to be vaccinated that those who had an exam less than a year ago. Also, those who agreed that getting a PPV was wise and whose physician or loved one recommended PPV were over 8 times more likely to be vaccinated. Finally, those who agreed that pneumonia was risky and the vaccine was effective in preventing it were nearly 3 times more likely to be vaccinated.

See "Predictors of pneumococcal polysaccharide vaccination among patients at three inner-city neighborhood health centers," by Richard K. Zimmerman, M.D., M.P.H., Melissa Tabbarah, Ph.D., M.P.H., Mary Patricia Nowalk, Ph.D., R.D., and others, in the September 2005 American Journal of Geriatric Pharmacotherapy 3(3), pp. 149-159.

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