1
|
Schafer JJ, McRae J, Prioli KM, Harris LF, McCoy M, Cannon-Dang E, Pizzi LT. Exploring beliefs about pneumococcal vaccination in a predominantly older African American population: the Pharmacists' Pneumonia Prevention Program (PPPP). ETHNICITY & HEALTH 2021; 26:364-378. [PMID: 30175602 DOI: 10.1080/13557858.2018.1514450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Objectives: To assess the association of the Pharmacists' Pneumonia Prevention Program (PPPP) with changes in beliefs related to pneumonia vaccination (PV) in a predominately older African American population.Methods: PPPP was an educational intervention delivered using a senior center model of care consisting of a formal pharmacist presentation, live skit, small group action planning, and optional PV. A 15-item instrument assessed participants' beliefs at baseline, post-test, and three months across four domains: pharmacists and pharmacies, vaccination, pneumococcal disease, and physicians. Friedman tests and pairwise Wilcoxon signed rank tests were used to determine the statistical significance of the mean change in belief responses across timepoints.Results: 190 older adults participated; the sample was majority female (76.3%) and African American (80.5%), and had a mean age of 74.3 years. Statistically significant improvements in beliefs at post-test were observed in the following domains: pharmacists and pharmacies, vaccination, and the pneumococcal disease; however, some of these gains were incompletely sustained at three months.Conclusion: PPPP positively impacted beliefs post-program regarding the pneumococcal disease, pharmacists and pharmacies, and vaccination; however, sustained efforts may be needed to reinforce these gains.Policy implications: Support for pharmacist educational services in senior centers should be considered.
Collapse
Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jacquelyn McRae
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ, USA
| | - Lynn Fields Harris
- Grant Research and Development, Center in the Park, Philadelphia, PA, USA
| | - Megan McCoy
- Grant Research and Development, Center in the Park, Philadelphia, PA, USA
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ, USA
| |
Collapse
|
2
|
Root-Bernstein R. Age and Location in Severity of COVID-19 Pathology: Do Lactoferrin and Pneumococcal Vaccination Explain Low Infant Mortality and Regional Differences? Bioessays 2020; 42:e2000076. [PMID: 32869330 DOI: 10.1002/bies.202000076] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/17/2020] [Indexed: 12/21/2022]
Abstract
Two conundrums puzzle COVID-19 investigators: 1) morbidity and mortality is rare among infants and young children and 2) rates of morbidity and mortality exhibit large variances across nations, locales, and even within cities. It is found that the higher the rate of pneumococcal vaccination in a nation (or city) the lower the COVID-19 morbidity and mortality. Vaccination rates with Bacillus Calmette-Guerin, poliovirus, and other vaccines do not correlate with COVID-19 risks, nor do COVID-19 case or death rates correlate with number of people in the population with diabetes, obesity, or adults over 65. Infant protection may be due to maternal antibodies and antiviral proteins in milk such as lactoferrin that are known to protect against coronavirus infections. Subsequent protection might then be conferred (and correlate with) rates of Haemophilus influenzae type B (Hib) (universal in infants) and pneumococcal vaccination, the latter varying widely by geography among infants, at-risk adults, and the elderly. Also see the video abstract here https://youtu.be/GODBYRbPL00.
Collapse
|
3
|
Liu K, Lee GC. Healthcare utilisation and cost expenditures for pneumonia in individuals with diabetes mellitus in the USA. Epidemiol Infect 2019; 147:e212. [PMID: 31364575 PMCID: PMC6624864 DOI: 10.1017/s0950268819000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/28/2019] [Accepted: 04/16/2019] [Indexed: 01/03/2023] Open
Abstract
Pneumonia is one of the leading causes of hospitalisations among adults in the USA. Individuals with diabetes mellitus (DM) have been associated with increased risk for pneumonia and complications including death. The objectives of this study were to (1) compare the prevalence and healthcare utilisation patterns for pneumonia in individuals with and without DM, and (2) identify risk factors for pneumonia in those with DM. We performed a retrospective, cross-sectional analysis of the US adult population using Medical Expenditure Panel Surveys (MEPS) data from 2014. Overall, the data represented 24 million individuals with DM and 218 million without DM in the USA. The population-based rate for a pneumonia event was 34 per 1000 persons for individuals with DM and 19 per 1000 persons without DM. Compared to the non-DM group, individuals with DM were treated 1.8x, 2.6x and 1.4x more in the ED, hospital and outpatient, respectively. Furthermore, the average cost per pneumonia event was significantly higher among individuals with DM compared to non-DM in the inpatient setting ($11 931 vs. $7751; P < 0.001). Among individuals with DM, female sex, DM complications, smokers and administration of pneumococcal vaccines were significant factors associated with a pneumonia event.
Collapse
Affiliation(s)
- K. Liu
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
- The University of Texas Health San Antonio, School of Medicine, San Antonio, TX, USA
| | - G. C. Lee
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
- The University of Texas Health San Antonio, School of Medicine, San Antonio, TX, USA
| |
Collapse
|
4
|
Pizzi LT, Prioli KM, Fields Harris L, Cannon-Dang E, Marthol-Clark M, Alcusky M, McCoy M, Schafer JJ. Knowledge, Activation, and Costs of the Pharmacists' Pneumonia Prevention Program (PPPP): A Novel Senior Center Model to Promote Vaccination. Ann Pharmacother 2017; 52:446-453. [PMID: 29172664 DOI: 10.1177/1060028017745566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vaccination is the best way to prevent pneumococcal disease (PD), but 40% of older adults remain unvaccinated nationwide, with even greater nonvaccination rates among African Americans (AAs). Prior studies suggest that insufficient knowledge contributes to low vaccination rates. The Pharmacists' Pneumonia Prevention Program (PPPP) was designed to improve older adults' knowledge about PD and pneumococcal vaccination (PV). OBJECTIVE To measure PPPP's effect on knowledge and activation in a predominantly AA population and determine program costs. METHODS PPPP uses a senior center model with a pharmacist presentation, actors' skit, and small-group action planning. Knowledge about PD risk, transmission, symptoms, and PV side effects was assessed at baseline (BL), postintervention (PT), and 3 months (M3) and analyzed using an intention-to-treat (ITT) approach. Actions taken (got vaccinated, spoke to doctor or pharmacist, discussed with family/friends) were assessed at M3. PPPP costs ($US 2013) included staff time, PV, actor, and site fees. RESULTS Of 276 attending PPPP, 190 consented and were included in the ITT sample, which was largely black (80.5%) and female (76.3%) and had a mean age of 74.4 years. Knowledge improved by 46.8% (BL vs PT), with significant gains in all domains. At M3, knowledge improved by 54.2% vs BL, indicating sustained gains; 37.2% of previously unvaccinated participants reported receiving PV by M3. Program cost was $119 per attendee. CONCLUSION PPPP significantly improved PD and PV knowledge. It could be delivered more efficiently by holding larger events on fewer dates, staffing with volunteers where appropriate, and utilizing a local pharmacy to manage the vaccine supply.
Collapse
Affiliation(s)
| | | | | | | | | | - Matt Alcusky
- 4 University of Massachusetts Medical School, Worcester, MA, USA
| | | | | |
Collapse
|
5
|
Sevin AM, Romeo C, Gagne B, Brown NV, Rodis JL. Factors influencing adults' immunization practices: a pilot survey study of a diverse, urban community in central Ohio. BMC Public Health 2016; 16:424. [PMID: 27216805 PMCID: PMC4877755 DOI: 10.1186/s12889-016-3107-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/14/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Adult vaccination rates in the United States are well below recommendations with disparities in race, ethnicity, and education level resulting in even lower rates for these populations. This study aimed to identify the barriers to and perceptions of immunizations in adults in an urban, underserved, multicultural community. Understanding the factors that influence adults' decisions to receive routinely recommended vaccines will aid health care providers and public health officials to design programs to improve vaccination rates. METHODS This cross-sectional, survey-based study was conducted in January 2014 in Columbus, Ohio. Participants were recruited from four urban federally-qualified health centers and four grocery stores affiliated with those clinics. The survey gathered self-reported receipt of immunizations, knowledge about indications for immunizations, and factors influencing decisions to receive an immunization. Data was analyzed in 2014. Descriptive statistics were generated for all survey items and Chi-Square or Fisher's Exact tests were used as appropriate to test for associations between demographic characteristics and factors influencing immunization decisions. RESULTS The top five factors likely to affect the decision to receive an immunization among the 304 respondents were: "doctor's recommendation" (80.6 %), "knowing why I should get a vaccine" (78.2 %), "knowing which vaccines I need" (75.5 %), cost (54.2 %), and "concern about getting sick if I get a vaccine" (54.0 %). Significant differences in factors influencing the immunization decision exist among respondents based on ethnicity and education level. For those participants with self-identified diabetes, heart disease, or asthma, less than half were aware that certain immunizations could reduce the risk of complications associated with their disease(s). CONCLUSIONS Data from this study may inform and shape patient education programs conducted in clinics, retailers, and communities, as well as advocacy efforts for adult immunizations. Results from this study suggest that patients would respond to programs for promoting vaccine uptake if they focused on benefits and indications for vaccines. The results also highlighted the need for education regarding immunizations for patients with chronic diseases and special indications. The differences in perceptions found between groups can be used to create targeted interventions based on the needs of those patient populations.
Collapse
Affiliation(s)
- Alexa M Sevin
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 129C Parks Hall, 500W. 12th Avenue, Columbus, OH, 43210, USA
| | | | | | - Nicole V Brown
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Rodis
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 129C Parks Hall, 500W. 12th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
6
|
Understanding Black Patients' Refusal of Pneumococcal Vaccination. J Racial Ethn Health Disparities 2015; 4:1-8. [PMID: 27294765 DOI: 10.1007/s40615-015-0193-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/02/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Racial disparities in rates of pneumococcal vaccine (PPSV23) exist. In one practice, 3.1 % of white patients refused PPSV23 following doctor recommendation, whereas 11.2 % of black patients refused vaccination. Our objective was to understand reasons black patients refused PPSV23. METHODS Mixed-method telephone survey in 2012 of black patients aged ≥65 with a documented refusal of PPSV23. The survey assessed beliefs about PPSV23; reasons for non-receipt of PPSV23; receipt of other vaccinations; and comparative perceptions of adult vs. childhood vaccines. Participants responded to items on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). RESULTS Participants' (N = 40) mean age was 73 years; 95 % were female. Participants recognized pneumonia could be deadly (M = 4.3, SD = 1.0), but reported low levels of personal susceptibility (M = 2.8, SD = 1.4). Participants perceived childhood vaccines to be safer (M = 4.2, SD = 1.2) than adult vaccines (M = 3.4, SD = 1.4; p < 0.01). Qualitative analyses to understand reasons for refusal of vaccine both reinforced identified low perceptions of personal susceptibility as well as identified numerous additional barriers to receipt of PPSV23 (e.g., fear, side effects, and mistrust). CONCLUSIONS Black patients in our sample who refused PPSV23 may not perceive themselves susceptible to the disease, suggesting that strategies to improve PPSV23 rates among these patients may need to emphasize susceptibility to pneumonia. Further, given the discrepancies in perceptions toward childhood versus adult vaccinations, focusing on vaccination across the lifespan may be a promising vaccine promotion strategy.
Collapse
|
7
|
Ahmed MB, Patel K, Fonarow GC, Morgan CJ, Butler J, Bittner V, Kulczycki A, Kheirbek RE, Aronow WS, Fletcher RD, Brown CJ, Ahmed A. Higher risk for incident heart failure and cardiovascular mortality among community-dwelling octogenarians without pneumococcal vaccination. ESC Heart Fail 2015; 3:11-17. [PMID: 27668089 PMCID: PMC5019269 DOI: 10.1002/ehf2.12056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/07/2022] Open
Abstract
AIMS Octogenarians have the highest incidence of heart failure (HF) that is not fully explained by traditional risk factors. We explored whether lack of pneumococcal vaccination is associated with higher risk of incident HF among octogenarians. METHODS AND RESULTS In the Cardiovascular Health Study (CHS), 5290 community-dwelling adults, ≥65 years of age, were free of baseline HF and had data on pneumococcal vaccination. Of these, 851 were octogenarians, of whom, 593 did not receive pneumococcal vaccination. Multivariable-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for associations of lack of pneumococcal vaccination with incident HF and other outcomes during 13 years of follow-up were estimated using Cox regression models, adjusting for demographics and other HF risk factors including influenza vaccination. Octogenarians had a mean (±SD) age of 83 (±3) years; 52% were women and 17% African American. Overall, 258 participants developed HF and 662 died. Lack of pneumococcal vaccination was associated with higher relative risk of incident HF (aHR, 1.37; 95% CI, 1.01-1.85; P = 0.044). There was also higher risk for all-cause mortality (aHR, 1.23; 95% CI, 1.02-1.49; P = 0.028), which was mostly driven by cardiovascular mortality (aHR, 1.45; 95% CI, 1.06-1.98; P = 0.019). Octogenarians without pneumococcal vaccination had a trend toward higher risk of hospitalization due to pneumonia (aHR, 1.34; 95% CI, 0.99-1.81; P = 0.059). These associations were not observed among those 65-79 years of age. CONCLUSIONS Among community-dwelling octogenarians, lack of pneumococcal vaccination was associated with a significantly higher independent risk of incident HF and mortality, and trend for higher pneumonia hospitalization.
Collapse
Affiliation(s)
| | - Kanan Patel
- University of California San Francisco CA USA
| | | | | | | | - Vera Bittner
- University of Alabama at Birmingham Birmingham AL USA
| | | | | | | | | | - Cynthia J Brown
- University of Alabama at BirminghamBirminghamALUSA; Veterans Affairs Medical CenterBirminghamALUSA
| | - Ali Ahmed
- University of Alabama at BirminghamBirminghamALUSA; Veterans Affairs Medical CenterWashingtonDCUSA
| |
Collapse
|
8
|
Liu S, Xu E, Liu Y, Xu Y, Wang J, Du J, Zhang X, Che X, Gu W. Factors associated with pneumococcal vaccination among an urban elderly population in China. Hum Vaccin Immunother 2015; 10:2994-9. [PMID: 25483646 DOI: 10.4161/21645515.2014.972155] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination. METHODS A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multi-stage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis. RESULTS Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR = 1.67, 95% CI: 1.28 - 2.17), the safety of vaccination (OR = 2.00, 95% CI: 1.54 - 2.59), advice about the 23-PPV vaccination from family members (OR = 2.37, 95% CI: 1.39 - 4.40), influenza vaccination history (OR = 2.57, 95% CI: 1.66 - 3.98) and pneumococcal vaccination history (OR = 7.48, 95% CI: 2.4-22.92). CONCLUSION The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants' willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.
Collapse
Affiliation(s)
- Shijun Liu
- a Hangzhou Center for Disease Control and Prevention ; Hangzhou , China
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lundgren F, Maranhão B, Martins R, Chatkin JM, Fouad Rabahi MF M, Amorim Corrêa R, Rúbia F. de Figueiredo M, Carvalho Andrada N, Stirbulov R. Vaccination in the prevention of infectious respiratory diseases in adults. Rev Assoc Med Bras (1992) 2014; 60:4-15. [DOI: 10.1590/1806-9282.60.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
10
|
Rightmier E, Stevens V, Brown J. Streptococcus pneumoniae vaccination in older adults. ACTA ACUST UNITED AC 2011; 9:392-404. [PMID: 22047941 DOI: 10.1016/j.amjopharm.2011.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Streptococcus pneumoniae infections are a major cause of morbidity and mortality in older adults. Vaccination in older adults is intended to prevent S pneumoniae infections, yet little information is available regarding its efficacy in this patient population. OBJECTIVE The aim of this article was to review the current literature to determine the efficacy and tolerability of S pneumoniae vaccination in older adults. METHODS PubMed (1950-present) and EMBASE (1974-present) were searched using the search terms Streptococcus pneumoniae immunization, pneumococcus immunization, pneumococcus vaccine, and aged. Additional articles were identified from the reference lists of included studies. Studies were included if they reported information in older (55-<65 years) and elderly (≥65 years) adults and were related to at least 1 of the following topics: epidemiology of S pneumoniae, estimates of vaccine coverage, recommendations for vaccination, tolerability, and efficacy and/or effectiveness of vaccination against S pneumoniae. RESULTS Six randomized controlled trials and 18 observational studies that evaluated the efficacy of pneumococcal vaccination in older and elderly adults were reviewed. Findings from evaluations of efficacy, as measured by clinical outcomes and immunogenicity, in older adults have been conflicting, with some subsets of prospective, well-controlled studies finding little benefit, whereas findings from several retrospective studies have suggested significant benefit. This discord may have been a result of the limited power of the prospective subanalyses to detect significant differences. CONCLUSIONS In light of the potential clinical benefit and few reports of serious adverse events, vaccination in older adults is likely warranted. Prospective, well-controlled studies are needed to better quantitatively evaluate the benefit of pneumococcal vaccine in older adults.
Collapse
Affiliation(s)
- Elizabeth Rightmier
- Department of Pharmacy, University of Rochester Medical Center, New York, USA
| | | | | |
Collapse
|