By 2035, it's estimated that for the first time in U.S. history there will be more adults ages 65 and older than children younger than age 18. Because older adults are at an increased risk for acute and chronic diseases, preventing and decreasing the occurrence of illness in this population is imperative. One strategy is to ensure that older adults are up to date on the Centers for Disease Control and Prevention's recommended vaccinations. Yet, despite universal recommendations, many older adults are known to be underimmunized or unimmunized.

The likelihood of vaccination acceptance by patients increases when they've received an explanation of the risks of illness and the benefits of vaccines. With this in mind, researchers evaluated the design, implementation, and success of a quality improvement project involving an educational intervention for clinical staff that focused on best vaccination practices and appropriate Medicare billing in four NP-owned clinics. Before the intervention, the vaccination records of 808 patients age 65 or older were reviewed, and clinical staff members completed a survey to assess their knowledge of vaccination practices and commitment to the vaccination process. A 45-minute intervention was then conducted for the NPs and clinical staff at all four clinics. Three months after the intervention, the vaccination records of the same 808 patients were reviewed, and the survey was again completed by the same staff.

Before the intervention, rates for all but one vaccine in each clinic were below national averages and objectives. After the intervention, vaccination rates improved from baseline (the sample size for the zoster vaccine was too small for comparison). Scores on all but three items on the vaccination knowledge and attitudes survey also improved.

The authors note that the staff survey used in the study hasn't been tested for reliability or validity, and the sample size of those surveyed was small. In addition, they point out that the sustainability of interventions over time can't be determined.

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