1. Eliminating Disparities in Adult Immunization: A Primary Care/Public
Health Partnership
Christine Long
Sharon Humiston
Nancy Bennett
The Center for Rochester’s Health
The Center for Rochester’s Health, is a collaboration of the Monroe County Department of Public Health and the
University of Rochester

2. BACKGROUND
Need: Pneumococcal polysaccharide vaccine (PPV) rates were lower for African Americans (42%) than Caucasians (75%) in Monroe County
( Random Digit Dial Health Survey in 2001).
Setting: 7 urban Federally Qualified Community Health Centers (FQCHCs) and hospital clinics
Funding: Funded by the CDC as one of five READII sites (Racial and Ethnic Adult Disparities In Immunization Initiative)

3. Barriers to vaccination in primary care:
Urgent medical problems divert
attention from preventive care
Lack of accurate, complete lists
of patients who need vaccine
Low demand from patients
Confusing guidelines

4. Inner City Primary Care Practices Best Practices (Interventions)
Centralized, public health model to implement Tracking Reminder/Recall, and Outreach (TRO)
Tracking
Patient reminder/recall
Provider reminder
Outreach
Telephone
Home visit
Inner City Primary Care Practices
Best Practices (Interventions)
7 practices:
4 NHC
2 hospital
affiliated
1 urban
clinic

5. STRUCTURE Center for Rochester’s Health (CRH)
University of
Rochester
Monroe
County
Department
of Public
1 social worker and 4 health counselors employed
by CRH work 1-3 days a week in each of 7 primary care offices
Site G
FQCHC
Site A
Site B
Urban
Clinic
Site F
Hosp
Site C
Site D
Site E

6. DEFINITIONS
Active Patients: Monroe County residents, aged >65 years, seen at practice within past 1 to 5 years.
Vaccinated: PPV at age >65 years, or before age 65, but within the past 5 years.
Unvaccinated: No PPV since age 65, or PPV given before age 65 and > 5 years have elapsed.

7. METHODS
Business and confidentiality agreements signed with 7 practices
Data download of patients to immunization database at each site
Tracking: Determine PPV
status for active patients
Physician Reminders:
Flag charts of unvaccinated
Patient Reminders:
Postcards to patients
Tracking: Update
vaccine histories
TRO Intervention Cycle: Tracking, Reminder, Recall, Outreach
Patient Recall: Phone calls to
Patients still unvaccinated
Outreach: Repeat phone
calls & make home visits
to arrange appointments

8. RESULTS Racial and ethnic disparities were eliminated
for PPV immunizations
Improvement varied by age group and
primary care site, but vaccination rates
improved and disparities were reduced for all
Patient refusal rate did not differ by
race/ethnicity

9. Change in percent of patients vaccinated
with PPV by race and ethnicity
% Vaccinated at Start
% Vaccinated at End
National Rate 2003*
100
2010
Goal 79 79 78 78 80 64 61 58 60 57 60 37 40 31 20
African
Caucasian
Hispanic
Other
American
*source: National Health Interview Survey

10. Change in Percent of Vaccinated Patients by Site55 51 71 54 40 66 73 61 88 63 78 84 20 60 80
100 A B C D E F G
% Vaccinated at Start
% Vaccinated at End

11. Change in Percent of Vaccinated Patients by Age Group48 60 72 71 75 78 84 80 20 40
100
65-69
70-74
75-79
>=80
age group
% Vaccinated at Start
% Vaccinated at End

12. Pneumococcal Vaccine Refusals
African American % 8%
Caucasian % 7%
Hispanic % 4%
Other % 3%
Total % 7%
% refusals
among 1690 patients
not vaccinated
at start
among
all patients
Number of
patients

13. Challenges to working with
primary care sites:
Capacity of practices to accommodate
READII staff e.g., space, desk, phone,
computer access
Difficulty overcoming staff feelings of
intruding in practice
Lag time before benefits of program
are evident

14. Advantages of centralized
public health model:
READII staff could focus on preventive care,
not daily urgent patient care
READII staff followed all procedures of host site, and
interacted with patients as members of host site
READII staff contributed to quality performance of
host site
Sites liked having accurate patient lists and
vaccine histories
Patients liked personal contact and vaccine
information from culturally competent READII staff

15. Thoughts from READII outreach staff on building trust with host sites:
Explain program to all host site staff
Share progress and results
Persistent communication at all levels
Negotiate with people who make decisions
Be flexible in work time (Saturdays, evenings)
Share success -- good publicity is good for
host site too
Be patient. It took at least one year to feel
accepted in some sites

16. CONCLUSIONS A centralized public health model is powerful,
effective, and can serve different practice types
Proven strategies to improve quality of care can eliminate health disparities
Tracking, reminder, recall,and outreach should be extended to improve vaccine rates in younger adults with high-risk conditions.
The effectiveness of this public health model should be studied for other preventive health services
Health disparities can be eliminated only if communities commit to a comprehensive, coherent system of providing preventive health services to all people.

17. Thanks to the practices and staff,
community and professional organizations,
who participated in and supported
READII Rochester
Lourdes Arvelo
Juanita Alvarez Barbara McNair Lilleith Nisbeth
Teretha Wilson
Contact information: