Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders

J Gen Intern Med. 1999 Jun;14(6):351-6. doi: 10.1046/j.1525-1497.1999.00353.x.


Objective: To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate.

Design: A prospective controlled trial.

Setting: Department of Veterans Affairs ambulatory care clinic.

Patients/participants: There were 3, 502 outpatients with scheduled visits divided into three clinic teams (A, B, or C).

Interventions: During a 12-week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates.

Measurements and main results: Team A nurses assessed more patients than team B nurses (39% vs 34%, p =.009). However, vaccination rates per total patient population were similar (22% vs 25%, p =.09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C (p <.001).

Conclusions: Nurse-initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse-initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Ambulatory Care Facilities
  • Bacterial Vaccines / administration & dosage*
  • Clinical Protocols*
  • Cost-Benefit Analysis
  • Follow-Up Studies
  • Hospitals, Veterans
  • Humans
  • Nurses
  • Pneumococcal Vaccines
  • Pneumonia, Pneumococcal / prevention & control*
  • Prospective Studies
  • Reminder Systems*
  • Streptococcus pneumoniae
  • United States
  • Vaccination / statistics & numerical data*


  • Bacterial Vaccines
  • Pneumococcal Vaccines