Prenatal Vaccination Improvement Process in a Rural Clinic

Pregnant women and infants are at increased risk of complications from influenza and pertussis disease yet vaccine rates for these illnesses are historically low. Many barriers exist that prevent some high-risk groups from obtaining immunizations. By utilizing proven strategies and creative solutions providers can lead teams in process improvement activities that will influence women and their families to receive appropriate protective vaccines. A review of the literature reveals cases of pertussis in the U. S. has increased steadily with a 50-year peak reported in 2012. Currently, there are no tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination rates available but some estimates show them at less than 42%. Self-reporting of influenza vaccination rates are also low, some estimates report them to be between 32% to 64% during the 2009-2010 influenza season. Many barriers influence the low rates of maternal vaccine acceptance, including, lack of knowledge about susceptibility to influenza and pertussis disease, misinformation about vaccine effectiveness, concerns about vaccine safety and side effects, prior vaccination behavior, fear of needles, general mistrust of healthcare providers and system, and poor access to care. In addition, the research shows that these vaccines are safe and have increased effectiveness when given in pregnancy as compared to the postpartum period. The purpose of this project was to develop a process to increase the percentage of prenatal patients receiving the influenza and Tdap vaccines at a primary health care clinic in rural Utah. The specific objectives were to: 1) Identify barriers to obtaining the recommended immunizations during pregnancy, 2) develop an intervention to address the identified barriers in an outpatient clinic setting, and 3) present the findings and intervention to clinic stakeholders and clinics in surrounding communities. After obtaining institutional review board approval, a search of patients was acquired from the hospital where births for this rural clinic occurred. A questionnaire was developed and disseminated to this population to determine common barriers for immunization. Questionnaire results indicated that fear of harmful effects from the vaccine, fear of getting influenza from the vaccine, not having the vaccine recommended by the provider and just not following through to get the vaccine were identified barriers to immunization. Respondents did indicate that a providers' discussion of risks and benefits of immunizations have a positive influence on patients' choosing to be vaccinated. The findings of this project were presented to clinic stakeholders as well as to clinics in surrounding communities in order to help them determine and carry out a process change in an effort to improve immunization rates. It is important for pregnant women to receive the recommended vaccinations during pregnancy to decrease the sequelae from these diseases and to achieve the Healthy People 2020 goals. The recommendations are that at least 80% of pregnant women are given the influenza vaccine annually and that the number of pertussis cases is reduced to less than 2500 per year for children less than one year of age. Healthcare providers are important advocates for this recommend practice and must understand and address the barriers that keep pregnant women from obtaining this important intervention.