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theses

Purpose of Project:
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death. COPD causes weakness in the immune and respiratory systems, exposing those living with the disease to higher risk for flu and pneumonia (Restrepo et al., 2018). Pneumonia and flu, combined, rank as the eighth leading cause of death in the United States (Restrepo et al., 2018; Nace et al., 2011). Vaccination is one the most cost-effective ways of preventing pneumonia and flu related illness and hospitalization in COPD patients. Despite numerous studies supporting the need for pneumonia and flu vaccination among COPD patients, national rates still fall below the target. The main goal of this project was to improve flu and pneumonia vaccination rates and knowledge among patients living with COPD.

Method:
This research project was a quality improvement study with a pre/post-test design. This study took place at an internal medicine office located in New Jersey, with 45 participants. All participants were English-speaking adults, with a diagnosis of COPD who were previously not vaccinated for flu/ pneumonia. An educational brochure was designed using the most current vaccination guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the Centers for Disease Control and Prevention (CDC) and the Immunization Action Coalition for COPD patients. The pamphlet also addresses the most common barriers to vaccination based on the literature. A pre-educational survey developed by the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization was used to assess for specific barriers to vaccination in the project setting. A pre/post-test quiz based on the information from the pamphlet was implemented to assess for improved understanding of the education provided. The theoretical framework guiding this project was the Model for Improvement: Plan-Do-Study-Act (PDSA) Cycle.

Results:
Education had a statistically significant impact on test scores (t(44)= 9.284, p<0.001). Prior to education 57.8% of patients intended to receive the flu vaccine, with only a small percentage (66.7%) actually agreeing to getting the vaccine after reviewing the pamphlet (t(44)= 1.000, p=0.323); 8.9% intended to receive the pneumonia vaccine and only 17.8% agreed to vaccination after (t(44)= 1.274, p=0.209). Providing education and spending adequate time with patients did improve the patients’ knowledge on COPD and how it relates to flu and pneumonia. However education alone does not improve vaccination rates. Barriers to vaccination need to be addressed. A combination of techniques needs to be utilized to possibly improve rates in the future.

Implications for Practice:
Based on the study’s findings, there is a strong possibility of improving the intervention in the future. Once these results have been presented to the primary care site, the aim is to continue educating patients and distributing pamphlets. The most common barriers to vaccination in this study are worth addressing by the clinicians in order to improve vaccination rates. Recommendations for policy changes, in this case, are organizational and national. Although the vaccination results were not statistically significant, the intervention did improve knowledge as evident by the quiz result. With continuous reminders, along with the inclusion of non-English speaking patients, and addressing barriers, this intervention has the potential to improve rates in the future. Through the distribution of printed educational materials using evidence-based information from government websites, this project did not threaten the safety of patients. During this study implementation process, no identifiable information was collected. Therefore, there was minimal risk of breach of confidentiality. The intervention used in this study offers education to patients that is current and considered the standard of care in preventing worsening of COPD and hospitalization. Not only does the information presented in the pamphlet benefit the patient population, it keeps primary care providers updated on the necessary information to give to patients. According to Rest repo et al. (2018), COPD-related hospitalizations have contributed to roughly $10 billion in health care costs. Distributing printed materials and taking time to discuss vaccination with patients in the primary care setting is one of the most cost-effective ways of preventing further hospitalization and worsening of illness. While it is important to remember that this is not a complete guarantee for improvement, printed materials could help the process in a costly manner.

ETD_10943

DNP

Includes bibliographical references

doi:10.7282/t3-gjt9-4y21

ETD doctoral

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