Quality assessment of prescribing of pneumococcal vaccine to the elderly

Abstract

Quality evaluation of the prescription of the anti-pneumococal vaccine in the elderly Objectives: To evaluate the quality of prescription of anti-pneumococcal vaccine (APV) by Family Physicians (FP), to the elderly of the Primary Care Center (PCC) studied. Type of study: Quality evaluation study. Retrospective study. Location: Primary Care Center of Senhora da Hora, Matosinhos Population: 10% of elderly included in the lists of all the FP at the PCC of the study aged ³ 65 years at December 31st, 2007. Methods:We evaluated retrospectively (from January 1st, 2003 to September 30th, 2008) the technical and scientific quality of the prescription of APV by the 23 FP from the PCC of the study, in a sample of 10% of elderly aged ³ 65 years at December 31st 2007, selected randomly with replacement.We consulted the clinical data and SAM®. The following criteria were used as quality standards for prescription:Very low quality if prescription rate was <25%, Low quality if prescription rate was ³ 25% and <50%, Sufficient quality if prescription rate was ³ 50% and <75% and Good quality if prescription rate ³ 75%, seeking an educational intervention and structural changes. Results: Of the 418 cases studied, 238 (56.9%) accounted for elderly females. The average age was 75 years (maximum of 98 years and minimum of 65 years). In 382 cases (91.4%) there was no registry of prescription of APV. The registry of prescription was present in only 36 (8.6%) cases, resulting in a pattern of Very Low quality of prescription. In the 23 FP evaluated the rate of prescription varied between 0% and 37.5%. The age group where there was the greatest prescription rate was 70 to 74 years. Conclusion: The quality of APV prescription in the study PCC was very low.The absence of appropriate Portuguese clinical guidelines may be in the basis of this low prescribing of the vaccine.To improve the rate of prescription the authors propose structural measures (computer warning information to the vaccination, establishment of specific guidelines) and education (training meetings, lectures and leaflets) directed to health professionals and elderly.The authors propose revaluation, after implementation of the corrective measures already initiated in December 2008.