Suboptimal Pneumococcal Pneumonia Vaccination Rates Among Patients at Risk in a Managed Care Organization in Israel

OBJECTIVES: Pneumococcal pneumonia is a vaccine-preventable disease that poses a significant threat to immunocompromised patients. Vaccination rates tend to be low despite recommendations for vaccination in several groups of high-risk patients including any person aged 65 years or older. The purpose of this study was to (a) evaluate the vaccination rates among high-risk patients in a managed care setting in Israel and (b) gain a better understanding of the factors associated with suboptimal use of this vaccine. METHODS: Data were extracted from the electronic medical records of the managed care organization for patients with dates of service from January 2000 to December 2004 for whom the vaccine is recommended. Patients were identified via diagnosis codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Vaccination rates were calculated for patients in each disease category. These high-risk patients were contacted to participate in a telephone survey to evaluate the variance in knowledge and awareness levels of the disease between the vaccinated and unvaccinated patients. RESULTS: A total of 672 patients were identified by the ICD-9-CM codes; 140 (20.8%) had been vaccinated and 532 (79.2%) were unvaccinated. Vaccination rates were highest among patients with solid organ transplants (33.3%), followed by nephrotic syndrome (29.4%), bone marrow transplants (10.2%), and human immunodeficiency virus (HIV, 9%), for an overall rate of 20.8%. Of these patients, survey responses were obtained from 364 (54.2%). Respondents who were unvaccinated tended to be less well informed about which patient populations are at risk for the disease and the availability of the vaccine. CONCLUSIONS: The pneumococcal vaccination rate among immunocompromised patients in this managed care organization was found to be inadequate, at just 20.8% of the target population. Approaches based on direct contact with the patient, such as by a case manager, may be more successful in the future.