Immunization Disparities in Long-Term Care Facilities

Although the Advisory Committee for Immunization Practices (ACIP; https://1.usa.gov/ACIPVaccinations) recommends annual flu shots for all residents of long-term care facilities, vaccination gaps remain. For instance, Black residents are significantly less likely to get immunized than white residents, with studies finding a roughly 8% gap between immunization rates for white and for black residents. Why this gap persists hasn’t been clear. Studies that have examined overall immunization rates in long-term care, however, have found that certain policies and practices are associated with higher overall vaccination rates.

Now, a study published in the April issue of the Journal of the American Geriatrics Society (JAGS; www.ncbi.nlm.nih.gov/sites/entrez/21438863) finds that these same policies and practices may also help narrow the racial gap in influenza vaccination. In the study, Barbara Bardenheier, PhD, MPH, MA, of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, and coauthors, analyzed data from the 2004 National Nursing Home Survey (www.cdc.gov/nchs/nnhs.htm), which included more than 1100 nursing homes and more than 13,000 residents. In facilities that had adopted particular immunization policies and practices, Bardenheier and coauthors found that vaccination rates were higher for both white and black residents, and the racial vaccination gap was either small or insignificant.

These facilities had standing orders for influenza vaccinations, allowed verbal consent for vaccination, and routinely reviewed facility-wide vaccination rates. Facilities that did not follow these practices had lower overall vaccination rates and statistically significant racial vaccination gaps. In facilities that had standing orders for influenza vaccinations, 67.7% of white residents and 61.6% of black residents were vaccinated, compared with 61.5% and 50.9%, respectively, in facilities that did not have standing orders for influenza vaccinations. Vaccination coverage was similar but lower for the other two vaccination practices (ie, allowance of verbal consent for vaccinations and routine review of facility-wide vaccination rates).

Approximately 40.7% of the nursing homes included in the survey had adopted standing orders for influenza vaccinations. Because the study dates to 2004, additional research aimed at determining whether more nursing homes have instituted these strategies is needed, Bardenheier and coauthors wrote. “One key to improving vaccination outcomes and reducing racial inequities is to identify ways to assist nursing homes in effectively implementing such strategies as standing orders for vaccination, policies for verbal consent, and routinely reviewing facility vaccination,” Bardenheier and coauthors concluded. “Understanding to what extent internal facility barriers exist and how to effectively modify barriers, such as lack of support from facility leadership, high staff turnover rate, inadequate staffing, and lack of an immunization tracking system, are needed.”

Attending the American Geriatrics Society (AGS) 2011 Annual Meeting? Visit Annals of Long-Term Care: Clinical Care and Aging at the AGS Marketplace, May 11-14, Gaylord National Hotel & Convention Center, Suburban Washington, DC.