Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project

Abstract

Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. Aims: To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). Methods: A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients (n = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients (n = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). Results: More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Conclusions: Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.

Keywords

health services patient satisfaction quantitative research serious mental illness

Get full access to this article

View all access options for this article.

References

Alpert

P. T.

(2015). Adults need immunizations too: Strategies to increase rates. Home Health Care Management & Practice, 27(1), 41-43. doi:10.1177/1084822314537071

Breivik

(2015). Herpes zoster immunization in older adults has big benefits. Journal of Pain & Palliative Care Pharmacotherapy, 29, 188-200. doi:10.3109/15360288.2015.1037525

Bridges

C. B.

Coyne-Beasley

(2014). Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older: United States, 2014. Morbidity & Mortality Weekly Report, 63(5), 112-115.

Carney

C. P.

Jones

Woolson

R. F.

(2006). Medical comorbidity in women and men with schizophrenia: A population-based controlled study. Journal of General Internal Medicine, 21, 1133-1137. doi:10.1111/j.1525-1497.2006.00563

Carra

Bartoli

Carretta

Crocamo

Bozzetti

Clerici

Bobbington

P. E.

(2014). The prevalence of metabolic syndrome in people with severe mental illness: A mediation analysis. Social Psychiatry & Psychiatric Epidemiology, 49, 1739-1746. doi:10.1007/s00127-014-0835-y

Castillo

Rosati

Williams

Pessin

Lindy

(2015). Metabolic syndrome screening and assertive community treatment: A quality improvement study. Journal of the American Psychiatric Nurses Association, 21, 233-243. doi:10.1177/1078390315598607

Centers for Disease Control and Prevention. (2008). Vaccination coverage among U.S. adults: National Immunization Survey. Retrieved from http://www.cdc.gov/vaccines/stats/nis-adult-summer-2007.pdf

Centers for Disease Control and Prevention. (2010). Advisory committee on immunization practices: Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine. Morbidity and Mortality Weekly Report, 59(34), 1102-1106. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm

Centers for Disease Control and Prevention. (2011). Vaccine information statements. Retrieved from https://www.cdc.gov/vaccines/hcp/vis/index.html

10.

Centers for Disease Control and Prevention. (2012). Advisory committee on immunization practices morbidity and mortality weekly report: Recommended adult immunization schedule. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a9.htm

11.

Centers for Disease Control and Prevention. (2016). Guidelines and publications for immunization managers. Retrieved from https://www.cdc.gov/vaccines/imz-managers/guides-pubs/index.html

12.

Centers for Medicare and Medicaid Services. (2018). Immun-izations. Retrieved from https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html

13.

Centers for Disease Control and Prevention. (2019). Adult vaccination resources: Adult vaccination patient handouts. Retrieved from https://www.cdc.gov/vaccines/hcp/adults/for-patients/adults-all.html

14.

Clubhouse International. (2016). What we do. Retrieved from http://clubhouse-intl.org/what-we-do/overview/

15.

Decoux

(2005). Acute versus primary care: The health care decision making process for individuals with severe mental illness. Issues in Mental Health Nursing, 26, 935-951. doi:10.1080/01612840500248221

16.

Druss

B. G.

Marcus

S. C.

Campbell

Cuffel

Harnett

Ingoglia

Mauer

(2008). Medical services for clients in community mental health centers: Results for a national survey. Psychiatric Services, 59, 917-920. doi:10.1176/ps.2008.59.8.917

17.

Goad

J. A.

Taitel

M. S.

Fensterheim

L. E.

Cannon

A. E.

(2013). Vaccinations administered during off-clinic hours at a national community pharmacy: Implications for increasing patient access and convenience. Annals of Family Medicine, 11, 436-443. doi:10.1370/afm.1542

18.

Iitis

Misra

Dunn

Brown

Campbell

Earll

. . . DuBois

(2013). Addressing risks to advance mental health research. Journal of American Medical Association, 70, 1363-1371.

19.

Jeste

Depp

Palmer

(2006). Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: An overview. Schizophrenia Bulletin, 32(1), 121-128.

20.

Johnson

D. R.

Nichol

K. L.

Lipczynski

(2008). Barriers to adult immunization. American Journal of Medicine, 121(7), S28-S35. doi:10.1016.j.amjmed.2008.05.005

21.

Kaufman

E. A.

McDonell

M. G.

Chistofalo

M. A.

Ries

R. K.

(2012). Exploring barriers to primary care for patients with severe mental illness: Frontline patient and provider accounts. Issues in Mental Health Nursing, 33, 172-280. doi:10.3109/01612840.2011.638415

22.

Lin

M. T.

Burgess

J. F.

Carey

(2012). The association between serious psychological distress and emergency department utilization among young adults in the USA. Social Psychiatry and Psychiatric Epidemiology, 47, 939-947. doi:10.1007/s00127-011-0401-9

23.

Lorenz

R. A.

Norris

M. M.

Norton

L. C.

Westrick

S. C.

(2013). Factors associated with influenza vaccination decisions among patients with mental illness. International Journal of Psychiatry in Medicine, 46(1), 1-13. doi:10.219/PM.46.1a

24.

Mangurian

Giwa

Shumway

Fuentes-Afflick

Perez-Stable

E. J.

Dilley

J. W.

Schillinger

(2013). Primary care providers’ views on metabolic monitoring of outpatients taking antipsychotic medication. Psychiatric Services, 64, 597-599. doi:10.1176/appi.ps.002542012

25.

National Foundation for Infectious Diseases. (2008). Saving lives: Integrating vaccines for adults into routine care. Bethesda: MD: Author

26.

National Institute of Mental Health. (2014). Serious mental illness among U.S. adults. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml

27.

Ngamruengphong

Horsley-Silva

J. L.

Hines

S. L.

Pungpapong

Patel

T. C

Keaveny

A. P.

(2015). Educational intervention in primary care residents’ knowledge and performance of hepatitis B vaccination in patients with diabetes mellitus. Southern Medical Journal, 108, 510-515. doi:10.14423/SMJ.0000000000000334

28.

Rittle

Lang

Y. C.

Wenskovitch

J. E.

(2014). Tdap: The need to educate and immunize. Workplace Health and Safety, 62, 475-483. doi:10.3928/21650799-20140909-01

29.

Rockwell

P. G.

(2015). What you can do to improve adult immunization rates. Journal of Family Practice, 64, 625-633.

30.

Savoy

(2016). ACIP releases 2016 adult immunization recommendations. American Family Physician, 93, 318-320.

31.

Seminog

O. O.

Goldacre

M. J.

(2013). Risk of pneumonia and pneumococcal disease in people with severe mental illness: English record linkage studies. Thorax, 68, 171-176. doi:10.1136/thoraxjnl-2012-202480

32.

Shefer

Briss

Rodewald

Bernier

Strikas

Yusuf

Hinman

(1999). Improving immunization coverage rates: An evidence-based review of the literature. Epidemiological Reviews, 21(1), 96-142.

33.

Sowers

Arbuckle

Shoyinka

(2016). Recommendations for primary care provided by psychiatrists. Community Mental Health Journal, 52, 379-386. doi:10.1186/s12913-016-1768-9

34.

Tosh

Clifton

Bachner

(2014). General physical health advice for people with serious mental illness. Cochrane Database of Systematic Reviews, (3), CD008567. doi:10.1002/14651858.CD008567

35.

U.S. Department of Health and Human Services. (2017). Healthy People 2020: Immunization and infectious diseases. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=23

36.

Utah Bureau of Epidemiology. (2012). Pertussis weekly summary. Retrieved from http://health.utah.gov/epi/diseases/pertussis/index.html

37.

Van Hasselt

F. M.

Krabbe

P. F.

Postma

M. J.

Loonen

A. J

. (2015). Evaluation of health promotion programmes in severe mental illness: Theory and practice. International Journal of Methods in Psychiatric Research, 24(1), 83-97. doi:10.1002/mpr.1456

38.

Van Hasselt

F. M.

Oud

Loonen

A. J

. (2013). Improvement of care for the physical health of patients with severe mental illness: A qualitative study assessing the view of patients and families. BMC Health Services Research, 13. doi:10.1186/1472-6963-13-426

39.

Van Hasselt

F. M.

Schorr

S. G.

Mookhoek

E. J.

Brouwers

Loonen

A. J.

Taxis

. (2013). Gaps in health care for the somatic health of outpatients with severe mental illness. International Journal of Mental Health Nursing, 22, 249-255. doi:10.1111/j.1447-0349.2012.00859

40.

Walter

W. W.

Peng-Jun

O’Halloran

Kim

K. K.

Grohskopf

L. A.

Pilishvili

. . . Bridges

C. B.

(2016). Surveillance of vaccination coverage among adult populations: United States, 2014. Surveillance Summaries, 65(1), 1-36.

41.

Wright-Berryman

Hea-Won

(2016). Physical health decision-making autonomy preferences for adults with severe mental illness in integrated care. Journal of Social Service Research, 42, 281-294. doi:12.1080/01488376.2015.1093580