Running Head: PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 1

Pneumococcal Vaccine Adults 65 and Older

Erica Pass

Brigham Young University Idaho

NURS 433C Section 1

Sister Call

September 27, 2017

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 2

Pneumococcal Vaccine Adults 65 and Older

Part 1: Defining the Population

In Madison County, located in the state of Idaho, the percentage of adults aged 65 years

and older receiving the pneumococcal vaccination is significantly lower (54.3%) than the health

objective as well as the national average (Community Health Needs Assessment). This is a

community health problem because immunization can decrease the incidences of recurring

diseases in the community at a local, state, and national level. The CDC recommends that all

adults 65 years of age and older should receive the pneumococcal vaccination and are at an

increased risk for developing pneumonia (Centers for Disease Control and Prevention, 2016).

Lack of immunization against pneumococcal disease is a population health concern because

adults, as they grow older, become weaker physically and their immune system becomes less

resistant to disease and infectious organisms. These adults are also considered to be at an

increased risk if they have at least one or more of the following complications: asthma, diabetes,

myocardial infarction, angina or coronary heart disease, current smoker, chronic obstructive

pulmonary disease, emphysema, chronic bronchitis, or cancer, besides skin cancer (Centers for

Disease Control and Prevention, 2016). If older adults in this area are not receiving their

vaccinations, especially those with any of the previous complications listed, then they will be at a

higher risk and more susceptible to obtaining diseases (Lewis, 2014).

The Healthy People 2020 goal for adults aged 65 and older in receiving the

pneumococcal vaccination is 90%. The objective is to increase the percentage of non-

institutionalized adults aged 65 years and older who are vaccinated against pneumococcal

disease (U.S. Department of Health and Human Services, 2014). The main population that will

undergo assessment are adults aged 65 and older located in the Madison County in Idaho. Adults

will be assessed by whether or not they have received their pneumococcal vaccination.
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 3

Madison County is located in southeastern Idaho and has a population of 37,916. It largely

consists of White Americans (95.32%), urban areas (71.54%), and adults aged 18-24 years old

(31.5%) (Community Health Needs Assessment). The population of adults aged 65 and older is

only 6.11% of all citizens in Madison County (Community Health Needs Assessment). The

larger populated city in Madison County is Rexburg and is predominantly urban, but surrounding

the city is mostly rural communities. These communities grow many crops consisting of wheat,

potatoes, and barley. East of Madison County lays the infamous Grand Tetons and Yellowstone

National Park.

Figure 1: Map of Madison County, Idaho (Google).

There is a university located in the center of the county, Brigham Young University-Idaho, and

most of the students occupy the town of Rexburg. Brigham Young University-Idaho is a private
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 4

religious university and attracts many members of the Latter-Day Saint (LDS) faith to the town

of Rexburg. It is mainly because of this university that there are many LDS members and young

adults in the Madison County. There is also an LDS temple located at the southeastern corner of

the university. The temple stands as a landmark in this town and can be seen from the highway

as one is driving by.

Figure 2: Photo taken by Erica Pass.

Since Madison County is a smaller county, there is only one hospital in the Rexburg area

but there are a few clinics, urgent care centers, and specialized health care centers. The city of

Rexburg will often have community events in local parks and on Main Street that are geared

towards families. The local businesses are also catered towards college students, since the

university is central to the city. As mentioned before, the predominant religion is LDS in this

community. Most likely related to this, one will recognize that most of the members of the

community participate in clean, wholesome, recreational activities and hold high morals.
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 5

The adults aged 65 and older in Madison County participate in the local county fairs,

local town events, school events, in the LDS temple, and other public places. This population,

adults 65 years old and older in Madison County, lives in various communities consisting of

apartments, homes, health care centers, assisted living, and rehabilitation facilities. 5.6% of the

households in Madison County consist of someone 65 years of age and older who live alone;

30.5% of the population in Madison County lives below the poverty line and 10.1% of that

includes individuals aged 65 and older (Demographics, 2017).

The plan for generating data will be to interview key informants such as the local health

department in Rexburg, an immunization clinic, and the pharmacy in the local grocery store,

Broulims. Some resources that will be used to collect data for the population will be Healthy

People 2020, the Health Indicators Report through Community Commons, the Vaccination

Coverage Trend Report through CDC, and Idaho Health Behaviors through the Idaho

Department of Health and Welfare.

Part 2: Assessment

The primary data was collected by interviewing key informants consisting of the

following: the pharmacy in the local grocery store, Broulims, an immunization clinic, and the

local health department in Rexburg. The interviews with the pharmacy and immunization clinic,

Seasons Medical, consisted of similar questions, while the interviews with the adults and local

health department varied slightly. The pharmacy at Broulims and the immunization clinic,

Seasons Medical, were asked the following questions:

1. Do you administer the pneumococcal vaccine?

Broulims Pharmacy Seasons Medical Adult Health

Yes, we do administer the pneumococcal Yes we do administer the pneumococcal
vaccine, as well as the other vaccinations vaccine (Anonymous, personal interview,
(Anonymous, personal interview, October October 6, 2017).
11, 2017).
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER
2. Do you keep records of the age groups who receive vaccines?
Broulims Pharmacy
We keep record of every immunization
that we give, so yeah we do (Anonymous,
personal interview, October 11, 2017).
3. Out of the adults aged 65 and older who came to your facility, how many have received
the pneumococcal vaccine?
Broulims Pharmacy
On our computer system, every time
someone comes in over a certain age, it
will pick out certain information sheets. A
lot of those have to do with vaccinations. I
dont remember the pneumonia shot
specifically, but I do know that the shingles
shot does.
Whenever we deal with Medicare or the
flu shot, if they havent had the pneumonia
shot, then itll come up in the system
saying that they may be eligible for the
pneumonia shot. Most of the technicians,
when theyre putting a prescription in for a
flu shot, they will ask the person about the
pneumonia shot (Anonymous, personal
interview, October 11, 2017).
4. Do you advertise for vaccinations?
Broulims Pharmacy
We do. We advertise over the intercom. I
believe there should be a spot on the reader
board outside. And there are a few signs
outside for the flu shot (Anonymous,
personal interview, October 11, 2017).
5. Do you or health care providers encourage customers to get vaccinated?
Broulims Pharmacy
Absolutely. I ask them if they have had
their shot (Anonymous, personal
interview, October 11, 2017).
6
Seasons Medical Adult Health
We do keep records on file of whether
patients get their vaccines but we dont
divide them into age groups or categories
(Anonymous, personal interview, October
6, 2017).
Seasons Medical Adult Health
We dont keep track of whether a certain
age group has or hasnt received their
vaccines. Wed have to get some higher
levels system in order to do that! Adults 65
and older are at a higher risk for pneumonia
but we dont necessarily keep track of who
has or hasnt, especially because some
adults have already gotten the
pneumococcal vaccine through the routine
vaccination schedule (Anonymous,
personal interview, October 6, 2017).
Seasons Medical Adult Health
We dont advertise for pneumonia
because its not as common. We do
advertise for the flu shot as we get the
change of seasons (Anonymous, personal
interview, October 6, 2017).
Seasons Medical Adult Health
Health care providers do encourage adults
to get vaccinated if they recognize that the
patient hasnt received their vaccines
(Anonymous, personal interview, October
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 7

6, 2017).

The local health department in Rexburg was asked the same five questions as mentioned above

with some other additional questions:

1. Do you administer the pneumococcal vaccine?

Local Health Department - Rexburg

Yes we administer the Prevnar 13 and the pneumococcal 23 (Anonymous, personal
interview, October 11, 2017).

2. Do you keep records of the age groups who receive vaccines?

Local Health Department - Rexburg

Every month we are given a list of people who are in need of the shingles vaccine, so I
think they were thinking of pulling the report for people over 65 who havent received
their vaccine so we can contact them. Any client that comes in to see us, we keep a
record of their vaccines (Anonymous, personal interview, October 11, 2017).

3. Out of the adults aged 65 and older who come to your department, how many have

received the pneumococcal vaccine?

Local Health Department - Rexburg

Anyone who comes to us, we have their vaccine, but if they go to their pharmacy to get
them, we can access them in IRIS. Its a vaccination record; its the Idaho vaccination
reminder system. We have access to look at it if they ever wonder if they have gotten it or
not but if they havent come here, then we wouldnt keep record of it (Anonymous,
personal interview, October 11, 2017).

4. Do you advertise for vaccinations?

Local Health Department - Rexburg

Yes. Weve got some signs that we put out every once in a while. We also have our
Facebook page that our Idaho Falls office is in charge of. They put reminders on there
and when were holding free clinics or walk-in clinics and things like that. We also have
what we call our rat cards. It basically tells you all of the programs we have available and
how to contact people. We put that a lot of the times in the newspaper because we have
found that those older populations still read the newspaper and like looking at it. Ive also
heard on the radio reminders about different vaccinations. We try to get it out there!
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 8

(Anonymous, personal interview, October 11, 2017).

5. Do you encourage customers to get vaccinated?

Local Health Department - Rexburg

Any time that they come in, we do offer it. We let them know its available and we let
them know whats recommended for their age group and if theyre going on a trip, whats
recommended for their trip. We never try to convince them or coerce them or anything.
We definitely let them know whats recommended and let them choose; we give them a
lot of information about the vaccines and try to give them reliable resources where they
can read about the vaccines and information about those vaccines. We refer a lot of
people to our website. We get a lot of information from the CDC website, which is
Centers for Disease Prevention and Control; on there it has all of the VISs which has all
of the vaccine information sheet which is what you normally get when you get vaccines
at the doctors. It just has what the vaccine is, whats recommended, who should get it,
who shouldnt get it, what reactions youd expect if you have reactions and things like
that (Anonymous, personal interview, October 11, 2017).

6. Is the local health department aware about the low proportion of adults aged 65 and older

in Madison County in getting the pneumococcal vaccination? How do you stay up-to-date

with these kinds of health issues?

Local Health Department - Rexburg

Its kind of hard to keep track of it. We do see a lot of 65 and older that get the vaccines
here, but its hard to keep track of where they get it and when they get it. Sometimes
theyll go to the pharmacy and the pharmacies arent required to upload to IRIS so theres
no way to know if they actually got it. And I dont think the pharmacies keep track like
we would of the records. So if they got it, its their responsibility to keep track of it or get
record of it in order to have that record, or else were in kind of limbo.

Me: So its almost a lack of documentation?

Local Health Department: Thats kind of how I feel. Its hard to track it down or a lot of
these individuals think they got it somewhere when they actually got it somewhere else
so its hard to find where they got itfor reals.
The Prevnar 13 was just more recently recommended to ages 65 and older so theyre
recommended to have 2 doses of the pneumonia. That first one they get is the Prevnar 13,
which you normally get as a baby and then they would get the pneumococcal 23. So it
just gives them a boost of both of those vaccines and then theyre good for life, unless
they have some sort of chronic pneumonia or other reasons their doctor would want them
to have any other boosters (Anonymous, personal interview, October 11, 2017).
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 9

7. What do you think influences older adults (65 and older) to not get vaccinated?

Local Health Department - Rexburg

A lot of them dont know or they think they got it but they actually got something else
so they just dont know where to go or how to figure it out, so they just give up. Or we do
even have a population that doesnt even like vaccines so they just dont want to get
poked anymore! Theyll think, Oh Im healthy, Ill be alright, so they just dont get the
vaccines. But I think a lot more error on the side of Id rather get it than not is what
weve noticed. Mostly, I would say is they dont know that theyve had it so they just
dont get it again; so theyre afraid of having more than the recommended dose, I guess,
cause theyre afraid to get it a second time. But it really wont hurt them, itll just give
them more protection (Anonymous, personal interview, October 11, 2017).

The secondary data consists of data regarding vaccine recommendations, statistics, and

local, state, and national information in relation to the pneumococcal vaccine.

Recommendations were gathered in regards to the pneumococcal vaccination for adults

aged 65 and older. The Center for Disease Control and Prevention (CDC) states that:

As we get older, our immune systems tend to weaken over time, putting us at higher risk

for certain diseases. This is whyyou should also get pneumococcal vaccines, which

protect against pneumococcal disease, including infections in the lungs and bloodstream

(recommended for all adults over 65 years old) (2017).

In addition to this statement, the CDC also lists specific health conditions that place adults older

than 65 years old at increased risk for contracting pneumonia:

Pneumococcal vaccination is recommended forall adults aged 65 years and older. In

2008-2010, adults were considered at increased risk for pneumococcal disease or its

complications if they self-reported one or more of the following: 1) having current

asthma; 2) ever being told by a health professional they have diabetes, myocardial

infarction, angina or coronary heart disease; or 3) being a current smoker. In 2011-2015,

adults were considered at increased risk for pneumococcal disease if they self-reported

any of the previous conditions, or self-reported ever being told by a health professional
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 10

they have chronic obstructive pulmonary disease, emphysema, or chronic bronchitis, or

cancer (excluding skin cancer) (2016).

Local:

The Public Health Department of Madison County performed a health and wellness

assessment for adults aged 65 and older who had received the pneumococcal vaccination. The

department reported that only 54.3% had received the vaccine (Public Health: Idaho Public

Health Districts, 2017).

Figure 3: The Public Health Department of Madison County, Idaho

reported that 54.3% of adults 65 and older had received the
pneumococcal vaccination (Public Health: Idaho Public Health
Districts, 2017).

State:

The Bureau of Vital Records and Health Statistics, Division of Public Health, and Idaho

Department of Health and Welfare compiled a report consisting of the results from Idahos

Behavioral Risk Factor Surveillance System (BRFSS). Towards the end of the report, in

Appendix A, they recorded questionnaires of health concerns in the state of Idaho. One of the

questions about pneumonia asks citizens of Idaho if they had ever received the pneumonia shot.

33.1% reported that they had received the shot, while the majority, 66.9%, reported they had

never received the pneumonia shot (2017).

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 11

Figure 4: Screenshot of question about pneumonia vaccination in the state of

Idaho from the Idaho Health Behavior Results of 2015, from page 75 of the
report (Bureau of Vital Records and Health Statistics, 2017).

National:

Community Commons performed a Health Indicators Report for adults aged 65 and older

who self-reported that they had received the pneumococcal vaccine. They included a comparison

chart of the percentages of these adults who had received the vaccine from the local, state, and

national reports.

Figure 5: This represents the Community Health Needs Assessment Indicator Report of adults aged 65 and older who had
self-reported receiving the pneumococcal vaccination (Community Health Needs Assessment).

Community Commons clarified various factors that could have influenced these results by

mentioning the following statement:

This indicator is relevant because engaging in preventive behaviors decreases the

likelihood of developing future health problems. This indicator can also highlight a lack

of access to preventive care, a lack of health knowledge, insufficient provider outreach,

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 12

and/or social barriers preventing utilization of services (Community Health Needs

Assessment).

This table illustrates the population of adults aged 65 and older in Madison County, Idaho, and

how many adults in that population had received the pneumococcal vaccination. In comparison

to the state of Idaho and even the United States, Madison County is behind in the maintenance of

receiving the pneumonia vaccine. As Community Commons mentioned, many factors can

influence the determination of adults in receiving their vaccinations.

Part 3: Data Interpretation

When the key informants were interviewed, there were similarities as well as differences

amongst them. There are many potential factors that could result in the discrepancy of older

adults receiving the pneumococcal vaccination in Madison County. It could be related to the

healthcare system in Madison County, the possible miscommunication between health care

facilities in record keeping, or many other reasons throughout the healthcare system. Some

similarities between the key informantsBroulims pharmacy, Seasons Medical, and the local

health departmentconsisted of the access to the vaccines, access or lack of access to the

patients immunization history, and that each healthcare facility encourages patients to receive

their vaccinations.

Broulims, Seasons Medical, and the local health department each administer the

pneumococcal vaccination as well as keep records of those who have received it; that is, if they

have received it in Madison County. If a member of the community received the pneumococcal

vaccine in Madison County, then the healthcare facilities keep record of the immunization in

their electronic system, IRIS. IRIS is the Idahos Reminder Information System where healthcare

facilities and providers can keep record of their health records as well as immunization records in

case a patient ever wonders if they have received a particular vaccine or not. If a member of the
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 13

community has not received their vaccinations in Madison County or Idaho, then the healthcare

facilities will not have access to their records.

This was a common theme between the key informants: the limited access to the patients

immunization history. As the local health department reported, A lot of them dont know or

they think they got it but they actually got something else so they just dont know where to go or

how to figure it out, so they just give up (Anonymous, personal interview, October 11, 2017). In

the vaccination schedule for infants, it is recommended that infants receive the pneumococcal

vaccination at 2 months, 4 months, 6 months, and again between 12 and 15 months of age

(Centers for Disease Control and Prevention, 2017).

Figure 6: Recommended immunization schedule for children from birth to 6 years old (Centers for Disease Control and
Prevention, 2017).

This vaccination schedule supports the complicated processes of identifying which adults have or

have not received the pneumococcal vaccination. After receiving vaccinations, parents receive an

immunization record card that lists the vaccinations their child has received and when they were
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 14

administered. If these cards are lost, damaged, or thrown away, then one may not have access to

what infectious diseases they are immunized from. The local health department also made

mention of older adults not wanting to get the vaccination again or not wanting to have more

than the recommended dosage of a vaccination. These factors lead to the reduction of adults aged

65 and older in being up-to-date with their vaccinations, specifically the pneumococcal vaccine.

Another similarity between the healthcare facilities is that the healthcare providers in the

facilities and the facilities themselves encourage customers and patients to get vaccinated. A

pharmacist in the Broulims pharmacy reported that they ask customers if they have received

their shots and Seasons Medical made mention that the healthcare providers will encourage

patients to get vaccinated if they recognize they have not been vaccinated. The local health

department seemed to take it a step further by informing them that vaccinations are available and

what is recommended for their age group; they also educate them about receiving vaccines if

they are about to leave for a trip out of the country. In addition, the local health department will

guide customers to reliable resources, such as the Eastern Idaho Public Health (EIPH) and Center

for Disease Control & Prevention (CDC) websites. These websites provide information where

they can learn more about the vaccines, what is recommended, who should and should not

receive it, why it is given, and what reactions to expect, so that the individual can make an

informed decision on their own.

There were a few similarities between the key informants, but there were also a few

differences ranging from the advertisements for vaccinations, the reports of the record keeping

system, IRIS, and the percentage of older adults receiving the pneumococcal vaccination in the

state of Idaho. When the key informants were asked if they advertise for vaccinations, some

reported that they did not and another reported that they did. Broulims pharmacy described that

they advertise for vaccinations through the intercom, the reader board in front of the grocery
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 15

store, and signs along the building outside, for the flu shot; Broulims did not make mention of

advertising for the pneumococcal vaccination, specifically, though. Seasons Medical was similar

to Broulims. They reported that they do not advertise for pneumonia vaccinations since it is not

as prominent in the community as compared to influenza. Seasons Medical does, though,

advertise for the community to receive the flu shot as they experience the change of seasons.

Similar to what was mentioned before, the local health department advertises considerably more

when compared to the pharmacy and clinic. The local health department explained that they

would place signs outside the building every once in a while, post on their Facebook page,

provide announcements through the radio, and even put reminders in the newspaper. On the

Facebook page, they would post reminders about free clinics or walk-in clinics for vaccinations.

The health department recognizes that adults aged 65 and older are at a higher risk for

pneumonia and have a lower percentage for receiving the associated vaccination. For this reason,

the health department will post ads in the newspaper, in hope to reach the population of older

adults who continue to read the newspaper. Although the key informants are consistent in

encouraging the community to receive vaccinations, some fall short of advertising the

vaccination in the community, which could remind more members of the community about the

access to vaccinations, rather than just those who are patients of the pharmacy and clinic.

IRIS appears to be the system used throughout the state of Idaho for healthcare records

and for this circumstance, immunization records. When asked if they keep track of the adults

who have received the pneumonia vaccine, Broulims responded that with their system, it will

identify patients who have not yet received their vaccinations, even if that is not what they are

visiting the pharmacy for. The difference with this information, though, is what the local health

department explained about IRIS. When the health department was asked how they stay up-to-

date with health issues, especially being immunized against pneumonia, they responded that
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 16

when a patient receives a vaccine from a pharmacy, the pharmacies are not required to upload it

to IRIS, which could lead to many errors throughout the record keeping system. If the health

department is correct when they state that pharmacies are not staying current with the records,

then this could result in a lack of documentation, which would place the patients in a situation

where they would have to keep a personal record on their own for their immunizations. With this

situation, it is not necessarily analyzing who is to blame, but rather to identify the discrepancy of

communication and maintaining records throughout the healthcare system in Madison County.

Another difference between the Bureau of Vital Records and Health Statistics and the

Community Health Needs Assessment websites was the percentage of adults aged 65 and older

who had received the pneumococcal vaccine at the state level. The Community Health Needs

Assessment compared the county, state, and nations percentage of the pneumonia vaccine; they

reported 66.2% of those adults in the state of Idaho had received the vaccination (Community

Health Needs Assessment). The Bureau of Vital Records and Health Statistics conducted a

survey for the same population in receiving the pneumonia shot and reported that only 33.1%

responded that they had received it (Bureau of Vital Records and Health Statistics, 2017).

Figure 7: (Left) Statistical report for adults aged 65 and older in receiving the pneumonia shot at the Idaho state level. The
compared statistic was circled to identify the discrepancy (Bureau of Vital Records and Health Statistics, 2017).

Figure 8: (Right) Statistical reports for adults aged 65 and older in receiving the pneumonia vaccine at the local, state, and
national level. The compared statistic was circled to identify the discrepancy (Community Health Needs Assessment).

As identified and discussed, there are discrepancies throughout the healthcare system in

Madison County. The discrepancies can be as a result of the healthcare system itself and how it
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 17

is operated or because of those who manage it and the miscommunication. Regardless, there are

some strengths and challenges for this population of older adults aged 65 and older.

There are some strengths in this population for improving the percentage of adults in

receiving their pneumonia vaccine that consist of the following:

Healthcare facilities contain some sort of record keeping system that not only keeps records

of those who have received their vaccinations, but also reminds the facility of those who are

eligible to receive a vaccination

The local health department has identified the population of adults 65 and older at risk for

more diseases, including pneumonia, and has worked towards publicizing the availability of

the pneumonia vaccine

Each healthcare facility encourages as well as administers the pneumococcal vaccine. An

older adult who is in need of the pneumococcal vaccine has the opportunity to visit most of

the healthcare facilities in Madison County and be able to receive vaccinations

Some challenges in the population entail factors that reduce the likelihood of older adults

to receive the pneumococcal vaccine or puts them at a greater risk in contracting pneumonia such

as:

Older adults are at a higher risk for contracting infectious diseases due to the weakening

of their immune system (Lewis, 2014)

If adults received their vaccinations from a different area or state then it is more

challenging to identify which diseases the individual is immunized from

Older adults are also at a higher risk for neglect, referring to a lack of services that are

necessary for the physical and mental health of an individual by the individual or a

caregiver (Rubenstein, 2014)

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 18

For this population specifically, older adults aged 65 and older, there was significant

information and data found to validate that the lack of the pneumococcal vaccine in these adults

is a public health issue:

Out of the adults aged 65 and older in Madison County, only 54.3% had reported that

they had received the pneumococcal vaccination

The older adults and elderly are placed at a higher risk for developing infectious diseases,

emphasizing the need for current immunizations to prevent these diseases

Community-acquired pneumonia (CAP) is the sixth leading cause of death for people

ages 65 years or older in the United States (Mathers, 2014)

Part 4: Population Health Plan

When analyzing the data that was gathered and generated and then interpreting the

results, it can be identified that there are strengths in the Madison County health community as

well as challenges. For this reason, a specific health care plan needs to be created and

implemented to improve the following areas:

1. Communication: Among the health care providers and facilities that offer vaccinations, there

is a discrepancy in communication. The discrepancy arises somewhere when using the record-

keeping system, IRIS. As mentioned in Part 2, the health care department reported that some

pharmacies are not required to upload information to IRIS. This part of the interview was not

elaborated on but it alludes to the fact that IRIS might not contain all of the records for the

administered vaccinations.

Some recommendations to enhance communication amongst health care providers and

facilities in Madison County would be to (1) initiate a town or health care facility meeting, (2)

redefine the IRIS purpose and goal for each health care facility so as to better understand the

system, and (3) analyze and review the documentation requirements for all health care facilities
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 19

in Madison County. Initiating a town or health care facility meeting can enhance communication

by each health care facility explaining their own process of administering vaccines, advertising

for vaccines, encouraging clients to review their immunization schedule, asking them to identify

discrepancies, and documenting vaccinations given. This way, other health care facilities can

identify ways to improve their own systematic process with vaccinations. In a meeting setting,

other concerns can also be discussed and reviewed so as to ensure the community receives

quality health care. IRIS is the record-keeping system for the state of Idaho, but it might not

contain all of the records for the administered vaccines. If some facilities are not required to

document or upload records of administered vaccines, then a major miscommunication can result

amongst the other health care facilities. One idea to resolve this issue is to remind and re-educate

health care facilities about the IRIS system and ensure understanding of its purpose. Along with

this, there needs to be a re-evaluation of how documentation occurs in each health care facility.

When each health care facility is aware of the need to document records through the same

system, then communication will be enhanced and members of the community who have not

received the pneumococcal vaccine can be readily identified.

These recommendations can be evaluated for their effectiveness by (1) surveying health

care facilities about their knowledge and awareness of documentation and charting, (2)

determining if there has been an increase in records for vaccines through IRIS, and (3) receive

feedback from the different health care facilities about the town meeting and discuss whether it

was beneficial and has improved communication. When communication increases between

individuals, processes and procedures tend to run smoother and be more efficient. As a result of

increased communication, health care providers will be enabled to identify individuals who have

not received their pneumonia shot and can subsequently encourage or remind them about their

lack of immunization. Another result of improving communication is increasing confidence in

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 20

the quality of documentation and charting. Documentation is an essential aspect of health care

and should be a standard among every health care facility. If communication and documentation

is improved, then health care facilities can be more confident in their records and then identify

other ways to improve the administration of vaccines for the community.

2. Education: In the Bureau of Vital Records and Health Statistics, the questionnaire made

mention of asking adults whether or not they had received the pneumonia shot; however, they

also felt the need to reiterate what the pneumonia shot is. A pneumonia shot or pneumococcal

vaccine is usually given only once or twice in a persons lifetime and is different from the flu

shot. Have you ever had a pneumonia shot? (Bureau of Vital Records and Health Statistics,

2017). It is important to ensure understanding so as to not confuse important health care matters,

but it also introduces a potential lack of knowledge about the pneumococcal vaccine.

Recommendations to propose teaching methods amongst the adults aged 65 and older in

Madison County would be to (1) advertise and direct clients to the public health departments

website, (2) provide informational classes in group settings, and (3) offer vaccine information in

the newspaper. During the anonymous interview, the public health department reported that they

have a website to inform the community about public health issues, one of those issues being

vaccinations. The public health department retrieves their information from the CDC website,

which provides information about what the disease is, what the vaccine to prevent it is, what the

recommendation is, who should not receive the vaccine, who should receive the vaccine, and

adverse reactions to the vaccine, if there are any. Health care providers can direct clients aged 65

and older to these websites or even review it during the visit to ensure that the client has at least

viewed the website and has more knowledge about the vaccines. Another way to educate this

population is to provide community classes about vaccines and inform the community about the

vaccine, similar to what would be taught through the website method. The public health
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 21

department also recognized that adults aged 65 and older might still read the newspaper as

compared to younger adults. For this reason, health information could be provided in the

newspaper so as to educate this target population.

Education can be a difficult intervention to measure to validate its effectiveness. It would

still be worthwhile, though, because it could potentially increase the amount of adults who

receive the pneumococcal vaccine. In order to determine if the teaching methods were successful

or not, the county can (1) keep record of who attends the informational community classes, (2)

identify how many individuals view the vaccination webpage, and (3) assess where adults

received their awareness of the pneumococcal vaccine. Oftentimes, barriers exist between

patients and their access to health care. One of those barriers can be health literacy. Some

individuals may not be aware of what services are offered, what the different vaccines are, or the

benefits of being immunized. Educating the community about vaccines can increase the amount

of vaccines administered as well as simply enabling the community to make an informed

decision of whether or not theyd like to be immunized.

3. Determining which diseases one is already immunized from: The public health department

mentioned in the anonymous interview that adults, 65 and older, often do not have access to their

immunization record if they had received a vaccine; the individual may have lost his or her

immunization card or it could have been misplaced throughout aging and moving. In addition,

older adults may have forgotten where and when they were vaccinated. This can also lead to a

reduction in receiving the pneumonia vaccine because some adults would rather not receive more

than the recommended dose of the vaccine or may disprove the idea of getting poked again.

Some recommendations to determine which diseases an individual is immunized from

would be to (1) ask if the client or patient still possesses his or her immunization record through

personal baby books or other personal documents and (2) provide a new immunization card
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 22

containing up-to-date vaccination records. This area of improvement can potentially be difficult

to improve and identify for each client in the county. Facilities can first assess if the client still

has his or her immunization record; this can eliminate further investigations of whether or not

they are immunized. Some adults may refuse the idea of receiving another vaccination, simply to

have the record on file. Adults should be reminded that although it is not ideal, it is still safe to

receive a vaccine again (Centers for Disease Control and Prevention, 2016). Receiving a vaccine

again can only ensure immunization from many infectious diseases.

These recommendations would need to be evaluated by (1) assessing if clients have

found their immunization record and (2) identify the number of new immunizations and

immunization cards administered. Although these methods could be difficult to initiate, it would

ensure immunization and lack of immunization. The patient would then be able to be reminded

of and more aware of their immunization record if they were to move or lose their record again.

Conclusion:

Adults aged 65 and older in Madison County are at risk for contracting pneumonia due to

their lack of immunization through the pneumococcal vaccine. They are placed at a higher risk

due to the weakening of their immune system and also to the fact that pneumonia is the sixth

leading cause of death for this age group. Through gathered and generated data, weaknesses and

certain aspects of the health care system in Madison County have been identified that could

contribute to the lack of the pneumococcal vaccine being administered. A few of the aspects of

health care that need improvement is the communication between health care facilities, education

of the older adult population, and access to immunization records. The Healthy People 2020 goal

for older adults in receiving the pneumonia shot can be reached if these specific parts of the

health care system are improved.

Reflection
PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 23

Throughout writing this paper, I was able to realize the different errors that can occur in

the health care system. Oftentimes when a problem is discovered, its easy to quickly blame one

specific aspect of health care; however, I have learned that it is not necessarily one sole

contributor, but rather multiple contributions from different aspects of health care. I can use this

realization and learning experience by recognizing that the health care system in many

communities can have many strengths but also weaknesses that can lead to deficits in health care.

When this is recognized, I can realize that there are many areas for improvement and I can take

action to help facilitate the movement to improve. This motivation to improve the health care

system can improve the lives of others in many ways, depending on the specific health care issue

in the community. I can specifically use communication and education to provide the necessary

resources for individuals and members of the community. Before working on this project, I

didnt think much about the health of the community but rather focused more on the health of the

individual. My thought process has definitely changed once realizing that the health of the

individual can directly affect the health of the community. This has motivated me to assess other

areas of health care in different communities that I may decide to live in sometime in the future.

This not only helps me determine if it would be a safe and healthy environment for myself and

my family, but it can also help me recognize what kind of individuals I would be caring for in the

health care environment.

PNEUMOCOCCAL VACCINE ADULTS 65 AND OLDER 24

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