Using Phone Call Reminder to Increase Pneumococcal Vaccination in Adult COPD Patients

Using Phone Call Reminder to Increase Pneumococcal Vaccination in Adult COPD Patients
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Using Phone Call Reminder to Increase Pneumococcal Vaccination in Adult COPD patients
Chronic obstructive pulmonary disease (COPD) is a chronic illness that is marked by a dysfunction of the airways or alveolar following exposure to hazardous fumes or particulates leading to continual airflow obstruction or respiratory symptoms (Ignatova, Avdeev, & Antonov, 2021). While the condition is preventable and treatable, the periodic exacerbations lower the quality of life and could lead to unwanted outcomes, mortality, and morbidity (Ignatova, Avdeev, & Antonov, 2021). An evidence-based approach used to minimize the likelihood of COPD exacerbation is the use of influenza vaccination at the Evidence A level as it minimizes hospitalization and mortality rates, and the use of the pneumococcal vaccine at the Evidence B level as it prevents the development of pneumonia in adult COPD patients (Ignatova, Avdeev, & Antonov, 2021). Despite the existence of evidence indicating that vaccination is an effective preventive measure that can minimize the exacerbations of COPD and lower the likelihood of contracting pneumonia, the uptake of the vaccine remains suboptimal. 
Description of the Problem
Research has shown that a pneumococcal vaccine is an effective approach for reducing the likelihood of pneumonia infections in adult COPD patients but their uptake remains dismal. A study by Fekete et al. (2020) showed that the uptake of the pneumococcal vaccine among adult COPD patients was 10 percent, while that of influenza vaccination was at 23.6 percent despite the evidence of the significant protective effect of the two vaccines in adult COPD patients. Based on the Centers for Disease Control’s (2022) data on the prevalence of COPD, the prevalence of the disease has remained unchanged between 2011 and 2020. The overall age-adjusted prevalence of the disease was 5.6, with the prevalence being significantly higher in women than in men.
Significance of the Problem
Notably, the death rate due to COPD has reduced from 123.9 per 100,000 reported in 1999 to 105.6 per 100,000 reported in 2019, with mortality in men being higher compared to the women population (CDC, 2022). The figures are in line with studies that have placed chronic lower respiratory disease including COPD as the fourth leading cause of mortality in the United States in 2019 (Wise, 2022). The death rate associated with COPD has only slightly declined despite the introduction of a vaccine as a potential preventive measure that can assist in reducing the occurrence of COPD exacerbation and minimizing pneumonia infections (Ignatova, Avdeev, & Antonov, 2021). In addition, the economic burden of COPD is staggering, with studies showing that the disease will lead to incurred costs of US$ 49 billion in 2019, mainly driven by hospitalizations (Wise, 2022). Thus, clinicians need to cure and manage COPD in the population.
Purpose of the Project
The DNP project was intended to raise the pneumococcal vaccination rates among adult COPD patients. After a literature review and a needs assessment, a PICOT question to guide the project was formulated as follows: Among adult COPD patients, what is the impact of phone call reminders compared to no phone call reminder on the total number of recorded vaccinations from January 2023 to March 2023? Therefore, the purpose of the project will be the implementation of phone call reminders to increase the rates of pneumococcal vaccinations among adult COPD patients. To this end, the overall objective is to increase the vaccination rate by 10% from January 2023 to March 2023 in adult COPD patients. The primary outcome measure shall be the total number of adult vaccinations recorded, while the secondary measure shall be the total number of patients who will be vaccinated as a consequence of phone call reminders.
Review of the Literature
Literature Search
To determine the viability of the proposed evidence-based project, it was essential to search relevant literature indicating that the adoption of the phone call reminder would be effective in increasing the adoption of pneumococcal vaccination among adult COPD patients. The database that was used to collect evidence included Medline, Wiley Online, Embase, PubMed, Nursing Reference Center, CINAHL Plus with Full Text, and the Cochrane Library. The main keywords that were used to complete the search n the identified databases were “pneumococcal vaccination,” “phone call reminder,” “benefits,” and “adult COPD patients” To ensure that the study findings were current, the sources were limited to those published from January 2017 to November 2022. Only studies published in English and had the specified keywords in their title and abstract sections were included in the study. Notably, the search included all forms of peer-reviewed studies not limited to clinical trials, meta-analyses, descriptive studies, and systematic reviews, among others. 
Following the compilation of the results from all the major databases, 57 sources relevant to the current study were identified. Of these, 11 studies were relevant to the current study and are included in the project proposal. Based on the guideline provided by the Agency for Healthcare Research and Quality (AHRQ), the identified pieces of literature were two meta-analyses and two systematic reviews (Level I), four randomized control trials (Level II), and three qualitative and quantitative studies (Level IV).
Level I Evidence
           Cafiero-Fonseca et al. (2017) identified 5,857 papers published between January 2010 and April 2016 on pneumococcal vaccination in adults. The studies reported that the uptake of pneumococcal vaccination resulted in health gains for the patient as well as contributed to significant savings in healthcare costs. Notably, some of the studies went further and captured the additional benefits of pneumococcal vaccination such as increased levels of productivity. Notably, the review may be limited due to several limitations of some studies included in the review such as the inclusion of only abstracts in some of the studies. 
In the same vein, Walters et al. (2017) conducted a systematic review to determine the effectiveness of pneumococcal vaccines in the prevention of pneumonia in adult COPD patients. The researchers searched for all the studies published on the effectiveness of the pneumococcal vaccine up to November 2016. The researchers retrieved 12 studies with 2,171 participants. Walters et al. (2017) found that vaccinated adult COPD patients had minimized the likelihood of developing pneumonia in the community. In addition, the vaccine reduced the likelihood of exacerbation of COPD in patients at statistically significant levels. Nonetheless, the findings did not find a significant difference in the effect of vaccination on hospital admissions or reduction in mortality among the control and the intervention groups. 
Kuehne et al. (2020) examined the effectiveness of involving patients in the decision-making process on pneumococcal vaccine uptake. From eight studies, the researchers found that the exchange of information with patients using interventions such as phone call reminders enhanced pneumococcal vaccine uptake compared to the control group. Nonetheless, the quality of evidence was low. 
Tretheway, Patel, and Turner (2019) conducted a scoping review to determine the effectiveness of phone call reminders in enhancing pneumococcal vaccination rates among adults. Following a literature search, the researcher picked seven articles reporting on potential interventions that could be used to enhance pneumococcal vaccination uptake. The findings suggest that patient-focused approaches such as the use of phone call reminders can improve the uptake of pneumococcal vaccination among adults. Nonetheless, the researcher cited a lack of high-quality studies. In the same vein, Jacobson Vann et al. (2018) conducted a systematic review to examine the effectiveness of various interventions intended to increase vaccination uptake including phone call reminders. The researchers found that the use of phone call reminders could improve the uptake of vaccinations among adults using moderate certainty evidence from 15 studies.
Level II Evidence 
Ho et al. (2019) conducted a cluster randomized controlled trial measuring the effectiveness of point-of-care informational interventions on the uptake of pneumococcal vaccination. The study was conducted in 22 private clinics in Singapore and covered all patients above 65 years. 4378 patients were included in the study. The rate of pneumococcal vaccine uptake among...