In the modern era, there is a considerable emphasis placed upon vaccinations across different age groups and their impact on health and wellbeing. Much controversy surrounds vaccination to increase immunity and to prevent or minimize the impact of a number of common illnesses. The elderly are particularly vulnerable to influenza and other illnesses due to decreased immunity and may experience significant complications if they contract these viruses. Therefore, it is necessary to consider the different strategies and considerations regarding the administration of vaccinations to older adults because of their increased vulnerability and low immunity. The proposed capstone project will evaluate the impact of a vaccination protocol, which includes four different vaccinations, in a primary care facility in order to determine compliance rates and efficacy in reducing the spread of different illnesses within this population group. It is suspected that a comprehensive vaccination protocol will have a positive impact on this population group and would decrease communicable diseases. The capstone project utilizes diffusion innovation theory in order to determine if innovative protocols and practices have a significant impact on the chosen population. The use of innovative techniques and practices in executing a vaccination protocol is likely to be effective in expanding vaccination rates and in reducing the spread of illness within the selected population. Therefore, diffusion of innovation theory requires additional exploration in regards to its impact on vaccination rates in the elderly to expand knowledge and insight regarding the benefits associated with vaccination protocols.
Keywords: vaccinations, immunization, primary care, health disparities
Introduction and Background
Today’s elderly population continues to grow in number as a result of expanded technological innovation, advanced clinical practice methods, expanded educational opportunities, and greater access to care and treatment. However, with the expansion of this population group, there remains a significant risk associated with lower immunity in this age group which may lead to an increased level of illness. For many older persons living in close quarters as community-dwellers in nursing homes, long term care facilities, assisted living facilities, and independent living locations, there is an increased risk of contracting influenza within these areas as a direct result of low immunity and low vaccination rates. Therefore, it is essential to explore the different factors that impact vaccination rates, such as cultural factors and perceptions, as a means of determining how to expand vaccination rates across the elderly population (Stanton, 2004). From a research-based perspective, it is important to identify the challenges and considerations associated with increasing compliance rates in the elderly through the expanded use of vaccinations. Therefore, it is necessary to identify organized programmatic efforts that are likely to be effective in supporting expanded vaccination efforts within this population It is necessary to develop protocol-based approaches that will specifically target elderly persons who are patients of a primary care physician in order to effectively impact this population. There are many issues to consider with respect to the development of protocols due to the challenging nature of vaccinations and the hesitancy on the part of some elderly persons to obtain these preventative mechanisms. Therefore, there must be a cultural shift and expanded education regarding vaccinations in order to provide a greater number of elderly persons with vaccinations on a regular basis. It is believed that a comprehensive vaccination protocol will be an effective indicator in promoting increased vaccination rates for elderly patients in a primary care practice, where there is a significant emphasis placed upon the administration of four critical vaccinations to prevent illness.
With respect to the elderly population, there are a significant number of patients who do not obtain the recommended vaccinations, which include influenza, pneumococcal polysaccharide, zoster, and tetanus/diptheria. This poses a significant problem for many elderly persons with low immunity and who are unable to fight viruses effectively. It is proposed that an expanded vaccination protocol must be established by the chosen primary care provider at a primary care facility in Broward County, Florida in order to promote increased vaccination rates in elderly persons. Therefore, the primary question is as follows: How can a vaccination protocol increase immunization rates in the elderly? How is this group educated in order to make an informed decision regarding whether or not to obtain a vaccine? In addition, the following should also be considered: What is the impact of increased vaccinations in the elderly, and doe these vaccinations support improved immunity and greater resistance to viruses and infections? These questions will be considered using the diffusion innovation theory as a means of evaluating the significance of the chosen vaccination protocol and whether or not it provides the desired benefits to the selected population group. This examination will also explore the different areas where there are weaknesses in demonstrating the importance of these vaccinations on the health and wellbeing of elderly persons. There appears to be a lack of education across many healthcare communities who provide direct care to elderly persons. Therefore, these gaps in knowledge must be addressed in an effort to increase vaccination rates and to improve immunity within the selected elderly population.
Objectives and Aims
The primary aim of the project is to identify the disparities that exist with respect to low vaccination rates in the elderly population so that additional steps might be considered to improve upon these weaknesses, such as the appointment of nurses to administer vaccinations to adults over the age of 65 so that preventative care options are maximized. The primary objectives of the project are as follows: 1) to identify the weaknesses that exist within current protocols regarding vaccinations for the elderly provided by primary care facilities; 2) to determine how to improve vaccination rates through an expanded education and outreach program for in-house staff members; and 3) to determine if the program has led to an increase in vaccination rates upon rollout. It is important to evaluate the existing conditions within the elderly population in regards to vaccination rates in order to determine where improvements are necessary, and to also recognize weaknesses in existing systems that have a negative impact on patient care for the elderly. These efforts will also support the continued expansion and availability of vaccinations for the elderly, even when access to these services is difficult due to internal conflicts or challenges. These considerations will play a significant role in the use of diffusion innovation theory in promoting favorable programmatic outcomes in areas where primary care facilities are limited in their ability to provide vaccinations to the elderly, or are unable to be effective in supporting programs to expand participation rates.
Review of Literature
A vast body of literature has evolved in recent years that explore the issues related to vaccinations and their impact on the elderly and on disadvantaged populations. In addition, diffusion innovation theory has evolved as a possible contributing factor in supporting the elements of expanding technologies and electronic approaches to be used within primary care facilities to enhance patient care and improve patient wellbeing. A number of literature sources have been selected that support these perspectives and will be addressed in the following paragraphs in order to promote the desired objectives.
An article by Baier in the Public Policy & Aging Report addresses the importance of techniques and practices that have been explored in different environments where large groups of elderly persons reside as a means of improving vaccination rates within these groups. The article supports a number of perspectives, including but not limited to an emphasis on access, demand, systems change, and policy as key drivers in expanding vaccination rates among the elderly (Baier). The article also explores the different drivers of strategic change in promoting increased vaccination rates in the elderly, which are impacted through physician-patient relationships and other factors (Baier). When an intervention is conducted, there may be a change to an existing patient-physician relationship, which some elderly persons might not find to be favorable (Baier). Therefore, interventions must be conducted in a manner that is sensitive to the responses of older persons and their specific needs (Baier).
An article by Boraschi et.al (2013) explores the different perspectives that are associated with increased life expectancy and its impact on immunity. To be specific, there is an increased focus on the development of programs that are designed to target elderly persons who are at risk for influenza and other viruses so that they will obtain the proper vaccinations in a timely manner (Boraschi et.al, 2013). However, there are risks to vaccination within this group that must also be addressed, which include negative inflammatory responses that may lead to other adverse events (Boraschi et.al, 2013). Therefore, when proposing vaccination programs for some groups, it is important to identify the challenges and considerations of vaccinations on elderly participants in order to make informed and appropriate decisions that will have a positive impact on this population group (Boraschi et.al, 2013). Nonetheless, there is an ever-increasing risk associated with viruses and infectious diseases within the elderly that cannot be ignored; as a result, it is essential to weigh the likely minimal risks of vaccinations against the risks of infectious disease, which are much greater and are much more prevalent in the modern era due to resistance to antibiotics (Boraschi et.al, 2013).
The process of vaccinating throughout adulthood and into the elderly years represents a challenge to many primary care providers because many questions are raised regarding the risks associated with vaccines upon administration and the realization of any side effects that may occur (Nettleman and Garcia-Chen, 2013). In 2009-2010 in South Dakota, it is known that “Only 14 percent of persons 60 years of age and older have received a dose of zoster vaccine. Only 60 percent of adults aged 65 years and older and 18.5 percent of high-risk adults under age 65 have received the pneumococcal vaccine (Nettleman and Garcia-Chen, 2013, p. 73). These findings suggest that it is necessary to evaluate existing methods for promoting increased vaccinations because disparities exist that are difficult to overcome without further analysis (Nettleman and Garcia-Chen, 2013). Furthermore, it is also evident that other conditions are prevalent in older adults beyond influenza which could be prevented or reduced with the use of vaccinations, such as pertussis and hepatitis B (Nettleman and Garcia-Chen, 2013). The article suggests that there is an opportunity to establish protocols that support the expansion of vaccinations for older adults that are based upon statistical evidence favoring the increased use of these vaccines, while also considering how to emphasize the need for vaccines, including verbal reminders and electronic health record reminders (Nettleman and Garcia-Chen, 2013). These strategies are likely to contribute to increased awareness regarding the importance of vaccinations, but may not resolve many of the concerns that elderly persons have regarding these alternatives and how they will impact their lives and overall health status (Nettleman and Garcia-Chen, 2013).
The challenges of vaccinations for elderly persons continue to increase due to significant disparities among different areas of this population, often based upon socioeconomic status and other factors (Logan, 2009). As a result, it is necessary to address primary health disparities and how they impact older adults, such as access to care and treatment in many communities (Logan, 2009). Since access is limited in many areas, many elderly persons are not always able to obtain the recommended immunizations from primary care providers (Logan, 2009). Under these conditions, there is an increased risk of infection and other illnesses if these vaccinations have not been received (Logan, 2009). Vaccinations are considered as a public health concern that requires significant attention from primary healthcare providers in order to improve immunization rates and reduce health disparities (Logan, 2009). For those in disadvantaged populations, however, these disparities are even greater for many elderly persons, particularly when they are limited by transportation barriers and other concerns (Logan, 2009). Primary health care providers must explore new strategies to improve vaccination rates and to address other concerns that have a direct impact on elderly persons (Logan, 2009).
A key component of the aging process is the decline of the immune system and its ability to fight even the simplest infections, and this leads to a greater disease burden and impact on the elderly (Gusmano and Michel, 2009). These conditions limit the ability of elderly persons to overcome illnesses when their immune systems are compromised; therefore, vaccination protocols must be innovative and user-friendly so that the selected population understands the importance of vaccinations and are able to access vaccinations without difficulty (Gusmano and Michel, 2009). These considerations also support the expansion of knowledge and education regarding vaccinations for the elderly so that they are able to boost their immunity and fight infections more effectively (Gusmano and Michel, 2009).
The challenging nature of immunity in the elderly population requires a greater understanding of how immunity evolves with individual age (Dey et.al, 2012). There are changes within T cells, cytokines, and other cellular components that naturally decrease immunity, and as a result, older persons are unable to fight infections in the same manner as their younger years (Dey et.al, 2012). Therefore, vaccinations are increasingly important for this group because they support enhanced immunity against a number of diseases, including influenza and zoster to prevent shingles (Dey et.al, 2012). Specifically, the ability to immunize older adults over the age of 65 is of critical importance in promoting their longevity and ability to fight routine infections, including influenza during seasonal outbreaks (Woodward, 2012). Although there are proven side effects, vaccinations are worth the risk for the most vulnerable members of the elderly population because they reflect an opportunity to expand alternatives with respect to immunization management (Woodward, 2012).
Although it is beneficial for the majority of elderly persons to receive vaccinations to combat a number of common diseases, it is also important to recognize the risks, but to also note that they may reduce mortality rates for many older adults (Eilers et.al, 2013). In this context, it is important to identify areas where there are significant opportunities for growth and education that will promote increased vaccination rates within the elderly population through practical knowledge and an understanding of the issues that are most prevalent to older adults (Eilers et.al, 2013). One area to consider is quality of life, which may be dramatically improved for persons who receive vaccinations to prevent influenza, shingles, and pneumonia, since their lowered immunity makes them increasingly susceptible to these conditions (Eilers et.al, 2013). The burden of these diseases continues to grow in conjunction with expanded life expectancy because of the severity of these conditions and their symptoms within this group; therefore, providing access to vaccinations and encouraging participation are critical to the wellbeing and quality of life of this group (Eilers et.al, 2013).
From a policy-based perspective, it is critical to establish a greater understanding of the issues and challenges that are prevalent in older adults with respect to vaccinations. An article by Pop-Vicas et.al examines the importance of developing policy initiatives that will have a significant impact on elderly persons, particularly those who face a greater risk of influenza and other common infectious diseases. Policies that address practical issues and explore the dimensions of care and treatment for elderly persons must recognize the sensitivity of this population group, but also their vulnerability to these diseases, as these efforts will contribute to the overall effectiveness of a vaccination protocol or strategy that is specifically designed for elderly persons (Pop-Vicas et.al). By promoting prevention in communities that are impacted the most by influenza and other conditions, it is likely that there will be a favorable response to vaccinations for elderly persons (Pop-Vicas et.al). A similar article by Blank et.al (2012) explores the availability of vaccinations for seasonal outbreaks of influenza in order to determine a method of expanding policies to promote adherence to recommended protocols. With this example, policymaking efforts must emphasize the importance of vaccination support and its overall impact on the elderly population through organized enforcement and understanding of the benefits of these vaccinations (Blank et.al, 2012).
For many elderly persons, influenza poses a significant risk to their general health and wellbeing, thereby mandating increased compliance with vaccination rates (Griffin, 2013). In South Dakota, there are approximately 62,000 cases of influenza on an annual basis, with almost 600 hospitalizations and 60 deaths; as a result, it is evident that there must be protocols in place that will have a significant impact on patient care and wellbeing in the context of these conditions (Griffin, 2013). Health promotion efforts for vaccinations, however, have been challenging at best because they are not clearly understood in many areas of the population (Griffin, 2013). In addition, since influenza strains change regularly from season to season, it is likely that some individuals do not believe that a single vaccine type will provide greater immunity against a variety of strains (Griffin, 2013). It is important to recognize these concerns and to take the steps that are necessary from a policymaking perspective to encourage individuals to participate in these vaccinations, particularly older adults who are often more vulnerable to these infections (Griffin, 2013).
One of the key considerations in the care and treatment of older adults is lack of knowledge and an understanding of the importance of routine preventative methods, such as vaccinations (Bostrom et.al, 2012). Under these conditions, Bostrom et.al (2012) consider the potential advantages of knowledge translation and its impact on the older adult population through the development of specific programmatic efforts that are designed for this group. Through the use of qualitative content analysis, knowledge translation is perceived as difficult to employ in many healthcare facilities and community-dwelling locations where many elderly persons reside (Bostrom et.al, 2012). This is perhaps due to the challenges associated with implementing these programs and their potential impact on the selected population due to lack of understanding and lack of willingness to comply with these recommendations in many situations (Bostrom et.al, 2012). In this context, expanding policymaking and knowledge translation efforts for elderly persons is often an uphill battle that is difficult to manage (Bostrom et.al, 2012).
In communities where in-house vaccination programs are available for implementation and use, it is important to recognize the challenges associated with these programs and how they are perceived by older adults (Westrick, 2010). Pharmacists who provide these programs to different populations are often faced with the task of promoting these programs and determining the best course of action to ensure that as many patients are possible are able to receive these vaccinations in a timely manner (Westrick, 2010). As a result, it is necessary to utilize different types of locations, such as drugstore pharmacies and onsite mobile clinics to ensure that as many older adults as possible receive these vaccinations without question (Westrick, 2010). In addition, the expansion of vaccination programs that go beyond traditional seasonal efforts are likely to be effective in supporting the development of new perspectives that will have a positive impact on patient care and wellbeing for many older adults, particularly when compliance rates increase in areas where community dwellers lie (Westrick, 2010).
Icardi et.al (2012) address the importance of different types of pneumococcal vaccination methods and their overall impact on the adult population. To be specific, the authors indicate that on an annual basis, there are approximately 550,000 cases of pneumonia in the United States, along with 200,000 cases requiring hospitalization and 25,000 deaths (Icardi et.al, 2012). Therefore, it is important to develop strategic approaches that will emphasize the importance of pneumococcal vaccinations and their impact on wellbeing, particularly in older adults, as this population group is most vulnerable to this disease in different forms (Icardi et.al, 2012). The elderly account for over 20 percent of all costs associated with annual pneumonia cases in the United States; therefore, their burden is perhaps the greatest and requires significant attention and support (Icardi et.al, 2012). Although it is difficult to improve compliance rates for pneumococcal vaccinations, this condition warrants further exploration of programmatic efforts because of the serious nature of this disease and its impact on older adults and their wellbeing (Icardi et.al, 2012). For many older adults, a pneumococcal vaccination could mean the difference between life and death (Icardi et.al, 2012).
Finally, a study conducted by Lau et.al (2012) addresses the importance of different perspectives regarding influenza vaccinations in older adults residing in adult community-based settings, such as long term care facilities and assisted living facilities. It is known that “Quality improvement interventions, especially those that assign vaccination responsibilities to nonphysician personnel or that activate patients through personal contact, can modestly improve vaccination rates in community-dwelling adults” (Lau et.al, 2012, p. 546). These findings suggest that there are critical missteps in many existing protocols that play a role in shaping outcomes and in preventing a growth of influenza within these communities (Lau et.al, 2012). From this perspective, it is important to identify areas where there are weaknesses in current protocols and to explore methods that involve personal contact so that when elderly persons recognize individuals and develop relationships with them, they are more likely to be effective in achieving greater compliance rates (Lau et.al, 2012).
In summary, the literature that has been presented supports the need for interventions and expanded protocols to increase the understanding and need for vaccinations in older adults, which includes vaccinations for influenza, shingles, and pneumonia, amongst others. Statistics are highly relevant in demonstrating that there are significant benefits to these vaccinations and in supporting new directives to educate primary care staff members to administer these vaccinations on a regular basis through education. By educating this group more effectively, it is likely that compliance rates will increase on a gradual basis due to advanced health promotion efforts and will demonstrate the importance of new approaches to compliance that involve innovative protocols to have a greater impact on this population group.
The establishment of expanded protocols to increase vaccination rates in elderly persons is largely dependent upon available resources and knowledge that supports these endeavors. Therefore, theoretical approaches are likely to be effective in addressing the significance of these protocols and their overall importance to the elderly population. For the purposes of this examination, the diffusion of innovation model is relevant because it explores the impact of innovation in promoting strategies that have not been successful under traditional conditions. This model is typically identified with the consumer population and buying strategies; however, it may also impact vaccination protocols and programs in its ability to recognize why primary care staff are limited in their vaccination education efforts (MacVaugh and Schiavone, 2010). This model, developed by Rogers in the 1960s, is best described as follows: “Knowledge is the first step of Rogers’ five-stages process of adoption. The other four steps are: persuasion, decision (to adopt or to reject new technology), implementation and confirmation. Accepting this framework, non-adoption can be explained as the final outcome of an individual process of adoption that failed. Rogers argues that a great number of conditions (e.g. personal limitations of the potential user) and/or external obstacles (e.g. ineffective communication channels) may inhibit the success of the adoption process” (MacVaugh and Schiavone, 2010, p. 198). These circumstances are readily adaptable to arguments for vaccinations because they require an acceptance of a new protocol or method that is perhaps unfamiliar to staff members within a given context and that is difficult for some staff to understand and recognize as valid (MacVaugh and Schiavone, 2010). Elderly persons are likely to be highly resistant to vaccination protocols in some settings as a result of this theory and its relevance in addressing weaknesses in vaccination protocols because primary care staff members are not ready to accept these challenges or are unaware of these protocols (MacVaugh and Schiavone, 2010). From this perspective, it is difficult for primary care staff to embrace a new type of innovation (protocol) that they are not familiar with, particularly since they have a greater tendency to be resistant to change within this population group (MacVaugh and Schiavone, 2010). Based upon this theoretical model, it is likely that there will be additional frameworks that are required to facilitate positive outcomes for primary care providers in their efforts to convince elderly persons that obtaining vaccinations will promote greater health and wellbeing. Therefore, it is important to address communication strategies and their potential impact on the efforts made by primary care providers to promote vaccination methods in communities, particularly those where large numbers of elderly persons reside (Nair and Nair, 2012). Communication is one of the most important areas to consider when addressing a new idea or innovation that a population group is unfamiliar with, as this will encourage them to better understand its premise and to demonstrate the importance of vaccination protocols and interventions so that positive outcomes are achieved in this manner (Nair and Nair, 2012).
The efforts made by nurses and primary care providers to promote vaccination efforts within the elderly population is also dependent upon behavioral traditions and tendencies that occur within this group. The science of preventative medicine is challenging in its own right because it is very difficult for many people when they are required to adjust their behaviors (Livingood et.al, 2011). Therefore, it is essential for primary care providers to examine how to understand the entire system, including the communities in which elders reside, so that they are able to adapt their vaccination protocols using systems-based approaches (Livingood et.al, 2011). These contributions play an important and meaningful role in developing methods under which elderly persons are more likely to comply so that primary care providers are able to administer these vaccinations more effectively (Livingood et.al, 2011). Furthermore, it is evident that evaluating these perspectives from the systems point of view is likely to benefit primary care providers in their efforts to perform outreach to the most vulnerable population groups, including elderly persons (Luke and Stamatakis, 2012). By exploring systems-based approaches, there is a greater possibility to identify methods whereby elderly persons might accept change and will adapt to vaccination protocols in a more favorable manner (Luke and Stamatakis, 2012). The ability to engage in health-related behaviors on a repeated basis is one of the key indicators of potentially successful outcomes, and this is particularly relevant in the elderly population where vaccination rates remain low and poor health outcomes are often the norm (Gierisch et.al, 2010). Each of these factors plays an important role in the development of evaluation methods that will encourage the development of new protocols and methods to facilitate positive outcomes for elderly persons in regards to vaccinations.
Capstone Project Design
The proposed capstone project will utilize an intervention-based method in order to evaluate the significance of an expanded vaccination protocol to increase vaccination rates within a specific elderly population who are patients of a primary care facility in Broward County, Florida. It is important to develop an intervention that utilizes existing knowledge and data in a manner that supports a modification to current methods, particularly as there are significant challenges in increasing compliance rates using current protocols. The intent of the proposed intervention is to utilize a modified vaccination protocol and to test its ability to be effective in promoting greater compliance with recommended vaccinations for the elderly. This will be accomplished through the expansion of communication and utilization of diffusion innovation theory to determine the reasons behind why compliance is low for many elderly persons. The communication intervention will incorporate different forms of technology within the primary care facility as a means of expanding staff members’ exposure to technology in promoting behavioral change.
Setting and Resources
The proposed intervention method will be conducted in a primary care facility in Broward County, Florida. Vaccines will be provided by the facility and the physician in charge, and paper and related supplies will be used as necessary.
Location of Group I
The change effort will be located in Broward County, Florida in a primary care facility. There is a strong need within this facility to examine existing protocols with respect to elderly patients. The key players include the director, advanced practice nurse, primary care physician, and patient population.
Capstone project Population
The proposed capstone project population will be derived from a group of patients at the primary care facility. A chart review of 150 charts was used to identify prior vaccination data history and to review rates and subsequent immunizations. It was necessary to conduct this chart review to establish a population that might benefit from the vaccination protocol as proposed by the facility.
Sources of Data
With the intervention method, capstone project staff will educate staff regarding the protocol in conjunction with the director and primary care physician to ensure that patients would be able to obtain the necessary vaccinations in a timely manner to prevent illness. It is expected that the capstone project population will participate in immunization clinics that will be offered by the facility in greater numbers.
The proposed intervention will be conducted in accordance with the potential increase in the four vaccinations under consideration, based upon first-time vaccinations and any subsequent vaccinations that were obtained as recommended by national guidelines. It is likely that these statistics will provide a basis for exploring new ideas and approaches in expanding the development of new protocols to support vaccination compliance in the elderly population that could be applicable throughout other communities with similar concerns.
The quality of the capstone project intervention and the data that is collected will be evaluated in the context of its accuracy and effectiveness as related to the vaccination protocol. However, the capstone project will also explore the different areas where technology might play an effective role in implementing the chosen protocol from a staff perspective and in improving adherence to recommended behaviors regarding vaccinations. These efforts will support the continued expansion of vaccination protocols within the primary care facility. For this capstone project, bias is a concern because there are significant factors associated with the ability of elderly residents to modify their behaviors in many settings. In addition, some staff members may be hesitant to adopt a new vaccination protocol and to change current methods. Therefore, it is likely some participants will be unwilling to comply with the recommended guidelines. This is a significant issue to consider when conducting a capstone project of this nature and scope, particularly with elderly residents whose behaviors are often routine and well-established.
Ethics and Human Subjects Protection
The proposed capstone project will attempt to provide maximum benefits to its participants through the creation of an environment that supports expanded education and administration of the vaccination protocol. A human subject protocol will also be written and submitted to the designated institutional review board in order to address human subject protections as necessary. However, participation in the capstone project is entirely voluntary and no coercive actions will be taken to increase participation rates, based upon the extraction of vaccination data from chart histories.
Timeframes or Timeline
In order to complete the project in a satisfactory manner, a timeline of three to six months is required in order to educate staff members regarding the vaccination protocol and to implement the new guidelines accordingly so that vaccinations may be administered as necessary.
The costs of conducting the capstone project are primarily involved in supplies, as the capstone project staff will be voluntary and will not be paid for the project. In addition, the vaccines will be administered without a cost to the capstone project itself. Therefore, it is expected that the supply budget will cost approximately $100, accompanied by the use of already existing technologies and statistical software.
Strengths and Weaknesses of the capstone project
Strengths: The capstone project will address the importance and effectiveness of a vaccination protocol and its impact on elderly persons in a primary care environment. This environment possesses some degree of unity in its key principles and core values for its patients; therefore, it serves as a positive starting point in the implementation of the chosen vaccination protocol in order to determine its effectiveness. In addition, the environment is controlled by its own boundaries, which play an important role in gathering data and in analyzing the results. In addition, educating primary care staff is likely to make a difference in protocol administration.
Weaknesses: In any capstone project involving a shift in practice within a primary care organization, there is likely to be resistance to change, which may have a significant impact on the capstone project results and the effective implementation of the chosen protocol. Furthermore, the use of a self-reporting mechanism is not likely to be the most accurate method; however, considering capstone project limitations, it is appropriate for the population of Broward County, Florida in order to determine its efficacy and applicability in larger environments where there is a greater need for expanded vaccination protocols for elderly patients. In addition, capstone project staff members may be resistant to change and may not be willing to accept a new method or practice that would require additional roles and responsibilities in the workplace setting. This is often a difficult challenge for many employees to accept, particularly when they possess different concerns regarding a new procedure and do not understand the full extent of the vaccination protocol.
An evaluation of the chosen method requires specific tool(s) or instruments that are likely to determine if the appropriate outcomes have been achieved with the vaccination protocol. For the selected primary care facility which uses computer-based systems, the implementation of the Comprehensive Clinic Assessment Software Application (CoCASA), offered free of charge via download from the Centers for Disease Control and Prevention (CDC, 2013). This tool is available for Windows-based operating systems and provides an assessment of immunization coverage within a given facility to determine if existing vaccination protocols are effective and appropriate for a selected population group (CDC, 2013). For the selected protocol, this tool will provide much-needed data that will determine the effectiveness of the protocol in supporting an increased number of vaccinations for elderly patients as recommended by primary care providers (CDC, 2013). This tool will enable the facility to generate reports that will provide statistics regarding vaccination compliance rates and the timing of these vaccinations versus the recommended rates (CDC, 2013).
The ability to increase awareness and compliance in vaccinations for elderly persons is a complex challenge in the modern era, due in large part to confusion and lack of understanding of the benefits versus the risks of these methods. Therefore, it is necessary to evaluate new methods of promoting vaccinations in the elderly using protocols that expand the use of technologies and provide greater insight into the needs and challenges of vaccinations in older persons. Vaccination protocols must be tested in a variety of environments; however community-based dwellers serve a as a platform for testing, evaluation, and modifications as necessary that are applicable to other communities. It is important to recognize the challenges of promoting vaccination protocols for the elderly due to their resistance to a change in their current behaviors. However, by applying diffusion of innovation theory, it is possible to examine the impact of expanded vaccination protocols that emphasize the importance of compliance within the elderly population.
The chosen method supports the development of knowledge-based interventions that will have a positive impact on elderly persons and that will support efforts to expand vaccinations to larger groups of patients throughout primary care facilities. The intervention will demonstrate that there is an important opportunity to convey the critical nature of vaccinations for influenza, shingles, and pneumonia, among other conditions, as a means of improving health and wellbeing for elders. It is likely that the intervention method will have a positive impact on the selected population group; however, additional methods must be explored in order to apply the intervention method to larger populations where there are significant numbers of elderly residents. These efforts will encourage the development of new educational methods that utilize innovation in order to promote greater vaccination compliance among elderly persons. Staff education efforts must be indicative of a successful implementation effort and should be measured in accordance with these guidelines to ensure that elderly vaccination rates are increased under this protocol implementation effort. The primary care facility under consideration serves as an example for other organizations to follow so that there are sufficient opportunities to expand vaccination protocols for elderly persons to reduce rates of illness and the overall burden to the healthcare system. Another possible evaluation tool is the use of pre and post interviews conducted with primary care staff members in order to identify the level of knowledge regarding the vaccination protocol at the onset of implementation and also at the end of the first wave of implementation to obtain feedback to improve the protocol over time and increase compliance rates.
Baier, R.R. (2012).Demonstrated and promising practices that improve older adult vaccination rates. The Gerontological Society of America, 22(4), 11-15.
Blank, P.R., Schwenkglenks, M., and Szucs, T.D. (2012). The impact of European vaccination policies on seasonal influenza vaccination coverage rates in the elderly. Human Vaccines & Immunotherapeutics, 8(3), 328-335.
Bostrom, A.M., Slaughter, S.E., Chojecki, D., and Estabrooks, C.A. (2012). What do We know about knowledge translation in the care of older adults? A scoping review. Journal of the American Medical Directors Association,13(3), 210-219.
Centers for Disease Control and Prevention (2013). CoCASA (Comprehensive Clinic Assessment Software Application). Retrieved from http://www.cdc.gov/vaccines/programs/cocasa/index.html
Dey, A.B., Chatterjee, P., and Das, P.C. (2012). Immune status in the elderly. Medicine Update 2012, 22, 721-724.
Eilers, R., Krabbe, PFM, van Essen, TGA, Suijkerbuijk, A., van Lier, A., and de Melker, H.E. (2013). Assessment of vaccine candidates for persons aged 50 and older: a review. BMC Geriatrics, 13(32), 1-11, retrieved from http://www.biomedcentral.com/content/pdf/1471-2318-13-32.pdf
Gierisch, J.M., Reiter, P.L., and Brewer, N.T. (2010). Standard definitions of adherence For infrequent yet repeated health behaviors. American Journal of Health Behavior, 34(6), 669-679.
Griffin, M.R. (2013). Influenza vaccination: a 21st Century dilemma. The Story of Immunization: A Special Edition of South Dakota Medicine, 110-118, retrieved from https://www.sdsma.org/pdfs/17%20-%20Griffin.pdf
Gusmano, M.K., and Michel, J.P. (2009). Life course vaccination and healthy aging. Aging Clinical and Experimental Research, 21(3), 258-263.
Icardi, G., Sticchi, L., Bagnasco, A., Iudici, R., and Durando, P. (2012). Pneumococcal vaccination in adults: rationale, state of the art and perspectives. Journal of Preventative Medicine & Hygiene, 53,78-84. Journal of Preventative Medicine and Hygiene, 53, 78-84.
Lau, D., Hu, J., Majmudar, S.R., Storie, D.A., Rees, S.E., and Johnson, J.A. (2012). Interventions to improve influenza and pneumococcal vaccination rates among community-dwelling adults: a systematic review and meta-analysis. Annals of Family Medicine, 10(6), 538-546.
Livingood, W.C., Allegrante, J.P., Airhihenbuwa, C.O., Clark, N.M., Windsor,
R.C., Zimmerman, M.A., and Green, L.W. (2011). Applied social and behavioral science to address complex health problems. American Journal of Preventative Medicine, 41(5), 525-531.
Logan, J.L. (2009). Disparities in influenza immunization among adults. Journal of the National Medical Association, 101(2), 161-166.
Loo, T.S., Davis, R.B., Lipsitz, L.A., Irish, J., Bates, C.K., Agarwal, K., Markson, L., and Hamel, M.B. (2011). Electronic medical record reminders and panel management to improve primary care of elderly patients. Archives of Internal Medicine, 171(17), 1552-1558.
Luke, D.A., and Stamatakis, K.A. (2012). Systems science methods in public Health: dynamics, networks, and agents. Annual Review of Public Health, 33, 357- 376.
MacVaugh, J., and Schiavone, F. (2010). Limits to the diffusion of innovation: a literature review and integrative model. European Journal of Innovation Management, 13(2), 197-221.
Nair, R., and Nair, S.S. (2012). Is behavior change communication an effective strategy for increasing immunization coverage? Advanced Tropical Medicine and Public Health International, 2(2), 40-60.
Nettleman, M.D., and Garcia-Chen, V. (2013). Vaccinating through a lifetime: adult priorities. The Story of Immunization: A Special Edition of South Dakota Medicine,73-79, retrieved from http://sdsma.org/pdfs/11%20-%20Nettleman.pdf
Pop-Vicas, A., Gravenstein,S., and Mor, V. (2012). Policy research needs for universal influenza vaccination of elders. The Gerontological Society of America, retrieved from http://www.geron.org/ppar/GSA-PolicyAgingReport-Fall2012_FINAL.pdf#page=26
Stanton, B.F. (2004). Assessment of relevant cultural considerations is essential for the success of a vaccine. Journal of Health, Population and Nutrition, 22(3), 286-292.
Westrick, S.C. (2010). Pharmacy characteristics, vaccination service characteristics, and service expansion: an analysis of sustainers and new adopters. Journal of the American Pharmacists Association, 50(1), 52-61.
Woodward, M. (2012). Immunization of older people. Journal of Pharmacy Practice and Research, 42(4), 316-322.