Pneumonia: Review of Literature

Pneumonia is a condition which can be fatal to individuals especially those with a weakened immune system. Pneumococcal vaccination can be crucial in reducing these rates of death from the condition. Despite this knowledge the African American population is largely reluctant in becoming vaccinated against Pneumonia. In order to address this barrier, the proposed project would implement a routine pneumococcal screening tool in primary care in order to improve the rates of vaccination and reduce rates of death from Pneumonia. An extensive literature review has been conducted to address the viability of the project.

The problem that will be addressed will be the low rates of pneumococcal vaccinations in the African American population. The intervention that will be implemented is a screening tool that will be used by primary care physicians with every other patient they see. The patient will have to answer questions to determine if they have obtained a vaccination. If they have not vaccinated the patient will be asked why they have not. The patient would then be offered a vaccination. The patient will be educated about the benefits of receiving the vaccination. The patients who obtained a vaccination will be compared to patients who were not given the screening tool. The clinical outcomes may determine that individuals who received the screening tool were more likely to get vaccinated. The clinical question will be whether the screening tool is effective in increasing rates of inoculation.

The evidence-based model that will be utilized to turn evidence into practice is the ACE STAR model. The model has a sequence that will be followed in order to provide practical use for the research. The discovery research will be conducted to obtain comprehensive knowledge about the topic. The summary of the pertinent evidence will be developed. From the evidence a set of guidelines will be developed. These guidelines may focus on how the patient is provided with the screening tool. The tool will then be integrated into the clinic’s practice. After a few months of implementation, the outcomes will be measured in the form of patients who were vaccinated.

The literature review that was conducted on the topic of interest revealed findings that determined the benefits of the screening tool. Ganesan (2003, Hebert (2005), Musa (2009), and Wray (2007) all found that African Americans were seeking preventive healthcare in the form of vaccination in smaller numbers than their Caucasian counterparts. These findings were similar for African American males, women and the elderly. These studies found that African Americans were also lacking proper care in other areas of health.

The reasons for the lack of vaccination were also found in the literature review. Armstrong (2001), Omer (2009) and Randall (1995) found that individuals in the African American community distrusted the health care system due to past cases of abuse such as the Tuskegee study. Gellin (2001) and Grumbach (2004) also found that primary care physicians were not doing a good job of presenting vaccinations to their patients. Harrison (2000) and Jacobson (1999) also found that African Americans were not aware of the vaccinations and the benefits it could provide.

These barriers can be overcome through the implementation of the screening tool. Through education the lack of knowledge and distrust surrounding vaccinations could be addressed. By placing the screening tool in physician office, the barrier of effective primary care will be addressed. The screening tool could save the lives of many African Americans. 

References

Armstrong, K., Berlin, M., Schwartz, J. S., Propert, K., & Ubel, P. A. (2001). Barriers to influenza immunization in a low-income urban population. American journal of preventive medicine, 20(1), 21-25.

Davis, M. M., Ndiaye, S. M., Freed, G. L., & Clark, S. J. (2003). One-year uptake of pneumococcal conjugate vaccine: a national survey of family physicians and pediatricians. The Journal of the American Board of Family Practice, 16(5), 363-371.

Ganesan, K., Teklehaimanot, S., Akhtar, A. J., Wijegunaratne, J., Thadepalli, K., & Ganesan, N. (2003). Racial Differences in Preventive Practices of African American and Hispanic Women. Journal of the American Geriatrics Society, 51(4), 515-518

Gellin, B., Modlin, J. F., Whitney, C. G., Schaffner, W., & Butler, J. C. (2001). Rethinking recommendations for use of pneumococcal vaccines in adults. Clinical infectious diseases, 33(5), 662-675

Grumbach, K., & Bodenheimer, T. (2004). Can health care teams improve primary care? practice? JAMA: the journal of the American Medical Association, 291(10),1246.

Harrison, L. H., Dwyer, D. M., Billmann, L., Kolczak, M. S., & Schuchat, A. (2000). Invasive pneumococcal infection in Baltimore, MD: implications for immunization policy. Archives of internal medicine, 160(1), 89

Hebert, P. L., Frick, K. D., Kane, R. L., & McBean, A. M. (2005). The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries. Health services research, 40(2), 517-538

Jacobson, T. A., Thomas, D. M., Morton, F. J., Offutt, G., Shevlin, J., & Ray, S. (1999). Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. JAMA: the journal of the American Medical Association, 282(7), 646-650

Mieczkowski, T. A., & Wilson, S. A. (2002). Adult pneumococcal vaccination: a review of physician and patient barriers. Vaccine, 20(9), 1383-1392

Musa, D., Schulz, R., Harris, R., Silverman, M., & Thomas, S. B. (2009). Trust in the health care system and the use of preventive health services by older black and white adults. Journal     Information, 99(7).

Nowalk, M. P., Zimmerman, R. K., Shen, S., Jewell, I. K., & Raymund, M. (2004). Barriers to Pneumococcal and Influenza Vaccination in Older CommunityDwelling Adults (2000–2001). Journal of the American Geriatrics Society, 52(1), 25-30

Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988

Randall, V. R. (1995). Slavery, Segregation and Racism: Trusting the Health Care System Ain't Always Easy--An African American Perspective on Bioethics. Louis U. Pub. L. Rev., 15, 191.

Scott, T. L., Gazmararian, J. A., Williams, M. V., & Baker, D. W. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical care, 40(5), 395-404

Shevlin, J. D., Summers-Bean, C., Thomas, D., Whitney, C. G., Todd, D., & Ray, S. M. (2002). A systematic approach for increasing pneumococcal vaccination rates at an inner-city public hospital. American journal of preventive medicine, 22(2), 92-97

Shui, I., Kennedy, A., Wooten, K., Schwartz, B., & Gust, D. (2005). Factors influencing African American mothers' concerns about immunization safety: a summary of focus group findings. Journal of the National Medical Association, 97(5), 657.

Stevens, G. D., & Shi, L. (2002). Racial and ethnic disparities in the quality of primary care for children. Journal of Family Practice, 51(6), 573-573.

Wood, D., Donald-Sherbourne, C., Halfon, N., Tucker, M. B., Ortiz, V., Hamlin, J. S., ... & Freeman, H. (1995). Factors related to immunization status among inner-city Latino and African American preschoolers. Pediatrics, 96(2), 295-301

Wray, R. J., Jupka, K., Ross, W., Dotson, D., Whitworth, A. R., & Jacobsen, H. (2007). How can you improve vaccination rates among older African Americans? Journal of Family Practice, 56(11), 925.

Zimmerman, R. K., Silverman, M., Janosky, J. E., Mieczkowski, T. A., Wilson, S. A., Bardella, I. J., ... & Nowalk, M. P. (2001). A comprehensive investigation of barriers to adult immunization: a methods paper. J Fam Pract, 50(8), 703.