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Center on Native Elder Health Disparities

Enhancing Native Elder Immunization

Project Leader: Dedra S. Buchwald, M.D.

American Indians and Alaska Natives (AI/ANs) are especially susceptible to respiratory diseases. According to Indian Health Services Statistics, influenza/pneumonia is the 6th leading cause of death among all AIs and the 4th among Native elders. Moreover, mortality increases markedly with age; for persons aged 65 years or more, mortality due to influenza/pneumonia is greater for AI/ANs than the general US population. Nonetheless, although data specific to AI/ANs are not available, minority populations receive influenza (IV) and pneumococcal (PV) vaccinations at substantially lower rates than whites. Since minority adults utilize preventative services less, present for care at more advanced stages of disease, and have greater morbidity and mortality than higher income individuals, AI/AN elders are at risk for not obtaining IV and PV. In this regard, our pilot work with urban Native elders in a primary care practice found that only 31% and 21% had received IV and PV, respectively, in accordance with published guidelines. In this study, we hope to determine what measures will increase these immunization rates and subsequently reduce the incidence of influenza and pneumonia among Native Elders.

This study addresses the following specific aims:

  1. Compare the effectiveness of “usual care” to 2 patient-targeted interventions in promoting immunizations among AI/AN elders at a large urban health center (either receipt of culturally appropriate educational materials addressing knowledge, attitudes, and beliefs informed by focus groups or an incentive);
  2. Assess the effectiveness of provider-targeted peer feedback versus usual care in increasing vaccination rates;
  3. Examine patient-related factors influencing receipt of immunizations.

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