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Orlando V. Zarate Jr. MD

  • Graduate 2020
Scholarly Research Project

Physician Education and Reminders Increase Rates of Pneumococcal and Hepatitis B Immunization in Patients with Diabetes at the Shadyside Family Health Center

Orlando Zarate, MD; Alan Finkelstein, MD; Barry Coutinho, MBBS; Michele Hebda, PharmD, BCPS


Morbidity and mortality due to Pneumococcal pneumonia or Hepatitis B are significant in patients with Diabetes due to their impaired immunity. The US Centers for Disease Control and/or Advisory Committee on Immunization Practices recommend the completion of Pneumococcal and Hepatitis B vaccine series for adults with diabetes. This project aims to increase immunization rates for these diseases in adult diabetics at SHY FHC.


In the first phase, providers received education on vaccination guidelines for diabetic patients through huddle reminders, weekly emails, and the already existing comprehensive diabetes report card, which includes the pneumococcal and hepatitis B immunization status, and is used by rooming staff and providers for every diabetic patient, regardless of visit type (preventive, acute).  In the second phase, a patient-friendly poster was placed in the SFHC waiting area highlighting vaccine recommendations for diabetics. EPIC reports generated data on vaccination rates for two subsequent periods: April 2019 to September 2019, and December 2019 to February 2020. Only active adult patients (age >18 years, seen within the last 3 years) with DM diagnosis were included.


After the first phase, completion rates for pneumococcal vaccines improved from 72.7 to 81.8 % (n=730, p<.05), and hepatitis B improved from 33.9 to 44.8% (n=730, p<.05) (April 2019 to September 2019). Completion rates further increased, although modestly, for pneumococcal vaccines from 81.8 to 83% (n=752, p<.05), and for hepatitis B from 44.8 to 45.1% (n=752, p<.05) after the second phase.


Active engagement through provider education, huddle reminders, and weekly emails was associated with a statistically significant increase in vaccine completion in diabetic patients at the SFHC. Poster use was associated with an additional modest increase in the immunizations rates. Using the diabetes report card can be an effective way to introduce vaccines along with other DM-related health maintenance topics.