It struck me today as was listening to the radio and reviewing an email summary of articles that I get every day that 2 “quality” measures that I am held accountable for don’t really help much. I am talking about this year’s influenza vaccine and the pneumococcal vaccine.
Lets start with the influenza vaccine. Where I practice I am supposed to make at least 79% of my patients over age 65 yrs of age take the vaccine. This doesn’t sound too bad right? Why shouldn’t it be 100%? Well the problem this year is that the influenza vaccine mostly sucks in this age group….per the CDC its only 9% effective in persons 65 yrs of age and older . (http://www.cdc.gov/MMWR/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w)
What about the pneumococcal vaccine? It should really help people right? I am supposed to make 95% of my patients take this vaccine. Well it kind a sucks also per Moberley S, Holden J, Tatham DP, et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2012 Jun 22;1:CD000422. DOI: 10.1002/14651858.CD000422.pub3. This well done Cochrane review found that invasive pneumococcal disease was prevented by the vaccine but not pneumonia or mortality. So all it really prevents is bacteremia if you get pneumococcal pneumonia but it actually doesn’t prevent pneumonia. Somewhat of a misnamed vaccine if you ask me.
There is little benefit of these 2 vaccines but yet I am supposed to recommend them to my patients. I don’t have great vaccination rates in my patients. Maybe I won’t feel so bad about that any longer. The policy wonks who make up these rules need to look at the data and measure what’s important. Unfortunately they don’t. They are mired in their measurement mentality without the benefit of an intellect.