Pneumococcal Infections Clinical Trial
Official title:
An Incitative Multifaceted PROcedure for Pneumococcal Vaccination at the Emergency Department; A Multicenter Prospective Randomized Open Trial The IMPROVED Project
Background :
Community-acquired pneumonia (CAP) is a threat in industrialized countries. It represents the
6th cause of death. CAP also frequently associates with other disorders responsible for
admission and death. Among bacteria responsible for CAP, Streptococcus pneumonia is a major
pathogen that is commonly involved and frequently leads to severe infection and admission.
Categories at risk for this pathogen have been determined, and can be proposed
anti-pneumococcal vaccination (APV) that efficiently and safely protects from this
microorganism.
In the context of US health services, monocenter pilot experiences have reported improvement
of pneumococcal prophylaxis implementing vaccination procedure at ED. A study that set in New
Mexico (2003) reported a significant increase in APV (from 18% to 84%) when patients at risk
were proposed vaccination at ED. To obtain these results, medical students were specifically
trained and dedicated to screen and vaccinate against St. pneumoniae. Another single center
trial (Tennessee, 2007) for APV at ED obtained an improvement (from 38.8 to 45.4%) when
physicians were alerted for pneumococcal risk by the software they usually utilized at
bedside. However these experiences remain sparse as additional dedicated resources are
required or patients and attending ED physicians can be reluctant to proceed to vaccination
at ED.
Mobile phone and derived communication modalities are current vectors to deliver information
in several fields including education and medicine. Initially used in developing countries,
short-message services (SMS) have improved behaviour of patients in various medical areas. In
France, the investigators have observed that most patients above 50 years of age admitted
after ED visit are equipped with mobile phone and can receive alerts by SMS.
These observations prompt us to propose a multifaceted procedure to improve APV after ED
visit in at-risk patients, combining structured oral interview, written information and SMS
as reminders.
Purpose : The investigators hypothesized that
- a multifaceted intervention to promote anti-pneumococcal vaccination combining a
structured oral interview, a written information to patient and his/her general
practitioner, and a series of 3 SMS,
- improves anti-pneumococcal vaccination at 6 months,
- in at-risk patients (65+ years) visiting the emergency department. In order to answer
this question, the investigators designed an interventional prospective multicenter
randomized study (cluster).
n/a
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