Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Dr. Mikael Jones

Committee Member

Dr. Elizabeth Tovar


Background: Nationally adult immunization rates continue to fall below the current benchmark goals. It is estimated adult vaccinations range from 20 to 60 percent, depending on the vaccine. There are different vaccine schedules for those of average-risk compared to those with high-risk conditions. Providers are being encouraged to explore their administration of vaccines as preventable, communicable diseases continue to be seen. Objectives: In a primary care clinic, a gap analysis was conducted to: 1.) Determine adult immunization rates, 2.) Compare vaccine administration rates of the Tdap, PCV13, PPSV23, and influenza vaccines between average and high-risk adults, 3.) Determine if specific chronic diseases correlate with increased or decreased vaccination rates. Methods: A retrospective chart review was conducted on a random sample of 120 patients in an urban, primary care clinic. The chart review was utilized to assess vaccine administration for those 50 to 64 years of age, who were high-risk status based on specific diseases, compared to average-risk adults, ages 65 to 80 years of age. Results: Comparing groups, average-risk patients had a higher rate of immunizations for three of the four vaccines (influenza, PCV13 and PPSV23), with a statistically significant difference favoring the average-risk group for PCV13 and influenza. Only the Tdap vaccine had higher frequency in the high-risk group but was not statistically significant. Conclusions: Immunization rates were low for both populations which concurs with national data. Possible explanations include difficulties with documentation in the EMR to the lack of emphasis placed on vaccines by patients and providers. Clearly, attention must be placed on adult immunizations and their role in preventive care.