Examining Structural and Clinical Factors Associated with Implementation of Standing Orders for Adult Immunization

Abstract

A proven method to increase vaccination rates in primary care is a standing orders program (SOP) for nonphysician staff to assess and vaccinate eligible individuals without a specific written physician order. This study describes a mixed methods approach to examining physicians' beliefs and attitudes about and adoption of SOPs for adult immunizations, specifically, influenza and pneumococcal polysaccharide vaccine. Focus groups and in-depth interviews of physicians, nurses, practice managers, and the medical director of a managed care health plan were conducted. Results were used to enrich a concise survey based on the Awareness-to-Adherence model of physician behavior and previous research, which was mailed to 1,640 general internists and family physicians nationwide. Barriers to SOPs identified through qualitative methods were lack of interest in changing the status quo, a physician-dominated hierarchy, and fear of malpractice. Facilitators included having an electronic medical record and a practice culture that was open to change. The survey (response rate 67%) confirmed the facilitators and further identified patient, physician, and practice factors that served as barriers to establishing and maintaining SOPs. This mixed methods approach provided the opportunity to develop a tailored and practice-oriented survey for examining the contextual factors influencing clinical providers' decisions to implement SOPs for adult immunization.

Widening socioeconomic disparities in cervical cancer mortality among women in 26 states, 1993‐2007

“…Widely recommended since 2007, !1 dose coverage among adolescent girls (ages 13-17 years) during 2009 was similar across racial/ethnic groups (43.9% for non-Hispanic whites, 44.6% for non-Hispanic blacks, and 45.5% for Hispanics). 33 Coverage was greater among girls living below the poverty threshold, suggesting the success of targeted programs for lowresource families. 33 Such programs should continue to ensure increases in equitable coverage among all eligible girls and women and may help ameliorate future disparities in cervical cancer mortality rates.…”

“…33 Coverage was greater among girls living below the poverty threshold, suggesting the success of targeted programs for lowresource families. 33 Such programs should continue to ensure increases in equitable coverage among all eligible girls and women and may help ameliorate future disparities in cervical cancer mortality rates.…”

Suggested use of vaccines in diabetes

“…[43] However, recent data on their use are not available. [44] Close follow-up by the diabetes treatment team of the subjects especially with those aged ≥65 years would help achieve the vaccination goals in the most vulnerable groups. Communication with the subjects about the need for vaccination and initiatives like educational packages on immunization, etc., will help generate awareness on the importance of immunization.…”

Standing orders for influenza and pneumococcal polysaccharide vaccination: Correlates identified in a national survey of U.S. Primary care physicians

“…Suboptimal adult vaccination rates and low reported use of SOPs suggest that there are barriers to SOP implementation. Primary care providers in outpatient settings vary in their acceptance and use of SOPs for influenza vaccine and PPV [ 13 , 24 ]. The purpose of this study was to identify factors that impede or promote consistent use of SOPs for adult vaccinations and to examine factors that distinguish practices that consistently use SOPs for both influenza vaccine and PPV, practices that use SOPs for influenza vaccine alone, and practices that have no SOPs for either vaccine.…”