Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People

Goebel, Lynne J.; Neitch, Shirley M.; Mufson, Maurice A.

doi:10.1111/j.1532-5415.2005.53320.x

Cited by 27 publications

(9 citation statements)

References 9 publications

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“…This strategy may be more effective if it was coupled with other strategies, such as year-round scheduling of influenza vaccination visits for the fall. 30 One practice strategy, standing orders, is recommended by experts [31][32][33] and has been associated with increased vaccine coverage in adult studies; [34][35][36][37] however, in our study, it was not associated with increased numbers of complete vaccinations. This paradoxical result likely reflects the inconsistent interpretation of the definition of standing orders, 38 the ineffective coupling with other strategies, and/or inability of standing orders to overcome the uncertainty about how many doses each child needed to be completely vaccinated.…”

Section: Discussioncontrasting

confidence: 54%

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

2010

PEDIATRICS

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Objective-To determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children aged 6-23 months.Methods-Clinical and demographic data from randomly selected children aged 6-23 months were obtained by chart review from a community-based cohort study in three U.S. counties. The proportion of children vaccinated by April 5, 2005 in each practice was obtained. To assess practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics predicting complete influenza vaccination were determined using multinomial logistic regression.Results-Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children aged 6-23 months who were studied, 27% were completely vaccinated. The proportion of children completely vaccinated varied widely among practices (0-71%). Most practices (87%) implemented ≥ 1 vaccination strategy (year-round discussion with parents about influenza vaccine, evening/weekend influenza vaccine clinics, standing orders, or saving a second dose for children who had received the first of two recommended doses). Complete influenza vaccination was associated with three practice characteristics--suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; and with child characteristics of younger age, existing high-risk conditions, ≥ 6 well visits to the practice by age 3 years, and any practice visit from October through January. [2004][2005]7 to children aged 6-59 months in [2006][2007]8 and to children aged 6 months-18 years in 2009-2010. 9 The administration of influenza vaccine presents unique challenges to healthcare providers since it requires yearly administration during a relatively short time period. Vaccine supply delays and shortages can occur, making it difficult for practices to predict when vaccination campaigns might begin and whether adequate supplies will be available. Because of poor immunogenicity of a single dose of vaccine in young children, two doses are required for children aged <9 years who previously have not been completely vaccinated. 9 Most studies evaluating methods to increase vaccination rates in young children were reported prior to the universal influenza vaccination recommendations for young children. [10][11][12][13][14] Since the majority of childhood vaccines are administered in primary care settings, 15 we sought to determine both practice and child characteristics and practice strategies that were associated with influenza vaccine coverage among children aged 6-23 months in 2004-2005, the first season that influenza vaccine was universally recommended. Methods Institutional Review BoardThis study was approved by the institutional review board of the Centers for Disease Control and Prevention (CDC) and of each ...

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Section: Discussioncontrasting

confidence: 54%

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

2010

PEDIATRICS

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“…If the Healthy People 2010 goal of more than 90% vaccination status is to be attained, new methods to increase vaccine uptake are required. A standing order in which nurses are given instruction and delegated authority to vaccinate all eligible patients aged 65 and older has been shown to be effective as a means of increasing uptake of influenza vaccine in inpatient and ambulatory settings 11–13 . Similarly, standing orders could be used to improve year‐round administration of pneumococcal vaccine.…”

Section: Discussionmentioning

confidence: 99%

Influenza Season Triggers Pneumococcal Vaccination

Goebel¹,

Mufson²

2006

J American Geriatrics Society

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Four-fifths of pneumococcal vaccine was administered in the fall and winter, and approximately half was given together with influenza vaccine. When influenza vaccine was in limited supply, physicians continued to vaccinate with pneumococcal vaccine alone. These findings suggest that the imminent influenza season provides the trigger for physicians to prescribe pneumococcal vaccine. Physicians should be reminded that pneumococcal vaccine can be administered any time of year.

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“…SOPs enable clinical personnel to assess and administer vaccines without a specific order for each vaccine, thus eliminating barriers such as the time required for the physician to assess vaccination status and issue a verbal or written order to vaccinate. SOPs for adult immunizations with or without other strategies have been shown to significantly improve adult vaccination coverage (Bond et al, 2009; Centers for Disease Control and Prevention, 2007;Goebel, Neitch, & Mufson, 2005;Loughlin, Mortazavi, Garey, Rice, & Birtcher, 2007). Thus, the Advisory Committee on Immunization Practices (Centers for Disease Control and Prevention, 2000), the Task Force for Community Preventive Services (Task Force on Community Preventive Services, 2000) and the Southern California Evidence-Based Practice Center-RAND (Health Care Financing Administration, 1999) have endorsed SOPs as a means to improve vaccination rates.…”

Section: Abstract Adult Immunizations Mixed Methods Research Standingmentioning

confidence: 99%

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

Yonas¹,

Nowalk²,

Zimmerman³

et al. 2012

Journal for Healthcare Quality

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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.

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Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People

Cited by 27 publications

References 9 publications

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

Influenza Season Triggers Pneumococcal Vaccination

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

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