HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Supplemental Appendixes 1-2 In Brief TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Zimmerman, R. K. PubMed PubMed Citation Articles by Zimmerman, R. K. Related Collections Prevention Vulnerable populations Quantitative methods

Understanding Adult Vaccination in Urban, Lower-Socioeconomic Settings: Influence of Physician and Prevention Systems

¹ Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
² University of Pittsburgh School of Medicine, the Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania

CORRESPONDING AUTHOR: Mary Patricia Nowalk, PhD, RD, Department of Family Medicine and Clinical Epidemiology, 3518 5th Ave, Pittsburgh, PA 15261, tnowalk{at}pitt.edu

PURPOSE Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.

METHODS PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables.

RESULTS Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%–98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be "reported time spent with patients for a well visit" (P = .01) and "use of enhanced immunization documentation" (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%–96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was "use of standing orders" (P <.001) and "average observed physician examination room time," regardless of visit type (P=.02).

CONCLUSIONS Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.

Key Words: Adult immunizations • influenza vaccine • pneumococcal polysaccharide vaccine

This article has been cited by other articles:

				K. C. Stange Actionable Ideas to Improve Health Care and Health Ann. Fam. Med, January 1, 2010; 8(1): 82 - 84. [Full Text] [PDF]

				L. S. Acheson and J. J. Frey III In This Issue: Multifaceted Research Ann. Fam. Med, November 1, 2009; 7(6): 482 - 483. [Full Text] [PDF]

TRACK Comments: