The Article in Brief

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

Mary Patricia Nowalk , and colleagues

Background Vaccination rates are relatively low in disadvantaged urban populations. This study was designed to (1) examine physician characteristics and office systems that are associated with vaccination rates among the elderly; and (2) account for variation in vaccination levels among physicians.

What This Study Found Analyzing data for 2,021 patients aged 65 years and older receiving care in 17 different practices, researchers found that PPV (pneumococcal polysaccharide vaccine) and influenza vaccination rates varied widely across individual physicians. Longer reported well-visits and enhanced vaccine documentation were associated with vaccination for PPV. The use of standing orders and average physician examination room time were associated with vaccination for influenza.

Implications

• The authors conclude that given the difficulty in increasing physician visit time, particularly in health professional shortage areas that often occur in disadvantaged urban communities, enhanced vaccination documentation using flow sheets or electronic medical records, and standing orders may be the most feasible ways to increase vaccination rates.