Primary studies included in this systematic review

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Primary study

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Understanding adult vaccination in urban, lower-socioeconomic settings: influence of physician and prevention systems.

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Journal Annals of family medicine
Year 2009
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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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.

Primary study

Unclassified

Increasing pneumococcal vaccination in managed care through telephone outreach.

Journal The American journal of managed care
Year 2007
Links Pubmed

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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OBJECTIVES: To determine the effectiveness of a telephone reminder to increase pneumococcal vaccination in a population that had received mailed reminders and to evaluate whether the intervention effect is similar for clinics serving primarily non-Hispanic black or non-Hispanic white patient populations. STUDY DESIGN: Randomized trial within a managed care network. METHODS: All unvaccinated patients 18 years and older with chronic medical conditions and 65 years and older without chronic medical conditions (N = 6106) were randomized to receive telephone intervention or standard care and followed up for 6-month vaccination status. The intervention was a telephone call initiated by a nurse to inform patients that pneumococcal vaccination was recommended and was a covered benefit of their insurance. RESULTS: Intervention patients were 2.3 times as likely to be vaccinated during the study period than control patients (P < .001). The success of telephone intervention versus control was similar across clinics (P = .16) and across the chronic disease and elderly groups (P = .14). In subanalyses of individuals reached by telephone intervention, unvaccinated black subjects were less likely to be vaccinated during the study than unvaccinated white subjects (34% vs 25%, P = .03). Nurse staff time for telephone intervention cost $147.35 per additional patient vaccinated. CONCLUSIONS: Telephone intervention was successful at increasing vaccination rates in a diverse managed care population that had already received mailed reminders. Tailored messaging for pneumococcal vaccination through telephone reminders increases patient demand for vaccination and should be implemented by managed care organizations seeking to increase their vaccination rates.

Primary study

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Influenza and pneumococcal vaccination in older veterans: results from the behavioral risk factor surveillance system.

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Authors Chi RC , Reiber GE , Neuzil KM
Journal Journal of the American Geriatrics Society
Year 2006
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVES: To compare influenza and pneumococcal vaccination rates of older veterans with those of nonveterans and to compare vaccination rates of veterans who receive care at U.S. Department of Veterans Affairs (VA) medical centers with those of veterans who do not. DESIGN: Cross-sectional population-based study. SETTING: United States and territories. PARTICIPANTS: Persons aged 65 and older who participated in the 2003 Behavioral Risk Factor Surveillance System. MEASUREMENTS: Telephone survey of sociodemographics factors, including veteran status and VA care, health and behavioral characteristics, and influenza and pneumococcal vaccine use. RESULTS: Thirty percent of adults aged 65 and older were veterans, and 21% of veterans reported receiving care at VA health facilities. Veterans, especially VA users, were older and described poorer self-perceived health than nonveterans. Influenza and pneumococcal vaccination rates were higher for veterans than for nonveterans (74% vs 68% and 68% vs 63%, respectively, P < .001 for both) and for VA users than non-VA users (80% vs 72% and 81% vs 64%, respectively, P < .001 for both). For veterans, VA care was independently associated with influenza (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.5-2.2) and pneumococcal (OR = 2.4, 95% CI = 2.0-2.9) vaccine use after adjusting for sociodemographics factors, perceived health status, diabetes mellitus, asthma, and smoking. Current smoking and black race were independent predictors of low influenza vaccine uptake. CONCLUSION: VA care was associated with improved influenza and pneumococcal vaccine coverage, although vaccination rates for all elderly veterans fell short of Healthy People 2010 goals. Increased efforts to reach undervaccinated groups, particularly blacks and smokers, are warranted.

Primary study

Unclassified

A comprehensive patient assessment and physician reminder tool for adult immunization: effect on vaccine administration.

Journal Vaccine
Year 2006
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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We determined if a patient-self assessment/provider reminder tool (A/R) would increase administration of the eight vaccines that may be indicated for adults. In three family practice clinics, the A/R was completed by intervention patients and given to their provider. Control patients received an exercise reminder. On the day of the intervention, influenza, pneumococcal polysaccharide, and tetanus-diphtheria (Td) vaccines vaccine were administered significantly (P<0.01) more commonly to intervention patients in one clinic, Td in the second, and none in the third. There were no additional significant differences during one year of follow-up. A number of barriers to comprehensive vaccination were encountered.

Primary study

Unclassified

Delivery of preventive services to older adults by primary care physicians.

Journal JAMA : the journal of the American Medical Association
Year 2005
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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CONTEXT: Rates of preventive services remain below national goals. OBJECTIVE: To identify characteristics of physicians and their practices that are associated with the quality of preventive care their patients receive. DESIGN: Cross-sectional analysis of data on US physician respondents to the 2000-2001 Community Tracking Study Physician Survey linked to claims data on Medicare beneficiaries they treated in 2001. Physician variables included training and qualifications and sex. Practice setting variables included practice type, size, sources of revenue, and access to information technology. Analyses were adjusted for patient demographics and comorbidity, as well as community characteristics. SETTING AND PARTICIPANTS: Primary care delivered by 3660 physicians providing usual care to 24 581 Medicare beneficiaries aged 65 years and older. MAIN OUTCOME MEASURES: Proportion of eligible beneficiaries receiving each of 6 preventive services: diabetic monitoring with hemoglobin A(1c) measurement or eye examinations, screening for colon or breast cancer, and vaccination for influenza or pneumococcus in 2001. RESULTS: Overall, the proportion of beneficiaries receiving services was below national goals. Physician and, more consistently, practice-level characteristics were both associated with differences in the delivery of services. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6% of revenue from Medicaid were more likely than those with more than 15% of revenue derived from Medicaid to receive diabetic eye examinations (48.9% vs 43%; P = .02), hemoglobin A1c monitoring (61.2% vs 48.4%; P<.001), mammograms (52.1% vs 38.9%; P<.001), colon cancer screening (10.0% vs 8.5%; P = .60), and influenza (50.2% vs 39.2%; P<.001) and pneumococcal (8.2% vs 6.4%; P<.001) vaccinations. Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a US or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines. CONCLUSIONS: Delivery of routine preventive services is suboptimal for Medicare beneficiaries. However, patients treated within particular practice settings and by particular subgroups of physicians are at particular risk of low-quality care. Profiling these practices may help develop tailored interventions that can be directed to sites where the opportunities for quality improvement are greatest.

Primary study

Unclassified

Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status.

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Journal Annals of family medicine
Year 2004
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Barriers to adult immunizations persist as current rates for pneumococcal polysaccharide vaccine (PPV) receipt among eligible adults remain below national goals. This study investigated potential barriers to patients receiving the PPV, including predisposing, enabling, environmental and reinforcing factors among physicians from a variety of practice and geographic settings. METHODS: Participants were 60 primary care physicians from inner-city, rural, suburban, and Veterans Affairs practices, which included adults aged 65 years and older. Elderly patients able to complete a telephone interview were randomly selected from each physician's practice. RESULTS: Self-reported PPV vaccination status was significantly related to physician report of routinely providing PPV to their patients and to the practice providing immunization clinics or other immunization promotion programs. Physicians who were highly unlikely to refer uninsured adults to health departments for immunizations had a significantly higher percentage of patients reporting receipt of PPV (P = .03). CONCLUSIONS: Enabling and environmental factors related to physicians, such as economic and insurance issues, were significant barriers to PPV vaccination. Vaccination rates might be improved through efforts that reduce likelihood of referral for immunizations and office systems that support immunization, such as patient and provider reminders and express vaccination clinics.

Primary study

Unclassified

Improving Physician Coverage of Pneumococcal Vaccine: A Randomized Trial of a Telephone Intervention.

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Authors Quinley JC , Shih A
Journal Journal of community health
Year 2004
Links Pubmed DOI

This article is included in 1 Broad synthesis Broad syntheses (1 reference) 3 Systematic reviews Systematic reviews (3 references)

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Improved pneumococcal vaccine (PPV) immunization for seniors is a national goal of the Medicare program. This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations. Medicare fee-for-service claims data were used to select New York primary care physicians with high volume (n=732) or African-American serving (n=329) practices. All practices received mailed feedback on their 1999 Medicare practice specific PPV coverage rates, along with educational materials and offers of assistance. Physicians randomized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only, and 27% vs. 17% (p=0.01) of high volume physicians and 34% vs. 22% (p=.052) of African American serving physicians achieved at least a 5% increase in their cumulative PPV claims coverage. This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization. However, improved methods may be needed to induce a large percentage of physicians to change. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Primary study

Unclassified

The physician's office: can it influence adult immunization rates?

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Journal The American journal of managed care
Year 2004
Links Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To determine which office and patient factors affect adult influenza and pneumococcal vaccination rates. STUDY DESIGN: Patient interviews and self-administered surveys of office managers. PATIENTS AND METHODS: In a 2-stage random cluster sample, 22 practices in 4 strata (Veterans' Affairs, rural, urban/suburban, and inner city) and 15 patients per physician in each practice (n = 946) were selected. Office managers completed a questionnaire regarding office practices and logistics affecting immunizations. Data were examined using chi2 and regression analyses without and with patient factors in the models. RESULTS: Practice factors significantly related to influenza vaccination status were stratum (VA OR = 2.04; 95% CI = 1.18, 3.53; P < .05 vs inner-city), time allotted for acute care visits (16-20 min vs 10-15 min OR = 2.49; 95% CI = 1.68, 3.09; P < .001), the practice not having a source of free vaccines (OR = .43; 95% CI = .3, .62; P < .001), and the interaction between being an urban/suburban practice and having a source of free flu vaccines (OR = 4.0; 95% CI = 2.63, 6.09; P < .001). Practice factors related to pneumococcal vaccination status were the number of immunization promotion activities (> or = 3 vs 0-2 OR = 1.97; 95% CI = 1.33, 2.94; P = .002) and the time allotted for acute care visits (16-20 min vs 10-15 min OR = 1.94; 95% CI = 1.18, 3.19; P = .011). When practice and patient factors were combined in the analyses, patient factors were more important. CONCLUSION: Although patient factors are more important than practice factors, practices that allot more time for acute care visits and use more immunization promotion activities have higher vaccination rates.

Primary study

Unclassified

Promoting pneumococcal immunizations among rural Medicare beneficiaries using multiple strategies.

Journal The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
Year 2003
Links Pubmed

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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CONTEXT: Vaccine-preventable diseases among adults are major contributing causes of morbidity and mortality in the United States. However, adult immunizations continue to be underutilized in both urban and rural areas. PURPOSE: To evaluate the effectiveness of a community-wide education campaign and mailed reminders promoting pneumococcal immunizations to rural Medicare beneficiaries. METHODS: We implemented a community-wide education campaign, and mailed reminders were sent to Medicare beneficiaries in 1 media market in Montana to increase pneumococcal immunizations. In a second distinct media market, mailed reminders only were sent to beneficiaries. FINDINGS: The proportion of respondents aged 65 years and older aware of pneumococcal immunizations increased significantly from baseline to follow-up among respondents both in the education-plus-reminder (63% to 78%, P = 0.04) and the reminder-only (64% to 74%, P = 0.05) markets. Overall from 1998 to 1999, there was a 3.7-percentage-point increase in pneumococcal immunization claims for Medicare beneficiaries in the education-plus-reminder market and a 1.5-percentage-point increase in the reminder-only market. Medicare beneficiaries sent reminders in the education-plus-reminder market compared to those in the reminder-only market were more likely to have a claim for pneumococcal immunization in 1999 (odds ratio 1.18, 95% confidence interval 1.08 to 1.28). The results suggest that these quality improvement strategies (community education plus reminders and reminders alone) modestly increased pneumococcal immunization awareness and pneumococcal immunization among rural adults. Mailed reminder exposure was associated with an increased prevalence of pneumococcal immunizations between 1998 and 1999 and was augmented somewhat by the education campaign.

Primary study

Unclassified

The effect of a combined influenza/pneumococcal immunization reminder letter.

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Journal American journal of preventive medicine
Year 2001
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: The effect of a combined influenza and pneumococcal immunization reminder letter on increasing influenza and pneumococcal immunization rates, and the timeliness of receiving immunizations after receipt of a reminder letter, have not been examined. This study addresses these issues using a sample of new Medicare beneficiaries residing in Hawaii. METHODS: Newly enrolled Medicare beneficiaries in Hawaii from 25 September 1995 through 31 August 1996 were randomly assigned to one of three groups: Group 1, no letter (n=2144); Group 2, influenza immunization reminder letter only (n=2213); or Group 3, pneumococcal and influenza immunization reminder letter (n=2171). Health Care Financing Administration claims data were compared among groups. RESULTS: In Group 3, the influenza immunization rate increased 3.8 percentage points (n=87; p=0.017) compared with Group 1. The Group 3 pneumococcal immunization rate increased 3.5 percentage points (n=78; p<0.001) compared to Group 1 and 4.0 percentage points (n=86; p<0.001) compared to Group 2. Sixty-six beneficiaries in Group 3 received simultaneous pneumococcal and influenza immunizations, a significant difference compared to Group 1 or Group 2. Increases in immunizations were observed immediately following the reminder letters and the effect persisted for 5 to 7 weeks. CONCLUSIONS: The combination letter increased both influenza and pneumococcal immunization rates and the simultaneous administration of immunizations without detrimental effect to influenza immunization rates. A combined reminder letter is inexpensive and recommended as part of a multicomponent campaign for adult immunization.