title: Vaccine storage practices in primary care physician offices: assessment and intervention.
abstract: OBJECTIVE
  To assess the proportion of primary care physician (PCP) offices meeting vaccine storage guidelines, identify factors associated with low compliance, and evaluate whether a quality improvement (QI) activity improves compliance.
  
  
  METHODS
  We examined compliance with guidelines of 721 PCP offices contracted with a national managed care organization in four cities. A QI activity (educational materials, written feedback, and distribution of thermometers) was conducted at baseline and a follow-up assessment occurred within 3 months.
  
  
  RESULTS
  Baseline compliance was relatively high, with >80% adherence to most guidelines. For example, 89% of offices had a thermometer; and 83% of temperatures were appropriate. Most units did not have vaccines stored in the door or food/biological materials in the unit (80% and 96%, respectively). Almost all vaccines had not expired. Multivariate analysis indicated that practice location, type of physician, participation in vaccine programs, and using guidelines were associated with compliance. For most of the compliance measures, pediatric offices had the highest compliance. Adherence to guidelines improved after the QI activity; the net change between pre- and post-intervention ranged from +1% to +19%. Measurements most impacted included temperature log posted (19% improvement in refrigerator; 16% improvement in freezer) and no vaccine stored in refrigerator door (14% improvement).
  
  
  CONCLUSIONS
  Despite generally high compliance, there are some opportunities for improvement in how PCPs store vaccines. Incorporating an intervention program in existing practice activities can improve storage practices. Further research is needed to determine the possible benefits of targeting interventions to certain types of providers who may be less knowledgeable about recommended guidelines.
authors.affiliation: Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Atlanta, Georgia 30322, USA. jagazma@sph.emory.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Gazmararian
authors.forename: Natalia V
authors.initials: NV
authors.lastname: Oster
authors.forename: Diane C
authors.initials: DC
authors.lastname: Green
authors.forename: Linda
authors.initials: L
authors.lastname: Schuessler
authors.forename: Kelly
authors.initials: K
authors.lastname: Howell
authors.forename: Janona
authors.initials: J
authors.lastname: Davis
authors.forename: Marybeth
authors.initials: M
authors.lastname: Krovisky
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Warburton
mesh_terms: D016009:Chi-Square Distribution; D004355:Drug Stability; D004356:Drug Storage / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D010824:Physicians' Offices / Q000592:standards*; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012034:Refrigeration; D013696:Temperature; D014612:Vaccines
chemical_list: D014612:Vaccines