title: Physician and practice factors related to influenza vaccination among the elderly.
abstract: BACKGROUND
  Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective.
  
  
  METHODS
  Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years. Questionnaires and interviews based on the PRECEDE-PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined.
  
  
  RESULTS
  The clinician response rate was 85% (60/71). Several factors of the PRECEDE-PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting ("strata"), of which the VA was highest.
  
  
  CONCLUSIONS
  Through proactive office systems and education, physicians may influence patients' intentions to be vaccinated and thereby increase influenza vaccination rates.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. zimmer@pitt.edu
authors.forename: Richard Kent
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Inis J
authors.initials: IJ
authors.lastname: Bardella
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Janine E
authors.initials: JE
authors.lastname: Janosky
authors.forename: Tammy A
authors.initials: TA
authors.lastname: Santibanez
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wilson
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
mesh_terms: D000368:Aged; D005260:Female; D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D008297:Male; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D007252:Influenza Vaccines