title: The physician's office: can it influence adult immunization rates?
abstract: OBJECTIVE
  To determine which office and patient factors affect adult influenza and pneumococcal vaccination rates.
  
  
  METHODS
  Patient interviews and self-administered surveys of office managers.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA. tnowalk@pitt.edu
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Inis Jane
authors.initials: IJ
authors.lastname: Bardella
authors.forename: Richard Kent
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Shunhua
authors.initials: S
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010824:Physicians' Offices; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011014:Pneumonia / Q000517:prevention & control*; D011897:Random Allocation; D011795:Surveys and Questionnaires
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines