Tailoring interventions: understanding medical practice culture.
This article describes the results of a study that used intensive direct observations of eight medical practices to assess the factors affecting the barriers and facilitators to adult immunization for influenza and pneumonia. The study aimed to describe the culture of these practices by identifying key features that facilitate or deter the immunization process. The article presents profiles of six of the eight practices describing their cultural and organizational frameworks. Six features that are critical to an understanding of the cultures of these practices, particularly as they relate to receptivity to influenza immunization for diverse practices and patient populations, are highlighted. These include policies and procedures, funding source, physician philosophy, patient receptivity to provider recommendation, and physical environment and social environment. The article also discusses strategies for applying knowledge about the culture of each practice to introduce appropriate and feasible interventions aimed at increasing immunization rates.
Silverman
Myrna
M
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. woman@pitt.edu
Terry
Martha A
MA
Zimmerman
Richard K
RK
Nutini
Jean F
JF
Ricci
Edmund M
EM
D000368:Aged; D005194:Family Practice / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007251:Influenza, Human / Q000276:immunology*; D008297:Male; D010414:Pennsylvania; D011014:Pneumonia / Q000276:immunology*; D019035:Rural Health Services; D014481:United States; D014493:United States Department of Veterans Affairs; D019037:Urban Health Services; D014611:Vaccination / Q000706:statistics & numerical data*