title: Physician practices and attitudes regarding adult immunizations.
abstract: OBJECTIVE
  To assess immunization practices and attitudes of U.S. primary care physicians regarding adult influenza and pneumococcal immunizations.
  
  
  METHODS
  Mailed survey of primary care internists and family physicians across the United States; four follow-up contacts by mail and telephone. Bivariate and multivariate analyses assessed immunization practices and attitudes and differences by physician characteristics.
  
  
  RESULTS
  Three hundred and sixteen of 668 eligible physicians responded (50 refused, response rate of 266 = 40%); 220 provided adult vaccinations. More than 64% indicated they routinely vaccinated patients >/=65 years and those <65 years with chronic disease indications with both influenza and pneumococcal vaccine. Reported barriers for influenza vaccination included vaccine safety concerns by patients (58%), urgent concerns dominating visits (43%), and inadequate reimbursement (26%). Reported barriers for pneumococcal vaccination included urgent concerns during office visits (44%), no patient immunization history (36%), patient concerns about vaccine safety (31%), and inadequate reimbursement (25%). Many physicians indicated willingness to try tracking systems (72%), chart reminders (55%), patient reminders (53%), standing orders (36%), external lists of unimmunized patients for pneumococcal vaccination (74%), external patient reminders (70%), and office training of physicians (36%) or staff (46%).
  
  
  CONCLUSIONS
  While most physicians favored adult vaccinations, practical barriers to vaccination exist. Most physicians would adopt evidence-based strategies to improve immunization delivery.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Strong Children's Research Center, Rochester, NY 14642, USA. peter_szilagyi@urmc.rochester.edu
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Laura P
authors.initials: LP
authors.lastname: Shone
authors.forename: Richard
authors.initials: R
authors.lastname: Barth
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Kouides
authors.forename: Christine
authors.initials: C
authors.lastname: Long
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Jackie
authors.initials: J
authors.lastname: Jennings
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires