title: Missed opportunities to vaccinate older adults in primary care.
abstract: OBJECTIVE
  During the 2000 to 2001 influenza season, distribution of influenza vaccine was delayed, and national self-reported vaccination rates declined. The purposes of this study were to characterize missed opportunities for adult vaccinations and assess the impact of the vaccine delay on missed opportunities for influenza vaccination as recorded in medical records.
  
  
  METHODS
  In a cross-sectional analysis, medical record data from 217 adult patients aged > or =65 years in primary care practices that received influenza vaccine supplies late in 2000 were used to assess rates and missed opportunities to vaccinate. Missed opportunities were defined as visits in which there was no record that vaccine had been given, discussed, or refused by the patient.
  
  
  RESULTS
  During the mean study period of 37.1 +/- 5.7 months, patients averaged 12.1 +/- 5.9 visits to their primary care physician's office. Medical records indicated that 75% of patients had received pneumococcal polysaccharide vaccine (PPV) and 30% had received tetanus toxoid from 1991 to 2001; 81% had received at least one influenza vaccine in the previous 4 seasons. During the 2000 to 2001 influenza season, influenza vaccination rates declined significantly to 41% from 57% in 1999 to 2000. Overall missed opportunities to vaccinate during the study period averaged 3.4 +/- 3.0 for influenza vaccine, 10.7 +/- 7.3 for pneumococcal vaccine, and 10.8 +/- 5.9 for tetanus toxoid. During the delay season, the number of visits increased, but missed opportunities to vaccinate also increased significantly, even after vaccine supplies had been received.
  
  
  CONCLUSIONS
  Missed opportunities to vaccinate occur frequently and vaccine shortages create additional challenges to adult vaccination. Missed opportunities may be minimized and maintenance of accurate adult immunization records may be achieved by assessing and recording vaccination status at each visit, regardless of vaccine availability. By so doing, providers can easily convey the message to their patients that immunizations are an important part of their care.
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: Richard Kent
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Cleary
authors.forename: Richard D
authors.initials: RD
authors.lastname: Bruehlman
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013745:Tetanus Toxoid / Q000008:administration & dosage; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D013745:Tetanus Toxoid