title: Standing orders in an ambulatory setting increases influenza vaccine usage in older people.
abstract: OBJECTIVE
  To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients.
  
  
  METHODS
  Retrospective analysis of influenza vaccine usage over 4 years (1999-2002).
  
  
  METHODS
  University ambulatory setting.
  
  
  METHODS
  Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group.
  
  
  METHODS
  Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used standing orders were compared with those of physicians who did not use standing orders.
  
  
  RESULTS
  Five hundred seventy-six (63%) patients of physicians who used standing orders received influenza vaccine, compared with 332 (38%) patients of physicians who did not use them (P<.001). Standing orders accounted for a significantly higher rate of influenza vaccination in each study year. Moreover, in 2001, when influenza vaccine delivery was delayed, physicians who used standing orders maintained their same rate of usage, but physicians who did not had rates of about one-half their usage of the other 3 years.
  
  
  CONCLUSIONS
  More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.
authors.affiliation: Department of Medicine, Joan.C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA. goebel@marshall.edu
authors.forename: Lynne J
authors.initials: LJ
authors.lastname: Goebel
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Neitch
authors.forename: Maurice A
authors.initials: MA
authors.lastname: Mufson
mesh_terms: D000046:Academic Medical Centers; D000368:Aged / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D002985:Clinical Protocols; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014903:West Virginia
chemical_list: D007252:Influenza Vaccines