title: Provider response to different formats of the adult immunization schedule.
abstract: BACKGROUND
  Providers' failure to administer vaccines in accordance with established recommendations is a well-recognized barrier to national immunization efforts. This study evaluated the ease of use of two different formats of the Centers for Disease Control and Prevention's (CDC) adult immunization schedule by physicians in private practice, where the majority of adult immunizations are administered.
  
  
  METHODS
  A series of focus groups was conducted with 94 physicians and other clinical staff in 11 private practices (family medicine and internal medicine) in six U.S. cities. Each session was based on a structured set of questions that explored barriers to adult immunizations, followed by three mock clinical scenarios to examine how each of two graphical depictions of the 2003-2004 adult immunization schedule (one from the CDC's Advisory Committee on Immunization Practices, and the other from the Immunization Action Coalition) might facilitate assessments of recommended immunizations. Group dialogue and individual participants' written responses to the scenarios and the alternate schedule formats were analyzed.
  
  
  RESULTS
  Providers perceived multiple barriers to adult immunization independent of immunization schedule formats, chiefly patients' low interest in immunization and refusal of vaccines. Most participants were not familiar with either format of CDC's adult immunization schedule before the study, but quickly developed strong preferences for one versus the other (usually the second format that they encountered). About half of the providers changed their vaccine recommendations for clinical scenarios when they consulted either schedule format, although some of the changes were not clinically appropriate. Participants suggested several ways to enhance the availability of the information contained in the schedule formats, especially through electronic means.
  
  
  CONCLUSIONS
  This qualitative study suggests ways in which graphic depictions of an adult immunization schedule may address adult immunization barriers. Greater provider familiarity with schedule formats will be critical to their appropriate application in clinical encounters.
authors.affiliation: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA. mattdav@med.umich.edu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Lakshmi K
authors.initials: LK
authors.lastname: Halasyamani
authors.forename: Vishnu-Priya
authors.initials: VP
authors.lastname: Sneller
authors.forename: Kathy R
authors.initials: KR
authors.lastname: Bishop
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011331:Private Practice; D014481:United States