title: Policies to increase influenza and pneumococcal immunizations in chronically ill and institutionalized settings.
abstract: BACKGROUND
  The objective of this study was to understand better the status of and ways to improve dissemination of influenza and pneumococcal standing-order vaccination policies to at-risk adults in health care institutions.
  
  
  METHODS
  A statewide sample of 5 different types of institutions serving at-risk elderly persons in North Carolina was surveyed. A 45-question telephone survey was administered to infection control nurses or facility directors at 267 (86% response rate) health care facilities involved in direct patient care.
  
  
  RESULTS
  A majority of respondents reported that influenza (81%) and pneumococcal (59%) diseases were important to their facility, and 63% stated that the influenza vaccine was very effective versus 47% for pneumococcal. Except nursing homes, few facilities reported adoption of standing-order policies to vaccinate routinely the at-risk adults. Over 70% of respondents stated that their facilities might consider adopting standing-order policies for influenza and pneumococcal disease. A majority of respondents also supported a state law that requires such vaccines for high-risk patients unless contraindicated or the patient refuses.
  
  
  CONCLUSIONS
  Respondents across diverse health care institutions appear interested in adopting standing-order policies to increase influenza and pneumococcal vaccination rates and are more likely to do so if provided with appropriate administrative and/or financial support for implementation.
authors.affiliation: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, USA. aog@med.unc.edu
authors.forename: Adam O
authors.initials: AO
authors.lastname: Goldstein
authors.forename: Jean E
authors.initials: JE
authors.lastname: Kincade
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Resnick
authors.forename: George
authors.initials: G
authors.lastname: Gamble
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Bearman
mesh_terms: D000554:Ambulatory Care Facilities; D040561:Assisted Living Facilities; D006291:Health Policy; D018574:Home Care Agencies; D006761:Hospitals; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D009657:North Carolina; D009735:Nursing Homes; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines