title: Acceptance of pneumococcal vaccine under standing orders by race and ethnicity.
abstract: OBJECTIVE
  To assess whether and how pneumococcal vaccine acceptance occurs after nurse recommendation varies by race/ethnicity.
  
  
  METHODS
  We prospectively evaluated nurses' standing orders to assess and vaccinate high-risk patients in a general medicine practice.
  
  
  RESULTS
  Of 370 adult patients surveyed (60% nonwhite), 78 (21%) declined vaccination following nurse recommendation, and 43 (12%) persisted in declining after physician consultation. Three-hundred-twenty-seven (88%) patients accepted vaccination: 292 (79%) accepted following nurse recommendation and 35 (9%) following physician consultation. African Americans (19%) were significantly more likely to decline compared with whites (8%) and Asians (5%) (P= 0.01). Reasons for refusal included believing vaccination was unnecessary (32%), fearing shots in general (21%), fearing vaccine-induced illness (26%) and wanting more informotion regarding the vaccine (9%).
  
  
  CONCLUSIONS
  Standing orders, physicians' firm recommendations and addressing patients' vaccine-related concerns may reduce racial/ethnic disparities in vaccination.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA. ndaniels@medicine.ucsf.edu
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Daniels
authors.forename: Susan
authors.initials: S
authors.lastname: Gouveia
authors.forename: Daniel
authors.initials: D
authors.lastname: Null
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Gildengorin
authors.forename: Carla A
authors.initials: CA
authors.lastname: Winston
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011008:Pneumococcal Infections / Q000208:ethnology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022242:Pneumococcal Vaccines