title: Understanding adult vaccination in urban, lower-socioeconomic settings: influence of physician and prevention systems.
abstract: OBJECTIVE
  Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.
  
  
  METHODS
  PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables.
  
  
  RESULTS
  Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%-98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be "reported time spent with patients for a well visit" (P = .01) and "use of enhanced immunization documentation" (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%-96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was "use of standing orders" (P <.001) and "average observed physician examination room time," regardless of visit type (P=.02).
  
  
  CONCLUSIONS
  Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Melissa
authors.initials: M
authors.lastname: Tabbarah
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Hart
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Fox
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003625:Data Collection; D005260:Female; D006299:Health Services for the Aged; D054625:Healthcare Disparities; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008913:Minority Groups; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011204:Poverty Areas; D011216:Practice Management, Medical; D011320:Primary Health Care; D012959:Socioeconomic Factors; D014504:Urban Health; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines