Use of standing orders for adult influenza vaccination a national survey of primary care physicians.
BACKGROUND
Influenza vaccination of adults remains below recommended levels. Standing orders programs (SOPs) that allow nonphysician medical staff to assess eligibility and administer vaccines without an individualized physician's order are a proven method to increase vaccination rates. However, recent data on their use are not available.


OBJECTIVE
Investigators surveyed primary care physicians nationwide in 2009 to assess factors related to awareness and use of SOPs.


METHODS
Using the AMA Master List, a stratified random sample of U.S. family physicians (n=820) and general internists (n=820) was selected to receive a mailed questionnaire. The inclusion criterion was providing primary care to adults in an office-based practice. The primary outcome measure, analyzed in 2010, was consistent use of SOPs.


RESULTS
The survey response rate was 67% (1015/1517). Forty-two percent of respondents who immunized adults in their practices reported consistent use of SOPs. Those physicians differed in several dimensions, including awareness of recommendations and regulations regarding SOPs for vaccines, size and type of practice, number and level of training of clinical staff, attributes of the staff. The two variables in logistic regression models that were associated with the highest likelihood of using SOPs were awareness of recommendations to use them (OR=3.0; 95% CI=2.2, 4.1) and agreement with their effectiveness (OR=2.7, 95% CI=1.9, 3.8).


CONCLUSIONS
Fewer than half of physicians report using SOPs for influenza vaccination, a number that is not much higher than it was about a decade ago. Approaches to increase use of SOPs are needed.
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Richard K
RK
Zimmerman
Steven M
SM
Albert
Mary Patricia
MP
Nowalk
Michael A
MA
Yonas
Faruque
F
Ahmed
D000328:Adult; D019538:Health Care Surveys; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D058007:Physicians, Primary Care; D057766:Policy; D010818:Practice Patterns, Physicians'; D014481:United States
D007252:Influenza Vaccines
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