title: An opt-out influenza vaccination policy improves immunization rates in primary care.
abstract: OBJECTIVE
  During the 2007-08 influenza season 36% of outpatients seen at our urban family medicine center received an influenza immunization. We explored the expected increase in vaccinations from an opt-out policy using standing orders in a lower-income population.
  
  
  METHODS
  A comparison of vaccination rates during the periods 10/1/2007 to 3/31/2008 (P1) versus 10/1/2008 to 3/31/2009 (P2) with adjustments for cohort non-independence.
  
  
  RESULTS
  The overall P2 vaccination rate increased to 49% [p<.000001]. P2 rates were significantly higher for those with diabetes, both genders, African American and European American patients from 3 to 64 years old, and in all insurance groups. The vaccination rates for patients with Medicaid insurance (37% and 54%) were higher than the rates for patients with commercial insurance (31% and 43%).
  
  
  CONCLUSIONS
  The opt-out policy is associated with a moderate (1.4 fold) increase in the vaccination rate. Primary care resource constraints may limit further improvement.
authors.affiliation: Family Medicine Research Center, Department of Family Medicine, Summa Health System, Akron, OH 44309-2090, USA. LogueE@summahealth.org
authors.forename: Everett
authors.initials: E
authors.lastname: Logue
authors.forename: Patricia
authors.initials: P
authors.lastname: Dudley
authors.forename: Trisha
authors.initials: T
authors.lastname: Imhoff
authors.forename: William
authors.initials: W
authors.lastname: Smucker
authors.forename: Jan
authors.initials: J
authors.lastname: Stapin
authors.forename: John
authors.initials: J
authors.lastname: DiSabato
authors.forename: Christine
authors.initials: C
authors.lastname: Schueller
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus; D005194:Family Practice; D005260:Female; D006291:Health Policy; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data* / Q000639:trends*; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D019037:Urban Health Services; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines