title: Standing orders for influenza and pneumococcal polysaccharide vaccination: correlates identified in a national survey of U.S. Primary care physicians.
abstract: BACKGROUND
  Standing orders programs (SOPs) allow non-physician medical staff to assess eligibility and administer vaccines without a specific physician's order. SOPs increase vaccination rates but are underutilized.
  
  
  METHODS
  In 2009, correlates of SOPs use for influenza vaccine and pneumococcal polysaccharide vaccination (PPV) were assessed in a nationally representative, stratified random sample of U.S. physicians (n = 880) in family and internal medicine who provided office immunization. The response rate was 67%. Physicians reporting no SOPs, only influenza SOPs, and joint influenza and PPV SOPs were compared using multinomial and logistic regression models to examine individual and practice-level correlates.
  
  
  RESULTS
  23% reported using SOPs consistently for both influenza vaccine and PPV, and 20% for influenza vaccination only, with the remainder not using SOPs. Practice-level factors that distinguished practices with joint influenza-PPV SOPs included perceived practice openness to change, strong practice teamwork, access to an electronic medical record, presence of an immunization champion in the practice, and access to nurse/physician assistant staff as opposed to medical assistants alone.
  
  
  CONCLUSIONS
  Physicians in practices with SOPs for both vaccines reported greater awareness of ACIP recommendations and/or Medicare regulations and were more likely to agree that SOPs are an effective way to boost vaccination coverage. However, implementation of both influenza and PPV SOPs was also associated with a variety of practice-level factors, including teamwork, the presence of an immunization champion, and greater availability of clinical assistants with advanced training.
  
  
  CONCLUSIONS
  Practice-level factors are critical for the adoption of more complex SOPs, such as joint SOPs for influenza and PPV.
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. smalbert@pitt.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albert
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Michael A
authors.initials: MA
authors.lastname: Yonas
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
mesh_terms: D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration; D007252:Influenza Vaccines / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008503:Medical Staff; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards*; D014481:United States
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines