title: Evaluation of a toolkit to introduce standing orders for influenza and pneumococcal vaccination in adults: a multimodal pilot project.
abstract: BACKGROUND
  Immunization of adults with influenza vaccine and pneumococcal polysaccharide vaccine remains lower than recommended levels. Standing order programs (SOPs) in which non-physician medical personnel are permitted to assess an adult patient's immunization status and administer vaccines without an individual physician order are a proven method of increasing adult vaccinations, yet they are used by less than one half of primary care physicians caring for adults.
  
  
  METHODS
  Following a national survey of primary care physicians about barriers to SOPs for adult immunizations, a SOP toolkit was developed. After review by a panel of experts, the toolkit was pilot tested in three primary care practices in a health care network with the same electronic medical record (EMR) system and low adult vaccination rates. Practice staffs were trained in the use of SOPs and the toolkit at a group meeting. This study was designed to pilot-test and evaluate the toolkit with the express intention of improving it. Three methods were used to evaluate the toolkit: (1) direct observation and interviews of each practice's staff; (2) surveys of each practice's staff; and (3) influenza and pneumococcal polysaccharide vaccine (PPV) vaccination rates.
  
  
  RESULTS
  The staffs at all sites were equally likely to find the presentations and toolkit useful and did not differ in their knowledge of using SOPs for vaccination. They expressed a common set of barriers to implementing SOPs despite using the toolkit, and provided ideas for improving implementation. One site viewed SOPs in general in a more negative light and expressed that SOPs unfairly increased their workload. Vaccination rates in this site did not differ from those of the control site.
  
  
  CONCLUSIONS
  The evaluation suggested that the SOP toolkit should be expanded to include additional strategies to improve its applicability and effectiveness.
authors: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States. tnowalk@pitt.edu
authors: Mary Patricia
authors: MP
authors: Nowalk
authors: Jean
authors: J
authors: Nutini
authors: Mahlon
authors: M
authors: Raymund
authors: Faruque
authors: F
authors: Ahmed
authors: Steven M
authors: SM
authors: Albert
authors: Richard K
authors: RK
authors: Zimmerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D010865:Pilot Projects; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011320:Primary Health Care; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines