title: Improving adherence to national recommendations for zoster vaccination through simple interventions.
abstract: OBJECTIVE
  In 2011, 15.8% of eligible patients in the United States were vaccinated against herpes zoster (HZ). To increase the usage of the HZ vaccine by studying physicians' knowledge, attitudes, practices, and perceived obstacles after interventions to overcome barriers.
  
  
  METHODS
  General internal medicine physicians were surveyed with a cross-sectional internet survey from October to December 2011 before interventions to increase the use of the HZ vaccine and 1 year later. Interventions included education, increasing availability at the medical center pharmacy, and electronic medical record reminders. Outcome measures included changes in knowledge, attitudes, and practices, and perceived barriers. McNemar chi-square tests were used to compare the changes from the baseline survey for physicians who completed the follow-up survey.
  
  
  RESULTS
  Response rate for the baseline study was 33.5% (89/266) and for the follow-up was 29.8% (75/252). Fifty-five completed both surveys. There was a decrease from 57% at baseline to 40% at follow-up in the proportion of physicians who reported that less than 10% of their patients were vaccinated. They were more likely to know the HZ annual incidence (30% baseline; 70% follow-up; P=0.02), and report having educational information for physicians (7% baseline; 27% follow-up; P=0.003). The top helpful intervention was nursing administration of the vaccine. Average monthly HZ vaccine usage in the affiliated outpatient pharmacy increased in 10 months between surveys by 156% compared with the 3 months before the baseline survey.
  
  
  CONCLUSIONS
  Interventions implemented during the study led to an increase in physicians' basic knowledge of the HZ vaccine and an increase in usage at the affiliated pharmacy.
authors.affiliation: Department of Ophthalmology (Z.P.E., E.J.C., E.C., I.H., J.J.J., L.P.), Division of Biostatistics and Department of Population Health (J.D.G., X.L., M.H.P.), and Division of General Internal Medicine and Department of Medicine (C.G., S.Z.), New York University School of Medicine, New York, NY.
authors.forename: Zachary P
authors.initials: ZP
authors.lastname: Elkin
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Cohen
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Li
authors.forename: Eliana
authors.initials: E
authors.lastname: Castano
authors.forename: Colleen
authors.initials: C
authors.lastname: Gillespie
authors.forename: Ilyse
authors.initials: I
authors.lastname: Haberman
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Jung
authors.forename: Sondra
authors.initials: S
authors.lastname: Zabar
authors.forename: Lisa
authors.initials: L
authors.lastname: Park
authors.forename: Michael H
authors.initials: MH
authors.lastname: Perskin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006562:Herpes Zoster / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage*; D006801:Humans; D007388:Internal Medicine / Q000193:education; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017010:Reminder Systems; D011795:Surveys and Questionnaires; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053061:Herpes Zoster Vaccine