Facilitators and barriers to the use of standing orders for vaccination in obstetrics and gynecology settings.
BACKGROUND
Many young and middle-aged women receive their primary health care from their obstetrician-gynecologists. A recent change to vaccination recommendations during pregnancy has forced the integration of new clinical processes at obstetrician-gynecology practices. Evidence-based best practices for vaccination delivery include the establishment of vaccination standing orders.


OBJECTIVE
As part of an intervention to increase adoption of evidence-based vaccination strategies for women in safety-net and private obstetrician-gynecology settings, we conducted a qualitative study to identify the facilitators and barriers experienced by obstetrician-gynecology sites when establishing vaccination standing orders.


METHODS
At 6 safety-net and private obstetrician-gynecology practices, 51 semistructured interviews were completed by trained qualitative researchers over 2 years with clinical staff and vaccination program personnel. Standardized qualitative research methods were used during data collection and team-based data analysis to identify major themes and subthemes within the interview data.


RESULTS
All study practices achieved partial to full implementation of vaccine standing orders for human papillomavirus, tetanus diphtheria pertussis, and influenza vaccines. Facilitating factors for vaccine standing order adoption included process standardization, acceptance of a continual modification process, and staff training. Barriers to vaccine standing order adoption included practice- and staff-level competing demands, pregnant women's preference for medical providers to discuss vaccine information with them, and staff hesitation in determining HPV vaccine eligibility.


CONCLUSIONS
With guidance and commitment to integration of new processes, obstetrician-gynecology practices are able to establish vaccine standing orders for pregnant and nonpregnant women. Attention to certain process barriers can aid the adoption of processes to support the delivery of vaccinations in obstetrician-gynecology practice setting, and provide access to preventive health care for many women.
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; General Academic Pediatrics, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO. Electronic address: Juliana.barnard@ucdenver.edu.
Juliana G
JG
Barnard
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; General Academic Pediatrics, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO.
Amanda F
AF
Dempsey
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
Sarah E
SE
Brewer
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
Jennifer
J
Pyrzanowski
Department of Obstetrics and Gynecology, Denver Health and Hospitals Authority, Denver, CO.
Sara E
SE
Mazzoni
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; General Academic Pediatrics, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO.
Sean T
ST
O'Leary
D000288:Administrative Personnel; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D004165:Diphtheria / Q000517:prevention & control; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000627:therapeutic use; D005260:Female; D006176:Gynecology; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control; D009726:Nurses; D009774:Obstetrics; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D057240:Patient Preference; D008486:Physician Executives; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D000071065:Standing Orders; D013742:Tetanus / Q000517:prevention & control; D014611:Vaccination; D014917:Whooping Cough / Q000517:prevention & control
D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007252:Influenza Vaccines; D053918:Papillomavirus Vaccines
human papillomavirus; immunizations; influenza vaccine; tetanus diphtheria pertussis; vaccines in pregnancy