Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers |
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| Affiliation: | 1. Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-4, Atlanta, GA 30326, United States;2. Oak Ridge Institute for Science and Education, U.S. Department of Energy, P.O. Box 117, Mail stop 36, Oak Ridge, TN 37831, United States;3. IHRC Inc, 2 Ravinia Dr Suite 1200, Atlanta, GA 30346, United States;4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States;5. Leidos Inc, 2295 Parklake Dr NE, Atlanta, GA 30345, United States;6. Berry Technology Solutions, Inc, 19 E. Broad St, Suite B, Newnan, GA 30263, United States;7. Immunization Action Coalition, 2550 University Ave W, Suite 415, St. Paul, MN 55114, United States;8. Abt Associates Inc, 10 Fawcett St, Suite 5, Cambridge, Massachusetts, United States;9. Westat, 1600 Research Blvd, Rockville, MD 20850, United States;10. United States Department of Health and Human Services, 200 Independence Ave S.W., Washington, DC. 20201, United States;1. Genomic Research Laboratory, Division of Infectious Diseases, University Hospitals and University of Geneva, Geneva, Switzerland;2. Swiss National Reference Center for Meningococci (www.meningo.ch), Bacteriology Laboratory, Geneva University Hospitals, Geneva, Switzerland;3. Invasive Bacterial Infection and National Reference Centre for Meningococci, Institut Pasteur, Paris, France;1. Department of Pediatrics, Houston, TX, United States;2. Department of Molecular Virology and Microbiology, Houston, TX, United States;3. Department of Medicine, Baylor College of Medicine, Houston, TX, United States;4. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States;5. Department of Obstetrics & Gynecology, Duke University, Durham, NC, United States;6. Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States;7. Saint Louis University School of Medicine, St. Louis, MO, United States;8. The EMMES Company, LLC, Rockville, MD, United States;1. Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA, USA;2. Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA;3. Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA;4. National Center Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta GA, USA;1. Trudeau Institute, Inc., Saranac Lake, NY, USA;2. Infectious Disease Research Institute, Seattle, WA, USA;3. University of Connecticut School of Medicine, Department of Immunology and Center on Aging, Farmington, CT, USA;1. Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;2. Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;3. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States;4. Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States;5. Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, IL, United States;6. Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, United States;7. Department of Pediatrics, University of Rochester, Rochester, NY, United States;8. Department of Pediatrics, University of California Los Angeles Mattel Children’s Hospital, Los Angeles, CA, United States |
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| Abstract: | ![]()
The revised Standards for Adult Immunization Practice (“Standards”), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists.Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices. |
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| Keywords: | Adult Vaccination Standards Immunization Providers |
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