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Examining structural and clinical factors associated with implementation of standing orders for adult immunization.

Abstract
A proven method to increase vaccination rates in primary care is a standing orders program (SOP) for nonphysician staff to assess and vaccinate eligible individuals without a specific written physician order. This study describes a mixed methods approach to examining physicians' beliefs and attitudes about and adoption of SOPs for adult immunizations, specifically, influenza and pneumococcal polysaccharide vaccine. Focus groups and in-depth interviews of physicians, nurses, practice managers, and the medical director of a managed care health plan were conducted. Results were used to enrich a concise survey based on the Awareness-to-Adherence model of physician behavior and previous research, which was mailed to 1,640 general internists and family physicians nationwide. Barriers to SOPs identified through qualitative methods were lack of interest in changing the status quo, a physician-dominated hierarchy, and fear of malpractice. Facilitators included having an electronic medical record and a practice culture that was open to change. The survey (response rate 67%) confirmed the facilitators and further identified patient, physician, and practice factors that served as barriers to establishing and maintaining SOPs. This mixed methods approach provided the opportunity to develop a tailored and practice-oriented survey for examining the contextual factors influencing clinical providers' decisions to implement SOPs for adult immunization.
AuthorsMichael A Yonas, Mary Patricia Nowalk, Richard K Zimmerman, Faruque Ahmed, Steven M Albert
JournalJournal for healthcare quality : official publication of the National Association for Healthcare Quality (J Healthc Qual) 2012 May-Jun Vol. 34 Issue 3 Pg. 34-42 ISSN: 1945-1474 [Electronic] United States
PMID22059731 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
Copyright© 2011 National Association for Healthcare Quality.
Topics
  • Adult
  • Allied Health Personnel
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Immunization Programs (organization & administration)
  • Primary Health Care
  • Professional Autonomy
  • Qualitative Research
  • Surveys and Questionnaires

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