Daniel B. Fishbein1, John M. Fontanesi
2, David Kopald
2, John Stevenson
3, Nancy Bennett
4, David Stryker
5, Christine Long
6, Margaret S. Coleman
7, and Abigail Shefer
8. (1) ISD-HSREB, CDC - NIP, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA, (2) Partnership of Immunization Providers, Community Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0927, La Jolla, CA, USA, (3) NIP/ISD/HSREB, CDC, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA, (4) Monroe County Department of Health, Rochester, NY, USA, (5) Infectious Disease and Internal Medicine Associates, PC, 500 Walter St NE #104, Albuquerque, NM, USA, (6) University of Rochester, Rochester, NY, USA, (7) National Immunization Program, Centers for Disease Control, 4770 Buford Highway, Mailstop - 52, Atlanta, GA, USA, (8) Centers for Disease Control and Prevention, Acting Branch Chief, HSREB, 1600 Clifton Road, NE, MS E-52, Atlanta, USA
KEYWORDS:
influenza, missed opportunities, adult, seasonality, risk factors
BACKGROUND:
Influenza vaccination levels in older patients have changed little since the mid-1990s. Despite identification of a number of cost-effective strategies to increase immunization coverage, many missed opportunities still occur during outpatient visits to health care providers.
OBJECTIVE:
To describe the organizational and operational characteristics of patient-provider encounters associated with missed opportunities to vaccinate adults for influenza.
METHOD:
Cross-sectional observation of 284 influenza vaccine-eligible patients 50 years of age and older. Observations were conducted during routine visits to 16 primary care providers in three geographic clusters of the United States between October 2001 and January 2002. Influenza vaccine was available at the time of the visit. A workflow data acquisition tool was used to directly observe and record information during the visit. A Classification Tree analysis was performed to identifiy factors associated with missed opportunities.
RESULT:
There were 120 (42.3%) missed opportunities during 284 observations. A Classification Tree analysis revealed that factors affecting missed opportunity differed by cluster. In cluster 1, lack of inquiry/discussion during the provider’s evaluation was associated with a 92% risk of missed opportunities. In clusters 2 and 3 the date of visit was most important, with all missed opportunities occurred during late November, December, and January.
CONCLUSION:
Missed opportunities were related to different factors in different clusters. Although no single procedure guaranteed that a patient would be vaccinated, the results of this study suggests that provider inquiry and discussion, especially later in the vaccination season when awareness of vaccination is lower, will reduce missed opportunities.
LEARNING OBJECTIVES:
Identify three factors associated with missed opportunities to immunize adults
See more of Barriers to Adult Immunization: Findings from Recent Studies
See more of The 37th National Immunization Conference
