Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Uunderstand features of medical practices that affect immunization rates.
2. Identify areas for interventions to increase immunization rates.


Background:
Health disparities exist in many areas, including adult immunization .For instance, African American and Hispanic adults are less likely to be immunized against influenza and pneumonia, despite nationally known guidelines recommending both vaccinations for people over 65 and people with certain chronic health conditions.

Objectives:
To contribute to the understanding of reasons for the disproportionate immunization rates, we conducted an observation study designed to explore features of medical practices that facilitate and impede adult immunization.

Methods:
Observations were carried out in 17 medical offices and health centers in Allegheny County, Pennsylvania. Nine practices serve a high percentage of African American patients and eight serve a majority of Caucasian patients. Building on previous work, trained observers noted physical features such as location, layout and exam room size; interactions such as those between staff and providers and between providers and patients; presence/absence of culturally appropriate general reading materials and educational information; gender and ethnic/racial composition of staff, including providers; and accessibility.

Results:
Among the findings are that practices in low-income neighborhoods tended to have more health education materials available for patients than practices in more affluent neighborhoods; and staff working in practices located in low-income areas viewed their patients more holistically than staff in other practices. In addition to meeting health needs, staff working in low-income neighborhoods addressed other issues, such as getting transportation, coordinating mental health services, and accessing financial resources such as job training and support to pay utility bills.

Conclusions:
Qualitative data collection is an effective means of obtaining insight into medical practice features that inhibit or promote immunization of adults that may not be assessed using typical survey techniques.