Using the Adult Immunization Schedule to Identify Recommended Vaccines in Clinical Case Studies

Background:
Based on the success of the childhood immunization schedule in practice, the Adult Immunization Schedule (AIS) was developed to inform adults' health care providers about vaccine recommendations. Accuracy of current AIS use by providers is unknown.

Objectives:
To assess providers' perceptions and use of the 2007-2008 AIS and application of the AIS to clinical scenarios.

Methods:
8 focus groups were conducted at community-based family and internal medicine private practices in 6 metropolitan areas from January-April 2008. Concurrent with the group meetings, 88 providers (35 physicians/nurse practitioners/physician's assistants and 53 nurse/medical assistants) were surveyed about their perceptions and use of the AIS. Providers also reviewed 3 clinical vignettes and indicated which vaccines they would consider, based on clinical knowledge and use of the 2007-2008 AIS. Standard univariate and bivariate analyses were performed.

Results:
Overall, 45% of health care providers were “very comfortable” using the AIS, but 17% had not seen it before. Depending on the clinical case, the proportion of providers who correctly identified all recommended vaccines ranged from 27%-34%. No differences in accuracy were found between family medicine and internal medicine practices or between provider roles (ie, physicians/NP/PAs vs nurses/MAs). Providers had several suggestions for improving functionality of the AIS, including: enhanced online interactivity and accompanying decision tools; adding prompts in electronic medical records, several of which either fail to include most adult immunization recommendations or apply them incorrectly; and improving the formatting of the AIS to minimize provider confusion.

Conclusions:
Despite familiarity with the AIS among providers in this study, only about one-quarter to one-third successfully applied the AIS to determine recommended vaccines in case scenarios. Providers have several suggestions for improvement and clarification of the AIS, which may improve the accuracy of its application in the clinical setting.