Are Standing Order Programs Associated with Influenza Vaccination? – NNHS, 2004

Background: Influenza vaccination coverage among nursing home residents has consistently been reported well below the Healthy People goals. We sought to determine if standing order programs (SOP) in long-term care facilities are associated with greater influenza vaccination coverage among residents.

Objectives: To assess if standing order programs (SOP) in long-term care facilities are associated with greater influenza vaccination coverage among residents. 

Methods: The National Nursing Home Survey (2004) is cross-sectional. A total of 1,152 U.S. long-term care facilities were systematically sampled with probability proportional to number of beds. A total of 11,939 people aged 65 years or older residing in sampled long-term care facilities between August and December 2004 were randomly sampled. Influenza vaccination coverage of residents was obtained from facility records. Facility’s immunization program included standing orders versus other (pre-printed admission order, advance physician order, personal physician order, and no program). Multinomial logistic regression was used to examine the relationship between type of influenza immunization program and receipt of vaccination, adjusted for resident and facility confounders.

Results: The proportion of residents aged ≥65 years that received influenza vaccination was 64%; 41% of residents live in a facility with an SOP. Influenza vaccination coverage among residents residing in facilities with standing orders was 68% compared to 59%-63% of residents in facilities with other program types.  Logistic regression showed that standing order programs were independently associated with greater influenza vaccination coverage (66.7% vs 62.0%, p<.01).

Conclusions: This study indicates that residents in long-term care facilities having standing order programs for influenza were more likely to be immunized. More research needs to be done to understand how to facilitate adoption of these programs.