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Physicians’ Use of Evidence-Based Strategies to Increase Adult Vaccination Uptake

  • Laura P. Hurley
    Correspondence
    Address correspondence to: Laura P. Hurley, MD, MPH, Denver Health, 301 W 6th Avenue, MC3251, Denver CO 80204.
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Division of General Internal Medicine, Denver Health, Denver, Colorado
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  • Megan C. Lindley
    Affiliations
    National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Mandy A. Allison
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Department of Pediatrics Children's Hospital Colorado, Aurora, Colorado
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  • Sean T. O'Leary
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Department of Pediatrics Children's Hospital Colorado, Aurora, Colorado
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  • Lori A. Crane
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Michaela Brtnikova
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Department of Pediatrics Children's Hospital Colorado, Aurora, Colorado
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  • Brenda L. Beaty
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
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  • Allison Kempe
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado

    Department of Pediatrics Children's Hospital Colorado, Aurora, Colorado
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      Introduction

      This study assesses the following among primary care physicians: (1) the use of evidence-based strategies to improve adult vaccination rates, (2) the number of strategies employed simultaneously, and (3) characteristics associated with assessing adult vaccinations at each visit.

      Methods

      An internet and mail survey was administered between December 2015 and January 2016 on primary care physicians designed to be representative of the American College of Physicians and American Academy of Family Physicians memberships. Data analysis was conducted in 2019.

      Results

      The response rate was 66% (617 of 935); 94% reported using electronic health records. Standing orders (84%) and electronic provider reminders at a visit (61%) were the most common strategies reported for influenza vaccine. Electronic provider reminders at a visit (53%) and recording a vaccination in an immunization registry (32%) were the most common strategies reported for all noninfluenza vaccines. Most physicians reported using 2 or more strategies, although this was more common for influenza (74%) than for noninfluenza (62%) vaccines. In multivariable analysis, physicians who reported assessing adult vaccinations at every patient visit were more likely to work in practices where decisions about purchasing and handling vaccines were made at a larger system level (RR=1.20, 95% CI=1.04,1.40), and they reported using electronic provider reminders (RR=1.38, 95% CI=1.15, 1.69) and standing orders (RR=1.45, 95% CI=1.21, 1.75) for all noninfluenza adult vaccines.

      Conclusions

      Several strategies are being used to increase adult vaccination, particularly for the influenza vaccine. Investment in implementing standing orders and electronic clinical decision support for all routine adult vaccinations could help facilitate assessment of adult vaccinations at each visit and potentially improve adult vaccination rates.
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