Determining/Understanding Barriers to Adult Immunization

Richard Kent Zimmerman, M.D., M.P.H. - Principal Investigator

Inis J. Bardella, M.D. - Co-Investigator
Seymour Grufferman, M.D., Dr. P.H. - Co-Investigator
Janine E. Janosky, Ph.D. - Co-Investigator
Tammy A. Mieczkowski, Ph.D. - Statistician
Mahlon Raymund, Ph.D. - Sample management and CATI programming

Each year, an estimated 65,000 deaths occur in the US due to vaccine-preventable diseases of which more than 30,000 are preventable by immunization. In 1995 only 58% and 36% of persons 65 years of age or older reported receiving influenza and pneumococcal vaccines, respectively and rates were even lower for certain minorities and persons below the poverty level. The objective in Healthy People 2000 to increase pneumonia and influenza immunization levels to at least 60% is unlikely to be achieved. Why are immunization rates for adult vaccines so low? Why are proactive systems used so little, given that the literature shows that they are effective in raising rates?

In the first phase of this study, the primary barriers to influenza and pneumococcal vaccination and to use of proactive systems will be identified by an in depth study in a diverse group of settings including Veterans Administration clinics (one of which uses proactive systems), inner city neighborhood clinics, and a set of primary care practices. To do this, a multidisciplinary team with qualitative expertise will conduct chart audits and clinician, staff, and patient interviews. Provider knowledge, attitudes, and practices will be quantified about:

• 1) vaccine indications, missed opportunities, and invalid contraindications;
• 2) disease severity, vaccine efficacy, and adverse reactions;
• 3) vaccine reimbursement;
• 4) influence of peers, experts, and patients;
• 5) vaccine litigation;
• 6) use of systems that enhance immunization, such as reminder/tracking systems;
• 7) barriers to office systems;
• 8) office operations, core values and openness to change;
• 9) personal vaccination status.

In the second phase, a more generalizable, national sample of primary rare physicians (family physicians, general practitioners, general internists, and geriatricians) will be interviewed by telephone about barriers to immunizations and to proactive systems, oversampling those practicing in areas with high proportions of minorities. This project will fumish relevant, up-to-date data to enhance policy planning, practice management and medical ,education. To enhance application of results, the team will identify typologies of practices that are open to specific.