Biomedical subjects

Mary Patricia Nowalk

Publications and source records attributed to Mary Patricia Nowalk.

At least 19 recordsLinked to original sources

PubMed2007

Impact of the 2004 influenza vaccine shortage on patients from inner city health centers.

In the fall of 2004, the FDA and British authorities suspended the license of one of only two manufacturers that provided the US supply of inactivated influenza vaccine. With a 50% reduction in supply, a severe vaccine shortage resulted. This situation necessitated the development of priority groups for vaccination including those > or =65 years, when ordinarily, influenza vaccine is recommended for those > or =50 years old. A sample of patients > or =50 years old (n = 336), who had been seen at one of four inner-city health centers, was interviewed in summer 2005 using computer-assisted telephone interviewing. Associations of survey responses were examined for three groups: those vaccinated in the 2003-2004 and 2004-2005 influenza seasons (n = 142), those vaccinated in 2003-2004 but not vaccinated in 2004-2005 because of the shortage (n = 63), and those unvaccinated in both seasons (n = 83). Bivariate and multivariate logistic regression analyses were used to determine factors significantly influencing the likelihood of vaccination status. A significantly larger proportion of patients 50-64 years of age were unvaccinated due to the shortage (73%) compared to those who were vaccinated during both seasons (36%, P < 0.001), but there were no racial disparities in vaccination rates. Compared with patients who were vaccinated during both seasons, those who were unvaccinated due to the shortage were more frequently employed, self-reported their health positively, saw their physician less frequently, rated the US government's response to the shortage as "terrible," and blamed the US government for the shortage. Vaccination during the influenza vaccine shortage appears to have followed preferential vaccination of the CDC-established priority group (> or =65 years) and did not result in racial disparities in inner-city health centers.

Black or African American↗

PubMed2006

Predictors of colorectal cancer screening in diverse primary care practices.

BACKGROUND: To explain why rates of colorectal cancer (CRC) screening including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy (CS), and barium enema (BE), are low, this study assessed determinants of CRC screening from medical records. METHODS: Data were abstracted from patients aged > or =64 years selected from each clinician from 30 diverse primary care practices (n = 981). Measurements included the rates of annual FOBT, ever receiving FOBT, ever receiving FS/CS/BE under a combination variable, endoscopy/barium enema (EBE). RESULTS: Over five years, 8% had received annual FOBT, 53% had ever received FOBT and 22% had ever received EBE. Annual FOBT was negatively associated with female gender, odds ratio (OR) = .23; 95% confidence interval = .12-.44 and positively associated with routinely receiving influenza vaccine, OR = 2.55 (1.45-4.47); and more office visits: 3 to <5 visits/year, OR = 2.78 (1.41-5.51), and > or =5 visits/year, OR = 3.35 (1.52-7.42). Ever receiving EBE was negatively associated with age > or =75 years, OR = .66 (.46-.95); being widowed, OR = .59 (.38-.92); and positively associated with more office visits: 3 to <5 visits/year, OR = 1.83 (1.18-2.82) and > or =5 visits/year, OR = 2.01 (1.14-3.55). CONCLUSION: Overall CRC screening rates were low, but were related to the number of primary care office visits. FOBT was related to immunization status, suggesting the possible benefit of linking these preventive services.

Aged↗

PubMed2006

Determinants of adult vaccination at inner-city health centers: a descriptive study.

BACKGROUND: Pneumococcal polysaccharide vaccination rates among adults 65 years and older or less than 65 years with high risk medical conditions are still below Healthy People 2010 recommended levels of 90%. This study was designed to: 1) assess self-reported pneumococcal vaccination rates following health center level interventions to increase adult vaccination rates; and 2) determine factors associated with vaccination. METHODS: Tailored interventions to increase immunizations were implemented at two inner-city health centers. We surveyed 375 patients 50 years of age and older. Multivariate logistic regression examines the predictors of 1) self-reported pneumococcal vaccination and 2) combined self-reported influenza and pneumococcal vaccination. Both of these models were stratified by age group (50-64 years and 65 years and older). RESULTS: Pneumococcal vaccination rates were 45% by self-report, 55% by medical record review, 69% for patients 65 years old and older, 32% for patients 50-64 years; they did not differ by race. Receipt of the previous season's influenza vaccine was significantly related to pneumococcal vaccination among both younger and older patients. Receiving both the pneumococcal vaccine and the most recent influenza vaccine compared with receiving neither, among younger patients was related to unemployment, more frequent physician visits, and belief that those who do not receive the flu shot are more susceptible to the flu. For older patients, receipt of both vaccines was related to nonsmoking status, believing that friends/family think the patient should be vaccinated, seeing posters advertising flu shot clinics, and belief that those who do not receive the flu shot are more susceptible to the flu. CONCLUSION: Our findings suggest that improving overall pneumococcal vaccination rates among eligible adults, has the potential to eliminate racial disparities. Interventions delivering vaccination messages specific to older and younger adult groups may be the best strategy for improving adult vaccination rates.

Black or African American↗

PubMed2006

Predictors of lower endoscopy use among patients at three inner-city neighborhood health centers.

Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., screening rates are low. Understanding the predictors of CRC screening is needed. In 2003, a random sample of patients aged 50 and over from three inner-city health centers was surveyed by computer-assisted telephone interview concerning CRC screening. The questionnaire was based on the Transtheoretical Model and the Theory of Reasoned Action. Factor analysis with Varimax rotation and logistic regression analyses were conducted. Of 319 surveys with data about endoscopy, 148 (46%) met guidelines (19 reported sigmoidoscopy within 5 years, 105 reported colonoscopy within 10 years, and 24 reported both within 5 years). Factor analysis identified three factors associated with increased likelihood of lower endoscopy within guidelines: Social Influence for CRC Screening (Eigenvalue 1.73), Barriers to Lower Endoscopy (Eigenvalue 2.00), and Lower Endoscopy Benefit/Ease (Eigenvalue 1.19). Variables in logistic regression associated with a lower rate of endoscopy include being African American (Odds Ratio (OR) = 0.35, 95% confidence interval = 0.13-0.96), being a current smoker (OR = 0.13, CI = 0.03-0.60), and having a higher score on the Barriers to Lower Endoscopy factor (i.e., viewed the inconvenience and unpleasant aspects as more troubling, OR = 0.33, CI = 0.18-0.60). The perceived inconvenience and unpleasant aspects of lower endoscopy are substantial barriers to screening. Advances in colon preparation procedures and better educational campaigns might lessen this perceived barrier and may be particularly important in disadvantaged and African American communities.

Black or African American↗

PubMed2006

Beliefs and attitudes about influenza immunization among parents of children with chronic medical conditions over a two-year period.

Influenza vaccination is recommended for children with chronic medical conditions yet is infrequently performed. The reasons for low influenza vaccination rates in this group have not been well studied. We assessed and compared parents of children with chronic medical conditions regarding their beliefs and attitudes about influenza vaccination in 2003 and 2004. Parents of 2- to 13-year-old children with chronic medical conditions from health centers in low-income urban neighborhoods completed a 19-question survey, mailed following the 2002-2003 and 2003-2004 influenza seasons. Parent-reported influenza vaccination rate declined from 2003 (44%) to 2004 (25%). The most important factors related to influenza vaccination status were perceived doctor's recommendation (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 3.7-9.7), parents' belief that the child should be vaccinated (OR = 5.4, 95%CI = 3.3-8.8), relatives' belief that the child should be vaccinated (OR = 1.7, 95%CI = 1.1-2.7), easy access to the doctor's office for a flu shot (OR = 2.4, 95%CI = 1.4-4.2), and receipt of a reminder from the doctor's office (OR = 1.7, 95%CI = 1.1-2.6). In 2004 compared with 2003, fewer parents reported getting a reminder, and fewer believed that their child's doctor recommended flu vaccine. Doctors' recommendation that children with chronic medical conditions should receive an annual influenza vaccine and vaccine availability are important factors that resulted in a higher likelihood of influenza vaccination. Our findings that fewer parents reported receiving reminders and that fewer children were vaccinated in 2004 suggest that sustained improvements in vaccination rates may require continual changes in the format and delivery method of vaccination reminders from physicians.

Adolescent↗

PubMed2006

Racial differences in beliefs about genetic screening among patients at inner-city neighborhood health centers.

BACKGROUND: Genetic testing has the potential to identify persons at high risk for disease. Given the history of racial disparities in screening, early detection and accessing treatment, understanding racial differences in beliefs about genetics is essential to preventing disparities in some conditions. METHODS: In 2004, a sample of older adult patients from four inner-city health centers was surveyed to assess beliefs about genetic determinants of disease, genetic testing and religion. Logistic regression determined which beliefs were associated with race. RESULTS: Of the 314 respondents, 50% were African Americans. Most respondents thought that sickle cell disease, cystic fibrosis and diabetes are primarily genetic. African Americans were more likely than Caucasians to believe that genetic testing will lead to racial discrimination (Odds ratio (OR): 3.02, 95% confidence interval (CI): 1.5-6.0) and to think that all pregnant women should have genetic tests (OR=3.8, 95% CI: 1.7-8.6). African Americans were more likely to believe that God's Word is the most important source for moral decisions (OR: 3.6, 95% CI :1.5-8.7). CONCLUSION: African Americans and Caucasians differ in beliefs about genetic testing and the basis for moral decision-making. Acknowledging and understanding these differences may lead to better medical care.

Black or African American↗

PubMed2006

Parental perspectives on influenza vaccination of children with chronic medical conditions.

BACKGROUND: Minorities and those living in the inner city have a higher respiratory disease burden than other groups. Yet, influenza vaccination rates among all children with chronic medical conditions remain low. METHODS: Parents of 2-13-year-old children with high-risk medical conditions from health centers in low-income urban neighborhoods completed a mailed survey. Immunization status from medical records was used to calculate validity measures. Survey data are presented for those whose vaccination status was concordant between parental report and the medical record (n=183). RESULTS: Parent-reported influenza vaccination versus medical record review showed 84.9% sensitivity, 68.7% specificity, 49.1% positive predictive value and 92.7% negative predictive value, with a kappa of 0.43. Vaccination rate was 30.6%. Medical record-verified influenza vaccination was associated with parental beliefs that the doctor recommends a flu shot (OR, 40.9; 95% Cl, 9.0-184.9) and that relatives recommend a flu shot (OR, 4.3; 95% Cl, 1.7-10.5), and was less likely if the parent believed that the child will get the flu if a household member is infected (OR, 0.2; 95% Cl, 0.1-0.6). CONCLUSIONS: The message that influenza vaccination is important to protect children with chronic medical conditions may be relayed through physician recommendation or a relative's suggestion and may be more effective if it addresses vaccine efficacy issues.

Adolescent↗

PubMed2005

Interventions over 2 years to increase influenza vaccination of children aged 6-23 months in inner-city family health centers.

The purposes of this study were to test the ability of tailored interventions to raise influenza immunization rates and assess the effect on timely receipt of other vaccines. We conducted a before/after trial over 2 years to increase influenza vaccination rates of patients 6-23 months old in five inner-city family health centers serving low-income children with a sixth site as a concurrent control. Influenza vaccination rates improved significantly from a baseline of 4.7-24.7% in the first year and 36.6% in the second year, P < 0.001. The increase in rates was greater in intervention sites than the control site (31.9% versus 25.7%, P = 0.02). In regression analyses of influenza vaccination, intervention year was associated with an odds ratio (OR) of 9.4 (95% confidence interval (CI) = 4.4-20.0) for the first intervention year and OR = 13.4 (95% CI = 6.5-28.0) for the second intervention year. Children vaccinated against influenza were more likely to have received DTaP 3 and MMR within 2 months of the recommended age than children not vaccinated against influenza (P < 0.001).

Female↗

PubMed2005

Vaccine criticism on the World Wide Web.

BACKGROUND: The incidence of vaccine-preventable diseases is directly related to the number of unvaccinated children. Parents who refuse vaccination of their children frequently express concerns about vaccine safety. The Internet can influence perceptions about vaccines because it is the fastest growing source of consumer health information. However, few studies have analyzed vaccine criticism on the Web. OBJECTIVE: The purposes of this paper are to examine vaccine criticism on the Internet and to analyze the websites in order to identify common characteristics and ethical allegations. METHODS: A structured Web search was conducted for the terms "vaccine," "vaccination," "vaccinate," and "anti-vaccination" using a metasearch program that incorporated 8 search engines. This yielded 1138 Web pages representing 750 sites. Two researchers reviewed the sites for inclusion/exclusion criteria, resulting in 78 vaccine-critical sites, which were then abstracted for design, content, and allegations. RESULTS: The most common characteristic of vaccine-critical websites was the inclusion of statements linking vaccinations with specific adverse reactions, especially idiopathic chronic diseases such as multiple sclerosis, autism, and diabetes. Other common attributes (> or = 70% of websites) were links to other vaccine-critical websites; charges that vaccines contain contaminants, mercury, or "hot lots" that cause adverse events; claims that vaccines provide only temporary protection and that the diseases prevented are mild; appeals for responsible parenting through education and resisting the establishment; allegations of conspiracies and cover-ups to hide the truth about vaccine safety; and charges that civil liberties are violated through mandatory vaccination. CONCLUSIONS: Vaccine-critical websites frequently make serious allegations. With the burgeoning of the Internet as a health information source, an undiscerning or incompletely educated public may accept these claims and refuse vaccination of their children. As this occurs, the incidence of vaccine-preventable diseases can be expected to rise.

Chronic Disease↗

PubMed2005

Barriers and facilitators of colon cancer screening among patients at faith-based neighborhood health centers.

We determined the barriers to and facilitators of colorectal cancer (CRC) screening among two faith-based, inner city neighborhood health centers in Southwestern Pennsylvania. Data from a random sample of patients 50 years and older (n = 375) were used to estimate logistic regression equations to compare and contrast the predictors of four different CRC screening protocols: (1) fecal occult blood test (FOBT) < or = 2 years ago, (2) colonoscopy < or = 10 years ago, (3) lower endoscopy (colonoscopy or sigmoidoscopy) < or = 10 years ago, and (4) any of these screening measures. Racial differences (between African Americans or Caucasians) in type of colon cancer screening were not found. Controlling for covariates, logistic regression equations showed that a physician's support of colon cancer screening was positively associated with the receipt of colonoscopy (OR: 19.47, 95% CI: 5.45-69.54), lower endoscopy (OR: 10.96, 95% CI: 3.77-31.88) and any colon cancer screening (OR: 10.12, 95% CI: 3.36-30.46). Patients who see their physicians more frequently were also more likely to be screened for CRC. Unlike other studies, the faith-based environment in which these patients are treated may explain the lack of racial disparity specific to our measures of CRC screening.

Aged↗

PubMed2005

Parental perspectives on influenza immunization of children aged 6 to 23 months.

BACKGROUND: For the first time, in 2002, the Advisory Committee on Immunization Practices encouraged the vaccination of healthy children 6 to 23 months against influenza, whenever feasible. Participating inner-city health centers designed interventions to introduce influenza vaccination among this group of children. The study was designed to assess parents' attitudes toward the vaccine. METHODS: Following the 2002-2003 influenza vaccination season, parents were surveyed to identify barriers to and facilitators of influenza vaccination. A low-literacy level, 19-question survey was mailed to parents in three waves, 4 weeks apart. A subset of children had medical record data available to confirm vaccination status. Measures of validity were calculated. This paper focused only on the children whose parent-reported vaccination status was concordant with that reported in medical records (n = 193). Associations of responses to vaccination status were calculated in 2004, using chi-square and logistic regression procedures. RESULTS: Sensitivity was 85.7% and specificity was 66% (kappa = 0.50), assessing the ability of parents to recall receipt or nonreceipt of influenza vaccine. The most important factors related to immunization of healthy infants were perceived doctor's recommendation (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.4-12.3; p < 0.001) and belief that getting an influenza shot is a smart idea (OR = 3.5; 95% CI = 1.3-8.9; p < 0.01) for those with medical record-confirmed vaccination status. CONCLUSIONS: A clear message that the doctor recommends influenza vaccination for a child is an important factor for ensuring vaccination, and may foster the idea that vaccination is "smart."

Data Collection↗

PubMed2005

Predictors of pneumococcal polysaccharide vaccination among patients at three inner-city neighborhood health centers.

BACKGROUND: Despite the availability of pneumococcal polysaccharide vaccine (PPV), vaccination rates are modest, and racial disparity in these rates is known to occur. OBJECTIVE: The purpose of this study was to identify determinants of patient-reported receipt of PPV among patients from 3 inner-city health centers that serve large numbers of minority and disadvantaged patients. METHODS: In 2003, a random sample of patients from 3 inner-city health centers was surveyed by computer-assisted telephone interview concerning their vaccination status and their attitudes and beliefs about PPV. The questionnaire was based on the theory of reasoned action, which emphasizes the contributions to behavioral intention of cognitive beliefs (including the likelihood of consequences), the value of those consequences, and normative beliefs. Factor analysis was conducted to examine whether survey items specific to attitudes about PPV would group together; the variance of the components resulting from the factor analysis was expressed in eigenvalues. Logistic regression analyses were conducted to determine which factors, demographic characteristics, and health habits were independently associated with PPV status. RESULTS: Of 674 patients sent introductory letters (13 of whom were ineligible), 325 (49%) completed the interview with usable data. These patients were primarily aged > or = 65 years (52% [168/325]), female (69% [223/325]), and white (57% [174/306]), and had an annual household income < 20,000 dollars (61% [174/287]). Vaccination status or intention to be vaccinated was unknown for 25 persons, reducing the sample to 300. Of these respondents, 59% (178) reported vaccination, 9% (26) intended to be vaccinated within 6 months, and 32% (96) had no intention of being vaccinated. Vaccination rates were 76% (119/157) for responders aged > or = 65 years and 41% (59/143) for responders aged 50 to 64 years (P < 0.001). Logistic regression analyses found 3 variables that were significantly associated with the likelihood of vaccination: age > or = 65 years; frequency of physician visits; and timing of the last complete physical examination. The factor analysis with varimax rotation identified 2 factors that increased the likelihood of reporting ever receiving PPV: attitudes about PPV and social influences (eigenvalue = 2.69), and beliefs about pneumonia risk and vaccine efficacy (eigenvalue = 1.24). When these factors were added to the model, the effects of age and frequency of seeing a physician became nonsignificant. Compared with those having a complete physical examination < 1 year ago, those having an examination 1 to 2 years ago (odds ratio [OR] = 0.16; 95% CI = 0.04-0.69) or > 2 years ago (OR = 0.10; 95% CI = 0.01-0.78) were less likely to be vaccinated. Those agreeing with the attitudes and social influence factor were more likely to be vaccinated (OR = 8.24; 95% CI = 3.97-17.12), as were those agreeing with the pneumonia risk and vaccine efficacy factor (OR = 2.63; 95% CI = 1.20-5.80). CONCLUSIONS: Attitudes about vaccination and a clinician's recommendation are the most powerful predictors of PPV status. Efforts to raise rates of vaccination and reduce racial disparities should emphasize communication of clinicians' recommendations to patients.

Aged↗

PubMed2005

Overcoming barriers to establishing an inpatient vaccination program for pneumococcus using standing orders.

OBJECTIVES: To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP. DESIGN: Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature. SETTING: As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine. RESULTS: Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments. CONCLUSIONS: A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.

Aged↗

PubMed2005

What predicts influenza vaccination status in older Americans over several years?

OBJECTIVES: To examine the correlates of repeat influenza vaccination and determine whether there are age-group (50-64, > or =65) differences in decision-making behavior. DESIGN: Longitudinal survey study. SETTING: Two community health centers in Pittsburgh, Pennsylvania. PARTICIPANTS: Two hundred fifty-three patients aged 50 and older in 2001 who visited one of the health centers and completed telephone surveys in 2002 and 2003 after the respective influenza seasons. MEASUREMENTS: Influenza vaccination status, demographic characteristics, and decision-making behavior were self-reported. Vaccination status was identified for three seasons: 2000-2001, 2001-2002, and 2002-2003. A three-level outcome was defined as unvaccinated all 3 years, vaccinated one to two times over 3 years, and vaccinated all 3 years. Factor analysis identified three decision-making behaviors. RESULTS: Predictors of being vaccinated across 3 years included being older, the belief that social forces influence vaccination behavior, and disagreement with the view that vaccine is detrimental. CONCLUSION: National educational efforts should be intensified to dispel the myths about alleged adverse events, including contracting influenza from inactivated influenza vaccine. Physicians should continue to share their personal experiences of treating patients with influenza, including the incidence of hospitalization and death.

Age Factors↗

PubMed2005

Tailored interventions to introduce influenza vaccination among 6- to 23-month-old children at inner-city health centers.

BACKGROUND: Because of high rates of hospitalization for influenza infections among very young children (< 2 years), the Advisory Committee on Immunization Practices initiated a new policy in 2002 that encouraged vaccination of healthy children aged 6 to 23 months against influenza. OBJECTIVE: To evaluate the effectiveness of implementing tailored interventions to introduce influenza vaccination of children 6 to 23 months of age in inner-city practices. STUDY DESIGN: A before-after trial with historical and concurrent controls was conducted in 6 health centers in low-income urban locations. METHODS: Intervention sites were selected, and interventions (directed at 1534 patients who were 6 to 23 months old) were implemented from a menu of strategies. Vaccination rates were measured from medical record reviews. Focus groups of nursing staffs provided evaluative information on strategies. RESULTS: Influenza vaccination rates improved significantly at the intervention health centers compared with the control center. Preintervention (2001-2002) rates ranged from 0% to 7.6%, and intervention (2002-2003) rates ranged from 15.2% to 49.2% (P < .001). The number of interventions ranged from 6 to 11. Sites that used more interventions (odds ratio, 1.24; 95% confidence interval, 1.15-1.34) and had staff support of the vaccination effort (odds ratio, 1.91; 95% confidence interval, 1.40-2.60) had higher vaccination rates. CONCLUSIONS: Tailored interventions resulted in successful introduction of influenza vaccination of 6- to 23-month-old children in inner-city health centers. More strategies and enthusiastic staff support may result in higher vaccination rates.

Community Health Centers↗

PubMed2004

Missed opportunities for adult immunization in diverse primary care office settings.

Adult vaccination rates are well below national goals of 90%. We examined medical records of 810 adults > or =65 years to determine number and type of visits, discussion and patient refusals of vaccines, influenza vaccinations over three seasons, and pneumococcal and tetanus vaccinations over 5 years. From the medical record, immunization rates were 24.1% for annual influenza, 49.1% for pneumococcal polysaccharide and 28.6% for tetanus vaccine. During the 27 month study period, patients averaged 1.3 +/- 1.9 acute visits, 6.9 +/- 5.1 chronic visits and 0.48 +/- 0.91 preventive visits (mean +/- S.D.). Missed opportunities to vaccinate ranged from 38.4 to 94.5% of visits. Vaccination rates were higher if medical records included health maintenance flow sheets. Failure to discuss vaccination, to vaccinate at acute care visits, and low frequency of preventive visits resulted in missed opportunities to vaccinate. A health maintenance flow sheet can prompt providers to discuss vaccination and record vaccines as they are administered.

Adult↗

PubMed2004

Physician and practice factors related to influenza vaccination among the elderly.

BACKGROUND: Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective. METHODS: Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years. Questionnaires and interviews based on the PRECEDE-PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined. RESULTS: The clinician response rate was 85% (60/71). Several factors of the PRECEDE-PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting ("strata"), of which the VA was highest. CONCLUSION: Through proactive office systems and education, physicians may influence patients' intentions to be vaccinated and thereby increase influenza vaccination rates.

Aged↗

PubMed2004

Feasibility of influenza immunization for inner-city children aged 6 to 23 months.

BACKGROUND: Annual influenza-related hospitalization rates of children aged < 2 years in the United States are second only to those of the elderly. Yet no recommendations existed for vaccinating healthy children aged 6 to 23 months until 2002, when the Advisory Committee on Immunization Practices encouraged influenza vaccination for them. This study tested the feasibility of vaccinating 6- to 23-month-old children against influenza and assessed the effect on timely receipt of other vaccines. METHODS: A pre-post trial was used in urban health centers serving low-income children. Sites selected interventions from strategies proven to increase vaccination rates. Targeted patients were aged 6 to 23 months by November 30, 2002 (N = 1534). RESULTS: Influenza vaccination rates for the 2002-2003 intervention season improved significantly from 6.5% to 38.5% for the first dose (p < 0.001). Second-dose rates were significantly improved over preintervention (1.9% preintervention, 13.2% intervention), but lower than first-dose rates. Mean ages at vaccination for other recommended childhood vaccines did not differ or were significantly younger (measles, mumps, and rubella vaccine [MMR] and varicella) for children who received influenza vaccine versus those who did not. Moreover, a higher percentage of influenza-vaccinated than unvaccinated children received MMR, diphtheria, tetanus, pertussis vaccine 3 (DTaP3), inactivated poliovirus vaccine 2 (IPV2), and Haemophilus influenzae b (Hib2) vaccines within a 2-month grace period of the recommended age (p < 0.039), with no differences between groups for Hib1, DTaP1, IPV1, and varicella. CONCLUSIONS: With directed effort, it is possible to increase influenza vaccination at health centers serving low-income children. The addition of a two-dose vaccine was not associated with delayed receipt of other vaccines among these children.

Child Health Services↗