FluAlert: A qualitative evaluation of providers' desired characteristics and concerns regarding computerized influenza vaccination alerts (original) (raw)
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A b s t r a c t Despite recognition that clinical decision support (CDS) can improve patient care, there has been poor penetration of this technology into healthcare settings. We used CDS to increase inpatient influenza vaccination during implementation of an electronic medical record, in which pharmacy and nursing transactions increasingly became electronic. Over three influenza seasons we evaluated standing orders, provider reminders, and pre-selected physician orders. A pre-intervention cross-sectional survey showed that most patients (95%) met criteria for vaccination. During our intervention, physicians were increasingly likely to accept pre-selected vaccination orders, Year 1 (47%), Year 2 (77%), Year 3 (83%); however vaccine administration by nurses was suboptimal. As electronic medical record functionality improved, patient receipt of vaccine increased dramatically, Year 1 [0/36; 0%], Year 2 [8/66; 12%], Year 3 [286/805; 36%]. Successful use of clinical decision support to increase inpatient influenza vaccination only occurred after initiation of CPOE for all medications and integration of an electronic medication administration record. Also, since most patients met criteria for influenza vaccination, complicated logic to identify high-risk patients was unnecessary. Ⅲ J Am Med Inform Assoc. 2008;15:776 -779.
Assessing vaccine safety communication with healthcare providers in a large urban county
2012
Purpose Vaccination is the primary public health tool for influenza control. Rapid assessment of the safety of any widely disseminated pandemic influenza vaccine is a public health priority. This study identifies practices, strengths, and weaknesses of vaccine-associated adverse event (AE) reporting to inform public health systems improvement. Methods A survey was developed with local and state health agencies' input. After pre-testing, the survey was distributed online and via mail to a random sample of King County, WA, healthcare professionals, composed of 60 commercial vaccinator employees and school health nurses, 500 physicians, and 300 pharmacists. Results The response rate was 36%. Results indicate that if an AE was suspected, 17% of respondents would not know how to report it, with 61% of respondents citing unclear definitions of a reportable AE as a barrier and 18% of respondents unaware of whose responsibility it is to report an AE. Conclusion Healthcare professionals who provide immunizations need additional information on their role in vaccine safety and AE reporting. Strengthening both passive and active reporting systems can enhance surveillance efforts during real-time events, such as mass immunization during a pandemic and other large-scale emergency countermeasure distribution programs.
Journal of the American Medical Informatics Association, 1999
The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users). Measurements: Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups. Results: The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P < 0.05). Both rates remained stable during a two-year baseline period (P = 0.34 and P = 0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P < 0.001), whereas the rates for the PR user group did not change significantly (P = 0.18). Conclusions: Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines.
Archives of family medicine, 2000
To determine if postcard and telephone reminders increased the rate of influenza immunization of Medicare beneficiaries. Before and after trial (postcard reminders) with systematically allocated control group (telephone reminder intervention). A semirural family practice residency program. All 475 noninstitutionalized persons older than 65 years who had received at least 1 office service in the previous 2 years. In September 1996, each of 475 patients received a postcard urging prompt influenza immunization. Those not responding within 1 month were systematically allocated either to a group receiving further telephone contact or to a control group. At the time of telephone contact, any offered information about influenza immunization received outside the Smoky Hill Family Practice Center, Salina, Kan, was recorded. We measured the percentage of change in practice-administered influenza immunizations compared with the baseline rate of the preceding 2 years; the difference in immuniza...
The Journal of Primary Prevention, 2008
As part of the ''Provider and Patient Reminders in Ontario: Multistrategy Prevention Tools'' demonstration project, the purpose of this study was to explore the practice and physician characteristics associated with influenza vaccination rates following a reminder letter intervention for patients 65 years of age and older. Using a sample of 179 physicians, we estimated a multiple linear regression model to examine variables predictive of vaccination delivery rates. Several provider characteristics, including certification with the College of Family Physicians of Canada and practicing in an urban area, were predictive of the success of the reminder letter campaign. Examining other physician and practice factors associated with vaccination delivery following a reminder letter campaign may help improve such prevention efforts.
Http Dx Doi Org 10 1080 10410236 2011 578332, 2012
In response to low influenza vaccination rates among health care workers, health officials have explored determinants of uptake and developed communication interventions. Key to these efforts is how workers seek and attend to vaccine information. We applied a model of risk information seeking and processing to survey 226 physicians and nurses at a large, urban hospital (response rate = 5.7%; cooperation rate = 91.5%). Our goals were to (1) apply the model to a new setting, audience, and issue and (2) explore novel concepts (e.g., source credibility and information usefulness) and moderating relationships among variables. Consistent with previous research, information subjective norms-perceived social pressure to remain informed about vaccination-were a strong predictor of information seeking and systematic processing. Neither source credibility nor information usefulness independently increased explained variance, although they moderated the relationship between norms and communication behavior. We discuss theoretical and practical implications of these findings.
Increasing Influenza Vaccination Rates in a Busy Urban Clinic
Journal of nature and science
Influenza infection is the cause of thousands of hospitalizations and deaths each year; infection during pregnancy results in increased morbidity and mortality. Underserved women are particularly susceptible to not receiving recommended vaccinations. This project explored the effect of a simple paper based prompt on the influenza vaccination rate in a resident continuity clinic for the underserved. Using this reminder to providers to discuss the influenza vaccination with their patients, we were able to increase vaccination rates in our clinic from 2.2% to 14.2%. This implementation of a simple, low cost, low tech prompt to providers increased the rate of influenza vaccination in our clinic and we present this approach as an easy to implement method of improving vaccination rates. We also suggest this method as an alternative to an alert in the electronic medical record in situations where the electronic medical record may not be accessed during every patient encounter.
Home Health Care Management & Practice, 2014
The recommendations for influenza and pneumococcal vaccines are widely known yet the rates of both immunizations for home health care patients are 70% or less. The purpose of this study was to identify the facilitators and barriers to immunizations ultimately to improve vaccination rates among home health care patients. Using a multi-case study approach with five agencies and one group of administrators, facilitators included providing patients with a vaccine "card" and using the agency's electronic medical record (EMR) for decision support/reminders. We determined that there were patient barriers (misperceptions about vaccines in general, difficulty in recalling vaccine status) and provider barriers (misperceptions about vaccines among health care workers, home health care agencies not receiving accurate information from other providers or difficulty in determining vaccine status).