Methods: The setting is an outpatient Internal Medicine practice in a tertiary-care urban teaching hospital. It is an accredited patient-centered medical home with an electronic medical record (EMR) staffed by 14 attendings and 90 residents. A multidisciplinary focus group of physicians and clinic support staff diagrammed the vaccination workflow and identified possible flaws; the area of greatest uncertainty regarded use of reminder systems, discussion of vaccines, and documentation of patient vaccine refusals by physicians. To evaluate this, the practice’s resident and faculty physicians were surveyed on vaccination views and practices.
Results: There were 74 survey responses (response rate 71%). All respondents felt vaccination should be reviewed at least yearly with patients in a primary care setting and nearly half (47%) felt it should be addressed at every visit. Most (85%) estimated that they offer vaccines in over half of clinic visits, yet the majority (82%) felt at least half of their patients were not up to date on recommended vaccines. 78% use EMR-based reminders of recommended health maintenance interventions to review patient vaccine status. 47% reported not documenting patient vaccine refusals more than half of the time, and 14% never document refusals. Physicians cited urgency of other patient health issues and time constraints as the most significant barriers to vaccinating. They ranked medical assistant (MA)-generated vaccine orders, followed by an EMR-based reminder, as interventions they felt would most help improve vaccine rates.
Conclusion: Physicians in this practice recognize vaccines as an important yet underutilized intervention but cite lack of time as a barrier. The EMR is relied upon heavily but is not being used to its full potential. Introduction of MA-generated Tdap orders, EMR-based vaccine reminders, and physician education on vaccine refusal documentation are initial steps proposed to improve vaccination rates in this practice.
K. Albujoq, None
M. Zervos, Pfizer: Principle investigator , Research grant to Henry Ford Hospital
Cerexa: Principle investigator , Research grant to Henry Ford Hospital
Tetraphase: Principle investigator , Research grant to Henry Ford Hospital
K. Reyes, Forest Research Institute: Principle investigator , Sponsor
Cubist Pharmaceuticals: Principle investigator , Sponsor
Covance: Principle investigator , Sponsor
D. Willens, None