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133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA |
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Nicholas A. Daniels, MD, MPH1, Elizabeth S. Gouveia, RN2, Daniel Null, MD1, and Carla A. Winston, PhD, MA3. (1) Department of General Internal Medicine, University of California, San Francisco, 1701 Divisadero Street, Suite 500, Box 1732, San Francisco, CA 94115, 415-353-7922, ndaniels@medicine.ucsf.edu, (2) Department of Orthopaedic Surgery, University of California, San Francisco, 400 Parnassus Ave., San Francisco, CA 94143-0332, (3) Health Services Research and Evaluation Branch, Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-52, Atlanta, GA 30333
BACKGROUND: The objectives of this study were to evaluate pneumococcal vaccine acceptance by patients after nurse recommendation; and to assess whether acceptance of vaccination varies by race and ethnicity when offered in a standardized manner in the context of usual care.
METHODS: In a university-based general internal medicine clinic from June through December 2004, we evaluated standing orders for nurses to assess patients for clinical indications and administer pneumococcal vaccine.
RESULTS: 370 patients (mean age 55 years; 54% women; 60% non-white) with a clinical indication for pneumococcal vaccination were approached to assess pneumococcal vaccine acceptance. Sixty-nine percent of patients surveyed were not aware of the pneumococcal vaccine. There were 327 patients (88%) who accepted pneumococcal vaccination, while 43 patients (12%) declined vaccination. Of the 327 patients who accepted vaccination, 292 (89%) accepted vaccination following the nurse recommendation; while 35 (11%) patients accepted vaccination after their doctor's recommendation. African Americans were significantly more likely to refuse pneumococcal vaccination compared to Whites and Asians (P=0.01). Reasons for refusal reported to the nurse included not feeling it was necessary (32%), being afraid of shots (21%); being afraid the vaccine might make them sick (26%), and wanting more information regarding the vaccine (9%).
CONCLUSION: The overwhelming majority of patients (88%) accepted pneumocococcal vaccination offered by a nurse under standing orders. Among patients who initially declined vaccination, 45% accepted after consultation with their physician. Standing orders may help reduce racial and ethnic disparities, but may not eliminate disparities unless patient's vaccine-related concerns are addressed.
Learning Objectives:
Keywords: Adult Health, Preventive Medicine
Presenting author's disclosure statement:
I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.
The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA