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Primary care providers miss opportunities during office visits for adult preventive care

Despite the success of vaccines in preventing certain infectious diseases, adult vaccination rates are well below national goals of 90 percent, and influenza and pneumonia continue to be the fifth leading cause of death among the elderly. A recent study confirmed that there are many missed opportunities to vaccinate elderly adults during primary care office visits. Only one-third of doctors discussed vaccination with patients during office visits, and many physicians did not take advantage of opportunities to vaccinate patients during acute visits or to schedule preventive care visits during which they could focus on immunization.

Researchers from the University of Pittsburgh Schools of Medicine and Public Health reviewed the medical records of 810 elderly adults seen in diverse rural, inner city, and suburban practices. For each patient, they determined the number and type of outpatient visits, influenza vaccinations over three seasons, and pneumococcal and tetanus vaccinations over 5 years, as well as discussions about and patient refusals of vaccines. Based on these records, only 24 percent of patients who had an office visit had annual flu shots, 49 percent received pneumonia immunizations, and 29 percent received tetanus vaccine.

During the 27-month study period, patients averaged 1.3 acute visits, 6.9 chronic care visits, and less than 1 (.48) preventive visit. Missed opportunities to vaccinate against influenza occurred at 38 percent of visits and at 47 percent of visits for pneumococcal disease. There were missed opportunities to vaccinate against tetanus at nearly all visits (94 percent). Vaccination rates were higher if medical records included health maintenance flow sheets, which can serve as a prompt for providers.

All three vaccines were administered primarily during chronic care visits (49-57 percent). Influenza and pneumococcal vaccines were administered least frequently during acute care visits (4 percent), while tetanus was administered 20 percent of the time during acute visits. About 20 percent of vaccines were given during preventive visits and 13-17 percent of vaccines had been received elsewhere. The broader view of prevention as part of every day care seems to be lacking in some practices, conclude the researchers. This study was supported by the Agency for Healthcare Research and Quality (HS09874).

See "Missed opportunities for adult immunization in diverse primary care office settings," by Mary Patricia Nowalk, Ph.D., Richard K. Zimmerman, M.D., and Joyce Feghali, P.A., in the September 3, 2004, Vaccine 22, pp. 3457-3463.

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