Understanding adult vaccination in urban, lower-socioeconomic settings: influence of physician and prevention systems.

Purpose: Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.

Methods: PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations.

Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers.

Objectives: To increase adult immunizations at inner-city health centers serving primarily minority patients.

Design: A before-after trial with a concurrent control.

Setting: Five inner-city health centers.

Assessing disparities in adult vaccination using multimodal approaches in primary care offices: methodology.

Racial disparities in invasive pneumococcal disease and pneumococcal polysaccharide vaccination (PPV) persist despite significant progress. One reason may be that minority patients receive primary care at practices with fewer resources, less efficient office systems, and different priorities. The purposes of this paper are: (1) to describe the recruitment of a diverse array of primary care practices in Pittsburgh, Pennsylvania serving white and minority patient populations, and the multimodal data collection process that included surveys of key office personnel, observations of practice operations and medical record reviews for determining PPV vaccination rates; and (2) to report the results of the sampling strategy.

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.

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).

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.

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.

Impact of vaccine economic programs on physician referral of children to public vaccine clinics: a pre-post comparison.

Background: The Vaccines for Children (VFC) Program is a major vaccine entitlement program with limited long-term evaluation. The objectives of this study are to evaluate the effect of VFC on physician reported referral of children to public health clinics and on doses administered in the public sector.

Methods: Minnesota and Pennsylvania primary care physicians (n = 164), completed surveys before (e.

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.

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.

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.

The 2002 United States varicella vaccine shortage and physician recommendations for vaccination.

Background: The US experienced a shortage of varicella vaccine in 2002, leading to the concerns about its impact.

Methods: 204 Minnesota and Pennsylvania physicians, most (164) of whom were interviewed in 1999 on the topic of varicella vaccine, responded to a 2003 survey.

Results: Although 67% were aware of the 2002 varicella vaccine shortage, 24% experienced it and only 45% were aware of the 2002 temporary change in national vaccination recommendations.

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.

Tailored interventions to increase influenza vaccination in neighborhood health centers serving the disadvantaged.

Objectives: We designed and evaluated interventions to increase adult immunizations within inner-city health centers.

Methods: Interventions included reminders, standing orders, and walk-in "flu shot clinics." Patients were surveyed and records evaluated.

Correspondence among patients' self-reports, chart records, and audio/videotapes of medical visits.

This pilot study examined the covariation of patients' self-reports of instrumental and affective aspects of communication during physician-patient visits with 2 other sources of data: medical chart records and audio/videotapes. Participants were 17 community-based (nonuniversity) primary-care physicians and 77 of their patients, ages 50 to 80. Patients were interviewed by telephone within 1 week after their medical visits.

The relationship between cognitive and physical performance: MacArthur Studies of Successful Aging.

Background: The relationship between change in cognitive and physical performance has yet to be fully understood. Because aging decreases the ability to learn new information while preserving more established knowledge, this article examines whether the association between change in cognitive and physical performance depends on the nature of the physical task.

Methods: Data from the MacArthur Research Network on Successful Aging Community Study--a longitudinal three-site, cohort study of high-functioning, disability-free Americans aged 70 to 79 in 1988 (reinterviewed in 1991 and 1995)--are used for this investigation.

A health and demographic profile of noninstitutionalized older Americans residing in environments with home modifications.

Objectives: In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications.

Methods: Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications.

Results: Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications.

Evaluation of the VA's Pilot Program in Institutional Reorganization Toward Primary and Ambulatory Care: Part II, A study of organizational stresses and dynamics.

Background: Many academically affiliated hospitals are moving from an inpatient, subspecialty orientation in their patient care and educational programs toward a greater emphasis on ambulatory and primary care. Few studies have focused on the organizational, staffing, and management issues involved in implementing these changes.

Method: The authors carried out a qualitative evaluation of the process of change in an academic Department of Veterans Affairs hospital during implementation of a major ambulatory primary care program.