Barriers to immunization — an examination of factors that influence the application of pneumococcal vaccine by house staff

Rushton, Thomas; Ganguly, R; Sinnott, John T.; Banerji, Madhabi

doi:10.1016/0264-410x(94)90239-9

Cited by 18 publications

(8 citation statements)

References 26 publications

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“…A low level of pneumococcal vaccination among the general US population has also been reported [35]. We hypothesize that this is due to several factors, including the reimbursement practices of some insurance payers, the lack of significant advertising or public health campaigns that advocated pneumococcal vaccination in the 1990s, the absence of a controlled clinical trial that demonstrates the efficacy of the vaccine in HIV-infected persons, and concern about vaccine-associated adverse reactions that occur after revaccination as well as observations of increased virus load [3,[35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Disease among Human Immunodeficiency Virus-Infected Persons: Incidence, Risk Factors, and Impact of Vaccination

Dworkin

Ward

Hanson

et al. 2001

Clinical Infectious Diseases

199

131

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To determine the factors associated with pneumococcal disease (pneumococcal pneumonia or invasive disease) and the impact of pneumococcal vaccine in HIV-infected persons, we analyzed patient data collected by the Adult and Adolescent Spectrum of HIV Disease Project for person-time between January 1990 and December 1998. Among 39,086 persons with 71,116 person-years (py) of observation, 585 episodes of pneumococcal disease were diagnosed (incidence, 8.2 episodes per 1000 py). Factors associated with an increased risk for pneumococcal disease (P < .05) included injection drug use (adjusted relative risk [RR], 1.5) and blood transfusion (RR, 2.0) as the mode of HIV transmission (referent, male-male sex); black race/ethnicity (RR, 1.5; referent, white race); history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic illness (RR, 2.1); a CD4(+) cell count of 200-499 cells/microL (RR, 2.5) or < 200 cells/microL (RR, 3.7; referent, CD4(+) cell count of > or = 500 cells/microL); and alcoholism (RR, 2.0). Factors associated with a decreased risk included prescription of antiretroviral therapy (RR for monotherapy, 0.6; for dual therapy, 0.7; for triple therapy, 0.5) and pneumococcal vaccination (RR for persons vaccinated at a CD4(+) cell count of > or = 500 cells/microL, 0.5). We recommend that pneumococcal vaccine be given to HIV-infected persons before profound immunosuppression has occurred.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal Disease among Human Immunodeficiency Virus-Infected Persons: Incidence, Risk Factors, and Impact of Vaccination

Dworkin

Ward

Hanson

et al. 2001

Clinical Infectious Diseases

199

131

View full text Add to dashboard Cite

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“…7,8,11,13 The reasons that house staff and attending physicians fail to vaccinate inpatients are multifactorial and include concern for other pressing clinical issues, fear of adverse postvaccination events, lack of knowledge about the efficacy of pneumococcal vaccination, and difficulty in confirming patient vaccination status. 21 Among general medicine staff physicians at our hospital, underuse appeared to be more a matter of forgetfulness, because vaccination is not a routine part of discharge planning. Cardiologists, however, believed that this intervention was more the responsibility of other providers than themselves.…”

Section: Commentmentioning

confidence: 95%

A Hospital-Based Pharmacy Intervention Program for Pneumococcal Vaccination

Vondracek¹,

Pham²,

Huycke

1998

Arch Intern Med

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“…As mentioned above, provider and system-related barriers play a substantial role in delaying immunization services and thereby achieving the national goal. Several studies have been conducted on service providers' knowledge, attitude toward patients, perception and attitude regarding vaccines and practical barriers against their utilization (Prislin et al, 1999;Ruston et al, 1994;Takayama & Gandelman, 1999;Szilagyi, 2001). For example, Prislin et al (1999) researched physicians' knowledge (understanding of the schedule, efficacy and side effects of the vaccines), attitude (evaluative reaction to the immunization) and vested interest (perceptions of personal and professional consequences of immunization).…”

Section: Literature Reviewmentioning

confidence: 99%

“…The findings showed that even the most knowledgeable group (pediatricians) could benefit from additional immunization education. Similarly, Ruston et al (1994) analyzed knowledge, perception, and attitude of internal medicine residents regarding practical barriers against the use of the pneumococcal vaccine. Although most physicians were convinced of the usefulness of the vaccine (94%), many failed to translate this knowledge into clinical practice.…”

Section: Literature Reviewmentioning

confidence: 99%

Barriers to Childhood Immunization: Findings from a Needs Assessment Study

Thomas¹,

Kohli²,

King³

2004

Home Health Care Services Quarterly

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This study examines the current status of immunization among 0-3 year old children in Bakersfield and identifies barriers that prevent families from immunizing their children. A survey research design using a stratified sampling method was employed to collect data from 207 randomly selected English and Spanish speaking households having at least one child between the ages of 0-3 in Bakersfield. The findings reveal that 49% of the parents had no shot cards regarding children's immunization status. However, a significant majority of them immunized their children despite having no records. The most commonly reported consumer related barrier for late immunization was having a sick child followed by lack of parental memory and fear of side effects. The major provider-related barriers included lack of an opening for an appointment with the health care provider, limited clinic hours, and long lines in clinics. Lack of transportation was the single most systemic barrier. These findings suggest that reminder calls, increased transportation, weekend clinics and better rapport with parents can improve the immunization rates in ethnically diverse rural communities.

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Barriers to immunization — an examination of factors that influence the application of pneumococcal vaccine by house staff

Cited by 18 publications

References 26 publications

Pneumococcal Disease among Human Immunodeficiency Virus-Infected Persons: Incidence, Risk Factors, and Impact of Vaccination

Pneumococcal Disease among Human Immunodeficiency Virus-Infected Persons: Incidence, Risk Factors, and Impact of Vaccination

A Hospital-Based Pharmacy Intervention Program for Pneumococcal Vaccination

Barriers to Childhood Immunization: Findings from a Needs Assessment Study

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