Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers

Abstract

The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.

Keywords: Adult; Immunization; Providers; Standards; Vaccination.

Fig. 1.

Proportion of clinicians* and pharmacists^† reporting implementation of each component of the Standards. *Data for clinicians were obtained from the 2015–16, 2016–17, and 2017–18 National Survey of Healthcare Providers Regarding Vaccination Practices for Adults, conducted for CDC by Abt Associates Inc. ^†Data for pharmacists were obtained from the 2015–16, 2016–17, and 2017–18 National Survey of Pharmacists Regarding Vaccination Practices for Adults, conducted for CDC by Abt Associates Inc. ^‡Full implementation of the Standards defined as: adherence to all individual components of the Standards for immunizing providers (assessment, recommendation, administration, documentation in IIS, patient referral) or select components of the Standards (assessment, recommendation, patient referral, patient follow-up components) for non-immunizing providers.