Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #119141

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:

• To discuss racial and ethnic disparities in adult immunization.
• To assess whether pneumococcal vaccine acceptance differs by race and ethnicity.

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.

Recorded presentation