Alamosa East, CO, United States
Alamosa East, CO, United States

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Mabachi N.M.,American Academy of Family Physicians | Mabachi N.M.,University of Kansas Medical Center | Cifuentes M.,University of Kansas Medical Center | Barnard J.,Childrens Outcomes Research Program | And 9 more authors.
Journal of Ambulatory Care Management | Year: 2016

The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Hurley L.P.,Wellington Webb Center for Primary Care | Lindley M.C.,Centers for Disease Control and Prevention | Harpaz R.,Centers for Disease Control and Prevention | Stokley S.,Centers for Disease Control and Prevention | And 7 more authors.
Annals of Internal Medicine | Year: 2010

Background: The herpes zoster vaccine is the most expensive vaccine recommended for older adults and the first vaccine to be reimbursed through Medicare Part D. Early uptake has been 2% to 7% nationally. Objective: To assess current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination among general internists and family medicine physicians. Design: Mail and Internet-based survey, designed through an iterative process and conceptually based on the Health Belief Model. Setting: National survey conducted from July to September 2008. Participants: General internists and family medicine physicians. Measurements: Survey responses on current vaccination practices, knowledge and practice regarding reimbursement, and barriers to vaccination. Results: Response rates were 72% in both specialties (301 general internists and 297 family medicine physicians). Physicians in both specialties reported similar methods for delivering vaccine, which included stocking and administering the vaccine in their offices (49%), referring patients to a pharmacy to purchase the vaccine and bring it back to the office for administration (36%), and referring patients to a pharmacy for vaccine administration (33%). Eighty-eight percent of providers recommend herpes zoster vaccine and 41% strongly recommend it, compared with more than 90% who strongly recommend influenza and pneumococcal vaccines. For physicians in both specialties, the most frequently reported barriers to vaccination were financial. Only 45% of respondents knew that herpes zoster vaccine is reimbursed through Medicare Part D. Of respondents who began administering herpes zoster vaccine in their office, 12% stopped because of cost and reimbursement issues. Limitations: Survey results represent reported but not observed practice. Surveyed providers may not be representative of all providers. Conclusion: Physicians are making efforts to provide herpes zoster vaccine but are hampered by barriers, particularly financial ones. Efforts to facilitate the financing of herpes zoster vaccine could help increase its use. © 2010 American College of Physicians.

Saville A.W.,Childrens Outcomes Research Program | Saville A.W.,Colorado Health Outcomes Research Program | Albright K.,Childrens Outcomes Research Program | Albright K.,Colorado Health Outcomes Research Program | And 9 more authors.
Academic Pediatrics | Year: 2011

Objective: To assess 1) pediatric practices' use of provider-based recall using an immunization information system 8 months after training on the recall process; 2) initiation and sustainability barriers to provider-based recall using an immunization information system; 3) strategies that facilitated recall initiation; and 4) recommendations for alternative approaches for conducting recall. Methods: In 2008, 11 practices received training on the automatic recall function in the Colorado Immunization Information System (CIIS) for both infants and adolescents. The 2-hour computer-based training provided an opportunity for attendees to run real-time recall reports with CIIS staff assistance. Eight months later, key informant interviews were conducted with 24 providers and staff from these practices. Results: Eight months after training, only 4 of 11 practices had implemented recall using CIIS: 3 practices recalled children ≤2 years of age, and 1 practice recalled adolescent girls for human papillomavirus vaccine. Initiation barriers included lack of awareness of baseline immunization rates, distrust in the accuracy of CIIS-generated data, and perceived difficulties recalling adolescents. Having unrealistic expectations about recall effectiveness was a barrier to sustainability. Strategies that facilitated recall included having a dedicated staff person for recall efforts and recalling children ≤2 years of age. Most key informants viewed population-based recall conducted by public health departments or schools as an acceptable alternative to provider-based recall. Conclusions: Even with a promising tool to assist pediatric offices, implementing provider-based recall is challenging for pediatric practices. Given existing barriers, providers expressed support for alternative recall methods. Copyright © 2011 by Academic Pediatric Association.

Allison M.A.,Childrens Outcomes Research Program | Allison M.A.,Childrens Hospital Colorado | Dunne E.F.,Aurora University | Dunne E.F.,National Center for HIV AIDS | And 16 more authors.
Academic Pediatrics | Year: 2013

OBJECTIVE: In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- To 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys.We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. METHODS: We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. RESULTS: The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- To 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- To 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- To 12-year-olds. CONCLUSIONS: Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings. Copyright © 2013 by Academic Pediatric Association.

Hurley L.P.,Wellington Webb Center for Primary Care | Bridges C.B.,National Center for Immunization and Respiratory Diseases | Harpaz R.,National Center for Immunization and Respiratory Diseases | Allison M.A.,Wellington Webb Center for Primary Care | And 9 more authors.
Annals of Internal Medicine | Year: 2014

Background: Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low. Objective: To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators. Design: Mail and Internet-based survey. Setting: Survey conducted from March to June 2012. Participants: General internists and family physicians throughout the United States. Measurements: A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics. Results: Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments. Limitations: Surveyed physicians may not be representative of all physicians. Conclusion: Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D. © 2014 American College of Physicians.

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