Doctors lack time and adequate staff support to effectively give flu shots USA

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Flu / Cold / SARS
Article Date: 17 Apr 2004 - 0:00 PDT

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Even when doctors have standing orders to give flu shots to older patients, they don't do it often enough because of lack of time or adequate staff support, a recent study has found.

The researchers, who observed 243 patients in doctors' office in San Diego, Rochester, N.Y., and Albuquerque, N.M., found that 38 percent left without a shot.

The study suggested that each doctor have at least four staff people, that a staff person should inquire about immunizations before the exam began, and that the doctor spend at least 10 minutes with the patient and ask about a flu shot during the exam.

When all four elements were in place, more than 90 percent of the patients studied left properly vaccinated. But all four pieces have to be present to make the system work, they say.

"Each activity in itself increased the likelihood of an immunization occurring, but the full sequence of events was more powerful than any combination of individual activities," says lead researcher John Fontanesi, Ph.D, of the University of California, San Diego. He and his colleagues used industrial-quality engineering techniques called critical path analysis to plot a patient's route through the doctor visit. Their findings appear in the American Journal of Preventive Medicine.

"Providers are more likely to discuss immunization needs if they have the time [and] information available, and the operational support to do so," Fontanesi says.

Besides staff preparation, time proved to be a crucial factor. Getting the patient registered quickly helped, as did holding down waiting room time. If patients had to wait more than twice their face-to-face time with the doctor, vaccination rates dropped dramatically, he says. That may represent more systemic problems in running the medical office.

"This may be a reflection of organizational inefficiency in which vaccination may be sacrificed for the sake of time," Fontanesi says.

Routine immunization should not be viewed merely as something tacked on to a general office visit. Even small variations from the critical path increase the likelihood of missed opportunities, he says.

BY AARON LEVIN, SCIENCE WRITER
HEALTH BEHAVIOR NEWS SERVICE

FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact John Fontanesi at jfontanesi@ucsd.edu.
American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292

Contact: John Fontanesi
jfontanesi@ucsd.edu
Center for the Advancement of Health

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