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Research article
First published October 2007

Improvement in Provider Immunization Knowledge and Behaviors Following a Peer Education Intervention

Abstract

Provider education programs that use academic detailing to improve childhood immunization have been implemented in several states. The purpose of this study was to evaluate the impact of these types of programs to improve immunization-related behaviors in private provider offices. The intervention included peer-based academic detailing in which teams of 1 physician, 1 nurse, and 1 office manager visited pediatric and family practices to deliver an educational presentation and develop practice-specific action plans. Comparison of pre—post intervention surveys showed that providers' willingness to give the maximum number of immunizations due at 1 visit (P < .001) increased. More providers reported routinely screening immunization records at sickness or injury visits (P < .05) and using minimum intervals (P < .001) postintervention. Mean change in baseline and postintervention overall scores was significant for pediatric practices (0.40, P < .05), small practices (0.64, P < .01), Vaccines for Children (VFC) practices (0.74, P < .05), and non-VFC provider practices (0.67, P < .01) but not for family or large practices.

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References

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.
Centers for Disease Control and Prevention. National, state, and urban area vaccination coverage levels among children aged 19-35 months—United States, 2004. MMWR Morb Mortal Wkly Rep. 2005;54:717-721.
Centers for Disease Control and Prevention. National, state, and urban area vaccination coverage levels among children aged 19-35 months—United States, 2005. MMWR Morb Mortal Wkly Rep. 2005;55:988-993.
Mell LK, Ogren DS, Davis RL, et al. Centers for Disease Control and Prevention Vaccine Safety Datalink Project. Compliance with national immunization guidelines for children younger than 2 years, 1996-1999. Pediatrics. 2005; 115:461-467.
Luman ET, Barker LE, Shaw KM, McCauley MM, Buehler JW, Pickering LK Timeliness of childhood vaccinations in the United States: days undervaccinated and number of vaccines delayed. JAMA. 2005 ;293:1204-1211.
Cohen NJ, Lauderdale DS, Shete PB, Seal JB, Daum RS Physician knowledge of catch-up regimens and contraindications for childhood immunizations. Pediatrics. 2003;111:925-932.
Wood D., Halfon N., Pereyra M., Hamlin JS, Grabowsky M. Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public providers in Los Angeles. Pediatr Infect Dis J. 1996;15:140-145.
Farizo KM, Stehr-Green PA, Markowitz LE, Patriarca PA Vaccination levels and missed opportunities for measles vaccination: a record audit in a public pediatric clinic. Pediatrics. 1992;89:589-592.
Holt E., Guyer B., Hughart N., et al. The contribution of missed opportunities to childhood underimmunization in Baltimore. Pediatrics. 1996;97:474-480.
Fairbrother G., Friedman S., DuMont KA, Lobach KS Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children. Pediatrics. 1996;97:785-790.
Wood D., Schuster M., Donald-Sherbourne C., Duan N., Mazel R., Halfon N. Reducing missed opportunities to vaccinate during child health visits: how effective are parent education and case management? Arch Pediatr Adolesc Med. 1998;152:238-243.
Zimmerman RK, Giebink GS, Street HB, Janosky JE Knowledge and attitudes of Minnesota primary care physicians about barriers to measles and pertussis immunization. J Am Board Fam Pract. 1995;8:270-277.
Cutts FT, Orenstein WA, Bernier RH Causes of low preschool immunization coverage in the United States. Annu Rev Public Health. 1992;13:385-398.
Hinman AR, Orenstein WA, Rodewald L. Financing immunizations in the United States. Clin Infect Dis. 2004;38:1440-1446.
Grabowsky M., Orenstein WA, Marcuse EK The critical role of provider practices in undervaccination. Pediatrics. 1996;97:735-737.
Ferris TG, Dougherty D., Blumenthal D., Perrin JM A report card on quality improvement for children's health care. Pediatrics. 2001;107:143-155.
Thomas M., Kohli V., King D. Barriers to childhood immunization: findings from a needs assessment study . Home Health Care Serv Q. 2004;23:19-39.
Smith A., McCann R., McKinlay I. Second dose of MMR vaccine: health professionals' level of confidence in the vaccine and attitudes towards the second dose. Commun Dis Public Health. 2001;4:273-277.
Simon SR, Majumdar SR, Prosser LA, et al. Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial. Am J Med. 2005;118: 521-528.
Albert DA, Anluwalia KP, Ward A., Sadowsky D. The use of “academic detailing” to promote tobacco-use cessation counseling in dental offices. J Am Dent Assoc. 2004;135:1700-1706.
Wong RY, Lee PE Teaching physicians geriatric principles: a randomized control trial on academic detailing plus printed materials versus printed materials only. J Gerontol A Biol Sci Med Sci. 2004;59:1036-1040.
Jackson SL, Peterson GM, Vial JH A community-based educational intervention to improve antithrombotic drug use in atrial fibrillation. Ann Pharmacother. 2004; 38:1794-1799.
Carter BL Implementing the new guidelines for hypertension: JNC 7, ADA, WHO-ISH. J Manag Care Pharm. 2004;10(5 suppl A):S18-S25.
Davis DA, Thomson MA, Oxman AD, Haynes RB Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995;274:700-705.
Heffner JE Altering physician behavior to improve clinical performance. Top Health Inf Manage. 2001;22:1-9.
Kim CS, Kristopaitis RJ, Stone E., Pelter M., Sandhu M., Weingarten SR Physician education and report cards: do they make the grade? Results from a randomized controlled trial. Am J Med. 1999 ;107:556-560.
Sinn JS, Morrow AL, Finch AB Improving immunization rates in private pediatric practices through physician leadership. Arch Pediatr Adolesc Med. 1999 ;153: 597-603.
Margolis PA, Lannon CM, Stuart JM, Fried BJ, Keyes-Elstein L., Moore DE Jr. Practice based education to improve delivery systems for prevention in primary care: randomized trial. BMJ. 2004;328:388.
Soumerai SB, Avorn J. Principles of educational outreach (“academic detailing”) to improve clinical decision making. JAMA. 1990;263:549-556.
Dalhousie University. Nova Scotia establishes an academic detailing service. Available at: http://www.gov.ns.ca/health/pharmacare/ads_summary.htm. Accessed May 16, 2005.
U.S. Census Bureau, Population Division. 2000 American Community Survey Summary Tables: Fort Bend/ Harris Counties, Tx: Total Population. Available at: http://factfinder.census.gov/servlet/DTGeoSearchByListServlet?ds_name=ACS_2000_EST_G00_&_lang=en&_ts=162207715232. Accessed May 15, 2005.
Cauffman JG, Forsyth RA, Clark VA, et al. Randomized controlled trials of continuing medical education: what makes them most effective? J Contin Educ Health Prof. 2002;22:214-221.
Darden P., Fournier J., Hedberg V., et al. Teaching Immunization Delivery and Evaluation (TIDE). Module C: Improving immunization rates in your practice. Office Practices Questionnaire . Available at: http://www.2.edserv.musc.edu/tide/modulec/roar.pdf . Accessed September 29, 2006.
Immunization Action Coalition. Suggestions to improve your immunization services Available at: http://www.immunize.org-catg.d-p2045tip.pdf. Accessed September 29, 2006.
Stata [computer program]. Version 8.0. College Station, Tex: Stata Corp; 2003.
Mazmanian PE, Davis DA Continuing medical education and the physician as a learner: guide to the evidence. JAMA. 2002;288:1057-1060.
Davis DA, O'Brien MA, Freemantle N., Wolf FM, Mazmanian P., Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999 ;282:867-874.
Davis DA, Taylor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997;157: 408-416.
Davis DA, Thomson MA, Oxman AD, Haynes RB Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA. 1992;268:1111-1117.
Muramoto ML, Campbell J., Salazar A. Provider training and education in disease management. Current and innovative technology. Dis Manage Health Outcomes. 2003;11:633-645.
Nardella A., Pechet L., Snyder LM Continuous improvement, quality control, and cost containment in clinical laboratory testing: effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med. 1995;119:518-522.
Avorn J., Soumerai SB Improving drug-therapy decisions through educational outreach: a randomized, controlled trial of academically based “detailing.” N Engl J Med. 1983;308:1457-1463.
Dietrich AJ Cancer: improving early detection and prevention, a community practice randomized trial. BMJ. 1992;304:687-691.
Putnam RW, Curry, L. Impact of patient care appraisal on physician behavior in the office setting . CMAJ. 1985; 132:1025-1029.
Raisch DW, Bootman JL, Larson LN, McGhan WF Improving antiulcer agent prescribing in a health maintenance organization . Am J Hosp Pharm. 1990;47: 1766-1773.
Steele MA, Bess DT, Franse VL, Graver SE Cost effectiveness of two interventions for reducing outpatient prescribing costs. DICP. 1989;23:497-500.
Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults: the Task Force on Community Preventive Services. Am J Prev Med. 2000;18:97-140.
Hulscher ME, van Drenth BB, Mokkink HG, et al. Tailored outreach visits as a method for implementing guidelines and improving preventive care . Int J Qual Health Care. 1998;11:193-200.
Lemelin J., Hogg W., Baskerville N. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. CMAJ. 2001;164:757-763.
Bordley WC, Margolis PA, Stuart J., Lannon C., Keyes L. Improving preventive service delivery through office systems. Pediatrics. 2001;108:e41-e48.
Aita V., Dodendorg DM, Lebsack JA, Tallia AF, Crabtree BF Patient care staffing patterns and roles in community-based family practices . J Fam Pract. 2001;50:889.
Jones KR, Fink R., Pepper G., et al. Improving nursing home staff knowledge and attitudes about pain . Gerontologist. 2004;44:469-478.
Richardson B., Kitchen G., Livingston G. The effect of education on knowledge and management of elder abuse: a randomized controlled trail. Age Ageing . 2002;31:335-341.
Heale J., Davis D., Norman G., Woodward C., Neufeld V., Dodd P. A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Proc Annu Conf Res Med Educ. 1988;27:72-77.
Avorn J., Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992 ;327:168-173.
Glasgow RE, Nutting PA, King DK, et al. Randomized effectiveness trial of a computer-assisted intervention to improve diabetes care. Diabetes Care. 2005 ;28:33-39.

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Article first published: October 2007
Issue published: October 2007

Keywords

  1. childhood immunization
  2. academic detailing
  3. provider behavior

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PubMed: 17522285

Authors

Affiliations

Julie A. Boom, MD
Baylor College of Medicine, Houston, Texas, Texas Children's Hospital, Houston, Texas, [email protected]
Cynthia S. Nelson, MPH
Texas Children's Hospital, Houston, Texas
Larry E. Laufman, EdD
Baylor College of Medicine, Houston, Texas
Alan E. Kohrt, MD
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Children's Healthcare of Atlanta, Atlanta, Georgia
Claudia A. Kozinetz, PhD, MPH
Baylor College of Medicine, Houston, Texas

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