Adult Immunization in University-Based Primary Care and Specialty Practices

Authors

  • Nicholas A. Daniels MD, MPH,

    1. From the *Division of General Internal Medicine, Department of Medicine, Center for Aging in Diverse Communities, and Medical Effectiveness Research Center, University of California at San Francisco, San Francisco, California.
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  • Tung T. Nguyen MD,

    1. From the *Division of General Internal Medicine, Department of Medicine, Center for Aging in Diverse Communities, and Medical Effectiveness Research Center, University of California at San Francisco, San Francisco, California.
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  • Ginny Gildengorin PhD,

    1. From the *Division of General Internal Medicine, Department of Medicine, Center for Aging in Diverse Communities, and Medical Effectiveness Research Center, University of California at San Francisco, San Francisco, California.
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  • Eliseo J. Pérez-Stable MD

    1. From the *Division of General Internal Medicine, Department of Medicine, Center for Aging in Diverse Communities, and Medical Effectiveness Research Center, University of California at San Francisco, San Francisco, California.
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  • Dr. Daniels is a recipient of the Robert Wood Johnson Minority Medical Faculty Development Award. This project was funded by Grant P30-AG15272 under the Resource Centers for Minority Aging Research program by the National Institute on Aging, the National Institute of Nursing Research, and the National Center on Minority Health and Health Disparities, National Institutes of Health.

Address correspondence to Nicholas A. Daniels, MD, MPH, University of California, San Francisco, Department of Medicine, Division of General Internal Medicine, 1701 Divisadero Street, Suite 500, Box 1731, San Francisco, CA 94115. E-mail: ndaniels@medicine.ucsf.edu

Abstract

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6–7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2–8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.

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