• influenza vaccine;
  • healthcare quality;
  • ambulatory care

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients.

Design: Retrospective analysis of influenza vaccine usage over 4 years (1999–2002).

Setting: University ambulatory setting.

Participants: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group.

Measurements: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used standing orders were compared with those of physicians who did not use standing orders.

Results: Five hundred seventy-six (63%) patients of physicians who used standing orders received influenza vaccine, compared with 332 (38%) patients of physicians who did not use them (P<.001). Standing orders accounted for a significantly higher rate of influenza vaccination in each study year. Moreover, in 2001, when influenza vaccine delivery was delayed, physicians who used standing orders maintained their same rate of usage, but physicians who did not had rates of about one-half their usage of the other 3 years.

Conclusion: More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.