摘要：Objectives. We designed and evaluated interventions to increase adult immunizations within inner-city health centers. Methods. Interventions included reminders, standing orders, and walk-in “flu shot clinics.” Patients were surveyed and records evaluated. Results. Records from 1 center showed that immunization rates increased from 24% to 30% (P < .001) for patients aged 50 to 64 years and from 45% to 53% for patients aged 65 years and older (P < .001). Self-reported vaccination rates did not increase. In logistic regression analyses, the strongest predictor of vaccination among patients aged 50 to 64 years was the belief that unvaccinated persons will contract influenza (odds ratio [OR] = 5.4; 95% confidence interval [CI] = 2.4, 12.0). Among patients aged 65 years and older, the strongest predictor of vaccination was the belief that friends/relatives thought that they should be vaccinated (OR = 9.7; 95% CI = 4.2, 22.3). Conclusions. Tailored interventions can improve immunization rates at inner-city health centers. In the United States, influenza is responsible for more than 36 000 deaths per year. 1 It is estimated that influenza vaccine prevents thousands of deaths each year, yet in the second quarter of 2002, the influenza vaccination rate was only 68% among adults aged 65 years and older. 2 Even lower vaccination rates among elderly minority populations have been reported, including rates of 47% for Hispanics and 52% for Blacks of nonHispanic origin. 3 For this reason, racial disparity in immunization rates is one of the areas targeted for elimination in the US Public Health Service’s Healthy People 2010 objectives for the nation. 4 Moderate overall immunization rates and racial disparity in rates are perplexing, given that (1) Medicare covers influenza vaccine, (2) influenza vaccine is known to be efficacious, and (3) systematic reviews of effective methods to increase immunization rates have been published. 5, 6 In our approach to the present study, we were influenced by the in-depth analyses of barriers to prevention of Miller, Stange, Crabtree, and others, who have pointed out the complexity and diversity of primary-care practices and the importance of understanding the internal operating models and values of each practice. 7– 9 They point to the need to tailor interventions to the practice to enhance success and continued use of the interventions. 9– 12 We sought to implement tailored interventions to raise adult immunization rates in inner-city health centers.
