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 patients 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 vie
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Contact: John Fontanesi
jfontanesi@ucsd.edu
Center for the Advancement of Health
16-Apr-2004