CONTACT: BECKY SOGLIN
Iowa City IA 52242
(319) 335-6660; fax (319) 384-4638
Release: April 26, 2001
UI studies show support for adult immunization by non-physicians
IOWA CITY, Iowa -- Iowa family physicians and their patients overall support
having adults receive immunizations from non-physician health care professionals
at sites outside of physician offices, according to two related studies by
University of Iowa researchers.
In addition, physicians and patients were supportive of having children
receive immunizations at certain non-physician locations such as community
health centers, but were less supportive of using locations such as pharmacies
for childhood shots. There also was some concern about the record keeping
and safety of out-of-office immunizations.
The studies, which were published in two journals earlier this year, have
implications for ways to increase immunization rates in Iowa and possibly
other states with similar populations.
Other studies have shown that using non-physicians, such as nurses, nurse
practitioners, physician assistants and pharmacists, to provide immunizations
may help more people keep their immunizations up to date. However, little
has been known about primary care physicians' interest in working with other
health care providers on immunization efforts, or patients' interest in getting
immunizations from non-physicians at locations such as community health centers,
schools and pharmacies.
The tandem studies were the collaborative work of three researchers: George
Bergus, M.D., associate professor of family medicine in the UI College of
Medicine; Michael Ernst, Pharm.D., assistant professor (clinical) in the UI
College of Pharmacy and pharmacist in the UI Family Medicine Clinic; and Bernard
Sorofman, Ph.D., associate professor in the UI College of Pharmacy.
Iowa and the United States as a whole did not meet the adult immunization
rates for influenza and pneumonia set by Healthy People 2000, a national health
promotion and disease prevention initiative. The target for pneumococcal vaccinations,
for example, was set at 60 percent of seniors (age 65 and older) during their
lifetime. However, by 1997 the national rate was 43 percent and no single
state had met the 60 percent target.
"The unmet Healthy People 2000 goal raises the question of what will
happen for Healthy People 2010, which has set goals of 90 percent for influenza
and pneumococcal vaccine for people age 65 and older," said Bergus, who
authored the study that focused on the survey responses of 476 members of
the Iowa Academy of Family Physicians.
The majority of the family physicians surveyed indicated that some of their
patients already are using non-physician providers, and many family practioners
said they are willing to work collaboratively with non-traditional immunization
Three of four physicians reported they already have worked with a provider
outside their office on patient immunizations. Nearly all the physicians (95
percent) expressed interest in working with non-physician providers in the
future, including 92 percent considering collaboration with a nurse practitioner,
89 percent with a school or public health nurse and 50 percent with a pharmacist.
Physicians in towns with populations of 20,000 or less were more likely
than physicians in more populous cities to report adult patients already getting
their shots outside of doctors' offices.
Two of three physicians also supported school-age children getting immunizations
(such as boosters for diphtheria-tetanus) from school nurses or community
health departments. While fewer than one in 10 physicians thought children
should get shots from pharmacists, many physicians thought adults could effectively
use pharmacies for immunization against the flu or pneumonia.
This finding about pharmacies was supported by the related study, authored
by Ernst, which was based on 420 surveys returned by people who had immunizations
at 22 sites, including family physician offices, community health departments
Adults reported that for flu and pneumonia immunizations they were most
likely to support using a physician's office followed by pharmacies and community
health departments. The National Vaccine Advisory Committee of the federal
Centers for Disease Control and Prevention recently supported the use of pharmacists
to provide adult immunizations such as flu and pneumonia shots.
"Our findings confirmed that people are using a variety of sites to
receive immunizations," Ernst said. "More importantly, we found
that people are very likely to again use some of these sites."
The UI research also showed that physicians' biggest concern is being kept
informed of their patients' immunizations, and patients want easy access to
their immunization records. However, only one-third of the physicians said
they usually or always received notification when a patient received an out-of-office
"Physicians in small towns were generally kept better informed about
the out-of-office immunizations of their patients than physicians elsewhere
were, regardless of formal collaborative relationships," Bergus said.
"However, even in cities such as Iowa City, pharmacists routinely 'close
the loop' and send physicians immunization updates about their patients. Patients
often ask their physicians for their immunization history, regardless of where
they may have gotten their shots."
At the same time, most doctors were not interested in a statewide immunization
database, he added. Although the team did not study the underlying reasons
for the lack of support, Bergus said it could be due to concerns about additional
Physicians also felt non-physician providers need the skills and knowledge
to deal with any complications that might arise during an immunization. Fainting
is the most common problem associated with immunizations, while allergic reactions
are relatively uncommon.
"Physicians were also concerned that if a patient goes elsewhere for
immunizations, they may lose out on opportunities to deliver preventive health
care such as mammograms," Bergus said.
Ernst added that while fragmentation of health care is a legitimate concern,
many non-physician health care providers already make it a point to remind
adults who come in for a vaccination to check in with their physician for
"As we involve more non-physicians in immunizations, it's important
that these health care providers use the opportunities to plug people back
into the health care system," Ernst said. "Non-traditional immunizers
shouldn't just give people their shots and let them walk out the door."
Ernst and Bergus both said that the studies did not examine whether programs
promoting the use of non-physician for immunizations actually would increase
"The next step would be to examine whether increasing immunization
availability through use of non-traditional immunizers in Iowa actually increases
immunization rates," Ernst said.
The researchers also said that the applicability of their findings to other
states may be limited, given that Iowa has a relatively large rural population
and a relatively homogenous population (more than 90 percent white).
The investigators added that the study would not have been possible without
the cooperation of the Iowa Pharmacy Association (IPA) and the Iowa Academy
of Family Physicians (IAFP), both based in Des Moines. In addition, the IPA
and the Family Health Foundation of the IAFP provided grants for both studies.
The research on "Physician Perceptions about Administration of Immunizations
Outside of Physician Offices" appeared in the March issue of Preventive
Medicine. The research on "Patients Acceptance of Traditional and Nontraditional
Immunization Providers" appeared in the January/February issue of the
Journal of the American Pharmaceutical Association.
Healthy People 2010 can be visited online at http://web.health.gov/healthypeople/
University of Iowa Health Care describes the partnership between
the UI College of Medicine and the UI Hospitals and Clinics and the patient
care, medical education and research programs and services they provide.