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1.
J Health Care Poor Underserved ; 33(4S): 202-208, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36533469

RESUMO

This report describes a public-private partnership supported, in part, by federal 340B funds between a community pharmacy and a harm reduction organization. The partnership provides life-saving health care services within a neighborhood disproportionately affected by substance use, poverty, homelessness, and crime and may serve as a model for other communities in need.


Assuntos
Pessoas Mal Alojadas , Farmácias , Transtornos Relacionados ao Uso de Substâncias , Humanos , Redução do Dano , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Problemas Sociais
2.
Heart Lung ; 51: 52-58, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34731698

RESUMO

BACKGROUND: Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. OBJECTIVES: Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. METHODS: Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. RESULTS: Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 - 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). CONCLUSION: The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Adulto , Estudos Transversais , Insuficiência Cardíaca/psicologia , Coração Auxiliar/psicologia , Humanos
3.
J Subst Abuse Treat ; 109: 23-33, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31856947

RESUMO

Hepatitis C (HCV) is a highly prevalent infection in current and former IV drug users. Current estimates indicate that over 70% of those in methadone maintenance treatment programs (MMTs) have HCV, but only 11% have initiated treatments despite availability of new treatments that are easily tolerated and can cure infection in about 8 weeks. We conducted a pilot randomized trial at four Philadelphia, PA MMTs to test acceptability, feasibility and promise of efficacy of our "Take Charge, Get Cured" mobile health (mHealth) treatment decision tool, developed through extensive formative work that included methadone patients' input and targeted directly to concerns of methadone patients with Hepatitis C (HCV). We compared its impact on perceptions and knowledge about HCV and HCV treatment, decisional conflict, intention to and actual initiation of HCV care to a web-based Cochrane-reviewed, non-targeted HCV decision tool. Subjects (n = 122) were randomized, administered baseline questionnaires, interacted with the targeted or non-targeted decision tool on an electronic tablet, and answered post-test questions. After 3-months subjects (n = 93; 76%) were surveyed for follow up. "Take Charge, Get Cured" users were more likely to report the tool helped with decision making and demonstrated greater improvement in knowledge, decisional conflict, and intention to be treated for their HCV infections than users of the non-targeted decision tool. They were significantly more likely to say the targeted tool was helpful and that they would recommend it to others. At three month follow up, targeted group participants were more likely to say the tool helped them make a better decision about treatment and prepared them to talk to their doctor about what matters most to them about treatment. No differences were seen in actions to initiate HCV care, but more targeted group participants reported talking to their doctors about HCV treatment. Results indicate a highly targeted mHealth decision tool is an important strategy to affect perceptions and knowledge of HCV treatment that lowers decisional conflict about initiating treatment, key components in decision making. We believe this highly acceptable and feasible intervention could be utilized in clinical settings to address the important barriers to initiating HCV treatment in a vulnerable population.


Assuntos
Técnicas de Apoio para a Decisão , Hepatite C/tratamento farmacológico , Metadona , Abuso de Substâncias por Via Intravenosa , Telemedicina , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hepacivirus , Hepatite C/epidemiologia , Humanos , Masculino , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Philadelphia/epidemiologia , Projetos Piloto , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Inquéritos e Questionários
4.
J Health Care Poor Underserved ; 30(4): 1433-1454, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680107

RESUMO

While most methadone maintenance treatment (MMT) patients have hepatitis C (HCV), less than 11% initiate treatment. The objective of this study was to assess this population's perceptions of HCV treatment. We surveyed 100 HCV+ MMT patients from four urban programs, asking scaled attitude scores about factors that may affect treatment decisions. Using bivariate and ordinal regression methods, results indicated that while education level and previous discussion about treatment with providers were associated with treatment initiation interest, age, race, gender, insurance type, difficulty paying for health care, and time since screening were not. Those who (a) believed HCV treatment is easy to take and cures quickly, (b) have had positive interactions with physicians, and (c) feel they have had enough HCV education were more likely to indicate treatment willingness. Interventions must emphasize positive treatment attitudes and not only focus on structural barriers to move HCV+ MMT patients towards initiating care.


Assuntos
Atitude Frente a Saúde , Hepatite C/complicações , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Adaptação Psicológica , Adulto , Idoso , Feminino , Hepatite C/tratamento farmacológico , Hepatite C/psicologia , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/psicologia , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Autoeficácia , Adulto Jovem
5.
Heart Lung ; 48(4): 302-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30905390

RESUMO

BACKGROUND: The International Society for Heart & Lung Transplantation (ISHLT) guidelines for Mechanical Circulatory Support (MCS) includes assessment of four elements of psychosocial functioning prior to Left Ventricular Assist Device (LVAD) implantation. Information about the practices and impact of assessments of psychosocial functioning are limited. OBJECTIVE: To describe the psychosocial function assessment practices used within US LVAD programs and the influence of psychosocial assessment results on clinical decisions for LVAD patient selection. METHODS: In 2017, a cross-sectional survey of LVAD programs listed in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (N = 164) was conducted to understand practices used for and the influence of psychosocial assessments for post-operative care planning decisions. RESULTS: Respondents included representatives of 69 LVAD programs from throughout the U.S. that implanted 64.8% of all U.S LVADs in 2016. More than 39 psychosocial screening instruments were used. Assessment of family, social and emotional support occurred most frequently (84.1% (n = 58) of programs assessed 100% of patients), but assessment was least likely to be conducted with standardized instruments (36.2%). Cognitive dysfunction was the least likely characteristic to be assessed (26.1% (n = 18) of programs assessed 100% of patients), but was most often conducted with standardized instruments (53.8% of programs). Twenty seven percent of programs used non-standardized instruments or patient observation. The influence of assessments on clinical decisions to implant an LVAD was most influential in the bridge to transplant pathway with 60% (n = 39) of respondents rating it very influential and least influential for patients in the destination therapy pathway with 39.4% (n = 26) of respondents. CONCLUSIONS: Current psychosocial assessment practices in LVAD programs vary widely and often yield non-standardized, non-comparable data that may lead to variations in care and limit generation of an evidence base for decision making regarding psychosocial eligibility for LVAD implantation.


Assuntos
Cognição/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Psicometria/métodos , Qualidade de Vida , Sistema de Registros , Função Ventricular Esquerda/fisiologia , Estudos Transversais , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Inquéritos e Questionários , Resultado do Tratamento
6.
J Addict Med ; 11(3): 191-196, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28252455

RESUMO

OBJECTIVE: Patients prescribed methadone maintenance treatment (MMT) demonstrate elevated prevalence of hepatitis B virus (HBV), hepatitis C virus, and HIV. Government agencies recommend testing for these infections in MMT programs, but uptake is limited. METHODS: We audited infection-related policies and practices of all 14 MMT programs in Philadelphia, Pennsylvania, in 2015. Results were tabulated and compared with the results from a 2010 audit of 10 of 12 MMT programs. The audit focused on which patients are tested, timing and frequency, specific tests ordered, vaccination, and communication of test results. RESULTS: Written policies were nonspecific, offering little guidance on appropriate testing. The principal change in policy between 2010 and 2015 involved adding clearer guidance for communication of results to patients. In 2010 and 2015, all MMT programs tested new patients for hepatitis C virus antibodies, although retesting of existing patients varied. HBV testing increased from 2010 to 2015, though it was not uniform, with 5 programs testing for HBV surface antibodies and 10 programs testing for HBV surface antigens. Six programs assessed hepatitis vaccination status, but only 1 administered vaccines. In 2010, city-sponsored HIV antibody testing was available at all MMT programs. Without this program in 2015, few MMT programs conducted HIV testing. CONCLUSIONS: Despite limited hepatitis and HIV screening in MMT programs nationally, this study shows that testing can be incorporated into routine procedures. MMT programs are positioned to play an integral role in the identification of patients with chronic infections, but additional guidance and resources are required to maximize their impact.


Assuntos
Analgésicos Opioides/uso terapêutico , Infecções por HIV/diagnóstico , Hepatite Viral Humana/diagnóstico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Auditoria Clínica , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Política de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hepatite Viral Humana/complicações , Hepatite Viral Humana/prevenção & controle , Humanos , Programas de Rastreamento/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/complicações , Philadelphia , Guias de Prática Clínica como Assunto , Vacinação
8.
Matern Child Health J ; 20(2): 240-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26496989

RESUMO

INTRODUCTION: Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD)framework was used to structure the analysis and interpret results. METHODS: Data collected through the Infant Feeding Practices Study II survey (2005-2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and child care characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses. RESULTS: College education [odds ratio (OR) 2.14, 95 %confidence interval (CI) 1.58-2.89] and marriage (OR2.19, 95 % CI 1.43-3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43-0.74), living in the south (OR 0.67, 95 % CI 0.47-0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28­0.66)were associated with lower odds of EBF lasting ≥ 4 months. DISCUSSION: Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.


Assuntos
Aleitamento Materno/psicologia , Emprego/psicologia , Disparidades nos Níveis de Saúde , Fatores Socioeconômicos , Mulheres Trabalhadoras/psicologia , Adulto , Aleitamento Materno/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Estudos Longitudinais , Razão de Chances , Cuidado Pré-Natal , Política Pública , Análise de Regressão , Determinantes Sociais da Saúde , Apoio Social , Fatores de Tempo
9.
Am J Public Health ; 104(10): 1993-2001, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25122033

RESUMO

OBJECTIVES: We reviewed the complexities of school-related immunization policies, their relation to immunization information systems (IIS) and immunization registries, and the historical context to better understand this convoluted policy system. METHODS: We used legal databases (Lexis-Nexis and Westlaw) to identify school immunization records policies for 50 states, 5 cities, and the District of Columbia (Centers for Disease Control and Prevention "grantees"). The original search took place from May to September 2010 (cross-referenced in July 2013 with the list on http://www.immunize.org/laws ). We describe the requirements, agreement with IIS policies, and penalties for policy violations. RESULTS: We found a complex web of public health, medical, and education-directed policies, which complicates immunization data sharing. Most (79%) require records of immunizations for children to attend school or for a child-care institution licensure, but only a few (11%) require coordination between IIS and schools or child-care facilities. CONCLUSIONS: To realize the full benefit of IIS investment, including improved immunization and school health program efficiencies, IIS and school immunization records policies must be better coordinated. States with well-integrated policies may serve as models for effective harmonization.


Assuntos
Política de Saúde , Sistemas de Informação/organização & administração , Instituições Acadêmicas/legislação & jurisprudência , Vacinação/legislação & jurisprudência , Criança , Cuidado da Criança/legislação & jurisprudência , Pré-Escolar , Humanos , Lactente , Sistemas de Informação/legislação & jurisprudência , Sistema de Registros , Estados Unidos
10.
Hisp Health Care Int ; 12(1): 24-33, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24865437

RESUMO

The human papillomavirus (HPV) vaccine has the potential to reduce rates of cervical cancer and other HPV-related morbidity among Hispanic women who are disproportionately affected by this disease. Understanding the barriers faced by this population is an important public health goal. In this qualitative pilot study, 17 mothers and grandmothers of adolescent girls from diverse Hispanic backgrounds in a large northeastern city in the United States were interviewed to examine attitudes regarding vaccine acceptability. The findings reveal that negative media, concerns about sexuality, side effects, and efficacy may impact vaccine uptake and completion. Of the 4 participants whose daughters had received the vaccine, only 1 had completed the full series, which may speak to the trend of lower series completion among Hispanics. This pilot data could inform important considerations when designing longitudinal research that may provide some necessary insights into the factors that facilitate or impede HPV vaccine completion among U.S. Hispanics.


Assuntos
Hispânico ou Latino/psicologia , Relação entre Gerações/etnologia , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Tomada de Decisões , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Relações Mãe-Filho/etnologia , Projetos Piloto , Neoplasias do Colo do Útero/etnologia
11.
Am J Med Qual ; 28(3): 232-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22930707

RESUMO

Influenza is responsible for significant morbidity and mortality in the United States. Despite long-standing national recommendations, only 47% of adults with a high-risk condition received the influenza vaccine in 2009-2010. Subspecialty practices provide a significant portion of ambulatory care visits for high-risk adults and understanding their role in the immunization infrastructure may increase immunization rates, decrease public health burden, and reduce influenza-associated disease. A cross-sectional survey of cardiology, pulmonology, and obstetrics/gynecology practices was conducted to assess influenza vaccination practices, plans, patient acceptance, frustrations, and reasons for not vaccinating. It was found that 51% of respondents planned to vaccinate patients. Plans differed significantly by practice type. Practices that do not vaccinate generally recommend vaccination and refer patients to public health clinics, primary care, and pharmacies. Administrative and patient-related barriers affected most practices, but practices that vaccinate were able to overcome these barriers. Improvements in vaccination may be addressed by adapting practice support services for subspecialty practices.


Assuntos
Vacinas contra Influenza/uso terapêutico , Medicina/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Cardiologia/estatística & dados numéricos , Estudos Transversais , Ginecologia/estatística & dados numéricos , Humanos , Influenza Humana/prevenção & controle , Medicina/métodos , Obstetrícia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Fatores de Risco
12.
Vaccine ; 30(49): 7059-66, 2012 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-23041124

RESUMO

CONTEXT: Immunization Information Systems (IIS), or registries, were developed to improve effectiveness and efficiency in immunization services. Complex laws that govern IIS and immunization records are developed at the state-level, interact with each other, and may impact utility for all immunization stakeholders. As states develop Health Information Exchange laws they may also interact with IIS laws. OBJECTIVES: To provide immunization stakeholders an overview of the laws applicable to healthcare providers and health departments. Comparisons are provided to illustrate the trends since the previous studies. METHODS: IIS relevant statutes, regulations and ordinances of jurisdictions (states, large cities) of 56 "Grantees" receiving funding under the 317b Public Health Service Act were identified via legal databases then systematically reviewed for authorization, reporting and consent requirements. Key provisions were coded and mapped according to 131 variables. RESULTS: Including subsections, 984 laws across Grantees relate to immunization records, falling under many administrative sections of state and city government. Most Grantees have more than one law that addresses immunization records reporting, exchange and privacy protections. Not all of these laws are in alignment, but there is a trend toward increased Grantee IIS authorizing laws, mandated reporting and implied consent provisions. Of the 56 Grantees, 37 (66%) had IIS authorizing laws, and 46 (82%) had laws addressing healthcare provider and vital statistics reporting. However, much variation remains, even within the provisions of these laws. The coding instrument received 93.7% agreement and a K-α of 0.791. CONCLUSIONS: The trend toward laws that encourage participation should continue to improve functionality and value, but inconsistencies among laws should be addressed, both across jurisdictions within states and between different states. They may impair the value of the information that is collected. Greater uniformity could improve the overall usefulness of IIS.


Assuntos
Programas de Imunização/legislação & jurisprudência , Programas de Imunização/normas , Sistemas de Informação/legislação & jurisprudência , Vacinação/legislação & jurisprudência , Vacinação/normas , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Recém-Nascido , Sistemas de Informação/tendências , Masculino , Estados Unidos , Vacinação/estatística & dados numéricos
13.
Am J Med Qual ; 20(5): 253-61, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16221833

RESUMO

Certain population groups are at risk for inadequate prenatal care and transmission of perinatal infections. Philadelphia's birth cohort comprises largely at-risk groups and its infant mortality rate is among the nation's highest. This study identifies factors associated with infectious disease screening, treatment, and prevention in Philadelphia. Delivery charts for a probability sample of 550 patients were reviewed. Demographic factors associated with prenatal and delivery care were identified through Pearson chi-square, analysis of variance, and stepwise logistic regression analysis. Nonstandard and incomplete documentation complicated abstraction. Some prenatal care was noted in 95% of the records and screening varied by disease. Factors independently associated with care include maternal race, insurance status, and maternal age. Screening for infections with well-established recommendations (hepatitis B virus, rubella, syphilis) occurred more often than for group B streptococcus, HIV, hepatitis C virus, and varicella. Adoption of standard reporting forms and processes could improve practice and aid in quality improvement efforts and patient communication.


Assuntos
Controle de Infecções/organização & administração , Programas de Rastreamento , Assistência Perinatal , Complicações Infecciosas na Gravidez , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Philadelphia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/terapia
14.
Gastroenterol Nurs ; 27(4): 163-9, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15326401

RESUMO

An estimated 5 million Americans are chronically infected with hepatitis B or C. They face socially and clinically significant reductions in mental and physical health. Improved coping and compliance with clinical therapies and harm-reducing behaviors can improve quality of life and, potentially, treatment outcomes. Motivation to join, participation, use, and usefulness of online and in-person hepatitis support groups was examined through observation and survey of group members and group leaders. Members joined primarily to get information particularly about treatments, diet, and treatment side effects. They also joined to get support. All received support that was often hard to get elsewhere. Healthcare providers were generally the most used source of information, yet support groups were the most useful source of information. Members used the information and support obtained to make treatment and lifestyle changes such as initiating or ceasing treatment, eliminating alcohol consumption, increasing openness with family and friends, and discussing side effects with healthcare providers. Providers caring for hepatitis patients should consider recommending support groups to their patients and also participate in the groups to ensure that valid and reliable information is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Hepatite/psicologia , Educação de Pacientes como Assunto , Grupos de Autoajuda , Adulto , Idoso , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Philadelphia , Apoio Social
15.
J Am Med Dir Assoc ; 3(6): 347-51, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12807601

RESUMO

OBJECTIVES: To determine the levels of knowledge and beliefs about pneumococcal disease and the pneumococcal polysaccharide vaccine (PPV), the level of PPV use, PPV-related practices, and factors associated with PPV use in Pennsylvania's nursing homes. DESIGN/SETTING: A 68-item, cross-sectional survey of Nursing Directors at a random sample of PA nursing homes (291) was conducted between April and June 1999. Survey results and facility characteristics were used to describe vaccination practices, estimate the vaccination level and determine through bivariate analysis, associations between vaccination level and facility characteristics and practices. RESULTS: Respondents are knowledgeable about PPV and recommendations for its use but less knowledgeable about financial reimbursement. Pneumonia is believed to be a serious threat to nursing home residents; PPV is thought to be important, effective, cost-effective, and safe for use in nursing homes. The estimated PPV rate is 49%, and vaccination practices are variable. Factors associated with higher vaccination level include: knowledge of financial reimbursement, strong belief in the importance of vaccinating residents and the effectiveness of the vaccine, practices related to policies, assessment, consent and orders, and organizational factors of size, ownership, average length of stay, and identification of a staff "vaccine advocate." CONCLUSION: Staff members are knowledgeable about the vaccine and believe it should be used in nursing homes. Efforts aimed at improving vaccination rates should concentrate on examples of effective vaccination programs and practices rather than basic information about the vaccine. Development of institutional policies, which guide vaccination practice and institutionalize the use of automated patient management systems that prompt staff to assess vaccination status and order vaccination, could have considerable impact in meeting the recommendation for vaccination of nursing home residents.

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