Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting

  • Jenni Buu
  • Shantel Mullin
  • Carrie McAdam-Marx
  • Margaret Solomon
  • Brandon T. Jennings
Keywords: influenza vaccine, clinical practice guidelines


Objective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system.

Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence.

Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine.

Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation.


Type: Original Research


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Practice-Based Research