Table 2.
Author, year | Methods | Participants; setting | Intervention/System | Barriers |
---|---|---|---|---|
Birmingham 2011
[32] |
Focus group |
21 pediatricians/nurse practitioners; New York, US |
Computerized clinical reminders (CCRs) for influenza/electronic health records (EHR) |
· Too much pop-up information makes it easy to ignore all alerts |
· Mixed confidence in reliability and accuracy of EHR alerts | ||||
· Strongly opposed to alerts that interrupted workflow or forced an action before continuing documentation in a note | ||||
· Concern that alerts will strain nursing staff | ||||
Clark 2006
[26] |
Mail survey |
756/1235 family physicians; 15 states in the US |
Patient immunization history tracking for RR interventions/state immunization registry |
· Too much cost/staff time |
· Insufficient technology assistance | ||||
Dombkowski 2007
[28] |
Mail survey |
389/600 pediatricians and family physicians; Michigan, US |
Patient immunization history tracking for RR interventions/state immunization registry |
· Accuracy of Medicaid data used to identify children with asthma and the potential restriction of the registry’s high-risk indicator to only Medicaid patients |
· Consistent access to the registry | ||||
· Overall accuracy and completeness of registry data | ||||
· Staff not accustomed to using registry to check patients’ immunization status | ||||
Deutchman 2000
[27] |
Mail survey |
158/250 family physicians with pediatric patients; rural Colorado, US |
Patient immunization history tracking for RR interventions/no specific system |
· Integration of new system into current computerized functions |
· Patient confidentiality | ||||
· Costs, staff time associated with using the system to track patients | ||||
Fung 2004
[30] |
Survey |
261/1304 clinical staff or informatics experts from 142 Veterans Health Administration (VHA) facilities; US |
CCRs including for immunizations/EHR |
· Perceived utility of CCRs, training and personnel support for computer use, EHR functionalities and performance data feedback to providers at each facility |
Humiston 2009
[33] |
Focus groups |
24 family physicians and nurses; New York, US |
Patient immunization history tracking for RR interventions/no specific system |
· Difficulties in identifying which adolescents were vaccinated, especially due to frequent moves |
· Neither EMR nor state registries are helpful given poor communication between school and primary care offices | ||||
Saville 2011
[31] |
Semi-structured interviews |
24 pediatricians, nurses and practice administrators from 11 practices; Colorado, US |
Patient immunization history tracking for RR interventions/state immunization information system |
· Difficulties overcoming the obstacle of inaccurate contact information |
· Perceptions of low compliance with recall notices for certain risk groups | ||||
· Perceived conflicts in the immunization algorithms between registry and the practice. | ||||
· Lack of dedicated time and personnel for recall activities | ||||
· Inaccuracies both with patient contact information and immunization data in system; | ||||
patient contact information was not routinely updated in system, only in EHR | ||||
· Unmet expectations for responses to recall efforts can lead to method discontinuation | ||||
· Extra time required to crosscheck recall with appointment schedules to ensure under-immunized patients have not already planned physician visit | ||||
Tierney 2003
[23] |
Semi-structured interviews and surveys |
18 clinician-administrators representing adopters and non-adopters; 912 (76%) pediatricians and public health staff completed surveys; US |
Patient immunization history tracking for RR interventions/no specific system |
· Both adopters and non-adopters of reminder or recall messages identified time and money as the most important barriers to implementing these methods. |
· Not having a simple way of identifying children at a specific age, review records or begin an initiative | ||||
· Lack of knowledge about how to get started and limited computer skills were named as barriers by only 10% to 18% of respondents in any subgroup | ||||
Wallace 2004
[34] |
Semi-structured interviews, questionnaires, group discussions |
Clinicians at 23 Spinal Cord Injury (SCI) centers in the VHA; US |
CCRs for influenza/EHR |
· Lack of coordination between EHR and vaccination data so cannot be sure patient has not been vaccinated elsewhere unless extra work is done |
· Different forms (and locations) for inpatients and outpatients is frustrating for clinicians | ||||
· Lack of training can result in inadequate information that is not useful | ||||
· Lack of access for all immunization staff | ||||
Yarnall 1998 [29] | Survey | Physicians caring for a sample of 1314 study patients in a large community health centre*; North Carolina, US | CCRs including those for immunizations/computerized health maintenance system | · Lack of time |
· Additional workload as staff still need to use and complete paper maintenance forms |
This table summarizes key details of the 10 articles included in the systematic review.
*Number of physicians not reported.