Posted by James
We interviewed a convenience sample of 22 men and women, mean age 62 years (range 46-80 years), who self-identified as white (n=3), Latino (n=9), and African-American (n=10). Sociodemographic and other health-related characteristics are depicted. The Latino participants were all foreign-born and came from Mexico, Central America, and Puerto Rico. In general, most of the participants were women (77%) and had health insurance. Each focus group had an average of 5.5 participants (range 3-10).
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Posted by James
We used a qualitative study design to better understand racial and ethnic differences in knowledge, attitudes, and perceptions regarding adult vaccinations and to assess the practicality of delivering adult vaccinations in community churches. Content analysis was performed to analyze the narrative data obtained through four focus groups completed in Catholic community churches in San Francisco between April and June 2003. The focus groups were conducted in the language of preference (English or Spanish). Participants were presented with a basic definition of the three primary adult vaccinations (e.g., flu, pneumonia, and tetanus) at the beginning of the focus group. Then, several open-ended questions were posed, such as, “Please tell us in your own words what you have heard about adult immunizations,” “Have you heard of the flu or tetanus vaccine?,” or “What do you know about the pneumonia vaccine?” Each focus group was professionally taped, transcribed verbatim, translated (Spanish to English), and submitted for thematic analysis by four of the investigators. Phrases and sentences were the unit of analysis.
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Posted by James
INTRODUCTION
Vaccinations have dramatically improved the health of Americans, but many, including racial and ethnic minorities, still do not have adequate immunization. Compelling evidence supports annual influenza vaccination in patients age >50 years and one pneumococcal vaccination in all persons age >65 years. It is poorly understood why racial and ethnic minorities are less likely to utilize adult immunizations. Some data suggest that educational, logistical, and psychological factors may affect a patient’s utilization of preventive medicine, particularly adult vaccinations. Even among those with access to healthcare, and among recipients of Medicare and Medicaid health insurance programs—which pay for influenza and pneumococcal vaccines—rates of adult vaccinations remain lower among minorities than among their white counterparts.
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Posted by James
This evaluation of Project DIRECT showed that at the end of the four-year study period, 40% of enrolled providers still participated in the program.
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Posted by James
Provider Retention
Forty-seven healthcare providers practicing alone or in a group in 15 institutions were recruited to participate in the CQIP program (Table 1). All but two providers were physicians. These providers were a physician assistant affiliated with a practice that dropped out at the end of the first year and a nurse practitioner with a practice that stayed three years in the program. No new practice entered the project after it started. However, following expansion of one practice in 1999-2000, four new physicians were enrolled. The biggest drop-out occurred at the end of the first intervention year because of disbandment of three practices with 14 providers that were owned by the same group (the medical director for these practices left and the providers discontinued their participation) and withdrawal of one provider. Thereafter, the drop-out rate remained constant (12-14%), with about 40% of providers still participating at the end of the fourth year. On a year-to-year basis, however, the project objective of retaining 70% of providers was met (83%, 88%, and 82% the last three study years, respectively). It is of interest to note that single practitioners were more likely to stay in the program. The reasons for withdrawing varied. Only one single-practitioner practice truly declined CQIP participation; others left for migration out of Raleigh (n=2 practices with six providers), retirement (two providers in a practice that remained in the program), and practice disbandment or reorganization (n=6 practices with 21 providers).
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Posted by James
Process Outcome
Retention plan. The plan was evaluated by the annual number of contacts with primary care providers recorded on DC practice records. These contacts were defined as a continuous variable and used to assess the objective’s implementation by the DIRECT staff. Overall attendance at education events was monitored, but attendance of specific CQIP providers was not transcribed.
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Posted by James
The CQIP used a one-group pre- and post-test design. The target population included African-American residents of southeast Raleigh, the historical center of Raleigh’s African-American community. The DC component was initiated in August 1996; the ongoing intervention is at its institutionalization phase. The North Carolina State University, Wake Forest University, and CDC Institutional Review Boards approved Project DIRECT protocols during the study.
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