Mandy A Allison

Children's Hospital Colorado, Aurora, Colorado, United States

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Publications (18)60.56 Total impact

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    ABSTRACT: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available. A national survey among private pediatricians and family physicians April to September 2011. Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children's Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty. Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.
    PEDIATRICS 02/2014; · 4.47 Impact Factor
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    ABSTRACT: Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low. To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators. Mail and Internet-based survey. Survey conducted from March to June 2012. General internists and family physicians throughout the United States. A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics. Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments. Surveyed physicians may not be representative of all physicians. Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D. Centers for Disease Control and Prevention.
    Annals of internal medicine 02/2014; 160(3). · 13.98 Impact Factor
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    ABSTRACT: OBJECTIVES: To ascertain, through two separate surveys among nationally representative networks of pediatricians (Peds) and family physicians (FM): 1) physicians' reported level of confidence in pre- and post-licensure vaccine safety studies; and 2) changes in reported level of confidence from 2007 to 2010/11. METHODS: Two surveys conducted August to October 2007 and November 2010 to January 2011. The survey response rates were 81% (FM, 79%, Peds, 84%, p=0.07) for the 2007 survey (691/848) and 66% (FM, 61%, Peds, 70%, p=0.003) for the 2010/11 survey (532/811). RESULTS: One in three family physicians compared to one in ten pediatricians in both surveys reported little or no confidence in pre-licensure vaccine safety studies (p<0.001). Compared to pre-licensure studies, higher percentages of both specialties reported a great deal of confidence in post-licensure vaccine safety studies in both years, and more physicians from both specialties reported a great deal of confidence in 2010/11 than in 2007. CONCLUSION: While most family physicians and pediatricians report confidence in post-licensure vaccine safety studies, one third of family physicians report little or no confidence in pre-licensure studies. More research is needed to better understand the reasons behind some physicians' lack of confidence in vaccine safety studies.
    Preventive Medicine 01/2013; · 3.50 Impact Factor
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    ABSTRACT: Pentavalent rotavirus vaccine (RV5) was recommended for routine use in 2006 followed by monovalent rotavirus vaccine (RV1) in 2008. To describe, among a U.S. sample of pediatricians (n=289 respondents) and family medicine physicians (n=243 respondents), (1) current practices regarding rotavirus vaccine (RV) and barriers to use with comparison to a 2007 survey and (2) knowledge of recent safety concerns regarding RV1 and their impact on its use. A mail and Internet survey was conducted with the physicians, from November 2010 to January 2011; analyses were conducted March-September 2011. Response rates were 70% (289/410) for pediatricians and 61% (243/401) for family medicine physicians; routine administration of RV was reported by 95% of pediatricians and 65% of family medicine physicians (2007: 85% and 45%). Almost all barriers to use of RV had decreased compared to 2007. For pediatricians and family medicine physicians, respectively, 94% and 70% were aware of the temporary suspension of RV1 due to presence of porcine circovirus; 49% and 45%, respectively, were aware of the addition to RV1 labeling regarding a possible increased risk of intussusception. Among physicians aware of the safety issues, <5% reported stopping giving RV as a result. After reading information about porcine circovirus, 35% of pediatricians and 59% of family medicine physicians reported it had increased their own concerns about the safety of RV; and 31% and 60%, respectively, reported this regarding intussusception. The acceptance of RV has increased, and barriers to use have decreased. Among physicians, recent safety questions about RV1 have not affected use of RV, although they have raised safety concerns.
    American journal of preventive medicine 01/2013; 44(1):56-62. · 4.24 Impact Factor
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    ABSTRACT: Determine among a representative sample of pediatricians (Peds), family medicine (FM), and general internal medicine (GIM) physicians in the 2009-2010 influenza season physicians': 1) practices and experiences with delivery of seasonal and pH1N1 influenza vaccines; and 2) anticipated and experienced barriers. Two US national surveys administered 7/2009-10/2009 (before pH1N1 distribution) and 3/2010-6/2010 (after pH1N1 distribution) to 416 Peds, 424 FM and 432 GIM. Of respondents who received both surveys, 62% (776/1253) completed both. Overall, 98% reported administering seasonal influenza vaccine and 86% pH1N1, with 70% reporting that working with public health in delivery of pH1N1 was a positive experience. Due to limited supplies of pH1N1, 63% of providers reported prioritizing who received vaccine even within high risk groups. Pre-distribution, 71% perceived that patient/parental safety concerns about pH1N1 would be a barrier, and post-distribution 72% perceived it had been a barrier. Physician concern about safety decreased, with 44% reporting safety a barrier pre-distribution and 12% post-distribution (p<0.001). In the setting of a pandemic most primary care physicians collaborated with public health in delivery of pH1N1. Physicians faced challenges with patient/parent safety concerns about pH1N1 and supply issues with pH1N1 that required physicians to prioritize who received vaccine.
    Preventive Medicine 04/2012; 55(1):68-71. · 3.50 Impact Factor
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    ABSTRACT: The meningococcal conjugate vaccine (MCV4) was recommended for those aged 11-18 years in 2005. Initial supply issues led to an emphasis on immunizing older adolescents. When supply improved in 2007, routine immunization was recommended for those aged 11-12 years. Among a U.S. sample of pediatricians and family medicine physicians, describe (1) recommendation and administration practices for MCV4; (2) preferences regarding MCV4 administration; and (3) attitudes and characteristics associated with recommendation for those aged >12 years. A mail and Internet survey in a nationally representative sample of physicians was conducted between December 2009 and March 2010. Analysis was conducted between March 2010 and October 2010, including a multivariable analysis to examine factors associated with deferring MCV4 to ages >12 years. Response rates were 88% (pediatricians 367/419) and 63% (family medicine physicians 268/423). In all, 95% of pediatricians and 73% of family medicine physicians reported administering MCV4 routinely to those aged 11-18 years (p<0.0001); 83% (pediatricians) and 45% (family medicine physicians) reported strongly recommending MCV4 for those aged 11-12 years (p<0.0001); 27% (pediatricians) and 40% (family medicine physicians) preferred to administer MCV4 to those aged >12 years (p<0.0001). Compared with those who strongly recommend for those aged 11-12 years, physicians who do not regularly stock MCV4, family medicine physicians, and physicians concerned about waning immunity were more likely to defer their recommendation, whereas physicians practicing in the Northeast and those with more Latino patients were less likely to defer. Most pediatricians and family medicine physicians administer MCV4, but many, especially family medicine physicians and those concerned about waning immunity, defer their recommendation for MCV4 to patients aged >12 years.
    American journal of preventive medicine 12/2011; 41(6):581-7. · 4.24 Impact Factor
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    ABSTRACT: Less than half of adults for whom seasonal influenza vaccine is recommended receive the vaccine. Little is known about physician willingness to collaborate with community vaccinators to improve delivery of vaccine. To assess among general internists and family medicine physicians: (1) seasonal influenza vaccination practices, (2) willingness to collaborate with community vaccinators, (3) barriers to collaboration, and (4) characteristics associated with unwillingness to refer patients to community sites for vaccination. Mail and Internet-based survey. National survey conducted during July-October 2009. General internists and family medicine physicians. Survey responses on vaccination practices, willingness to collaborate to deliver vaccine and barriers to collaboration. Response rates were 78% (337/432 general internists) and 70% (298/424 family medicine physicians). Ninety-eight percent of physicians reported giving influenza vaccine in their practice during the 2008-2009 season. Most physicians reported willingness to refer certain patients to other community vaccinators such as public clinics or pharmacies (79%); to collaborate with public health entities in holding community vaccination clinics (76%); and set up vaccination clinics with other practices (69%). The most frequently reported barriers to collaboration included concerns about record transfer (24%) and the time and effort collaboration would take (21%). Reporting loss of income (RR 1.40, 95% CI 1.03-1.89) and losing opportunities to provide important medical services to patients with chronic medical conditions (RR 1.77, 95% CI 1.25-2.78) were associated with unwillingness to refer patients outside of the practice for vaccination. Surveyed physicians may not be representative of all physicians. The majority of physicians report willingness to collaborate with other community vaccinators to increase influenza vaccination rates although some will need assurance that collaboration will be financially feasible and will not compromise care. Successful collaboration will require reliable record transfer and must not be time consuming.
    Vaccine 09/2011; 29(47):8649-55. · 3.77 Impact Factor
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    ABSTRACT: Identifying respiratory pathogens within populations is difficult because invasive sample collection, such as with nasopharyngeal aspirate (NPA), is generally required. PCR technology could allow for non-invasive sampling methods. Evaluate the utility of non-invasive sample collection using anterior nare swabs and facial tissues for respiratory virus detection by multiplex PCR. Children aged 1 month-17 years evaluated in a pediatric emergency department for respiratory symptoms had a swab, facial tissue, and NPA sample collected. All samples were tested for respiratory viruses by multiplex PCR. Viral detection rates were calculated for each collection method. Sensitivity and specificity of swabs and facial tissues were calculated using NPA as the gold standard. 285 samples from 95 children were evaluated (92 swab-NPA pairs, 91 facial tissue-NPA pairs). 91% of NPA, 82% of swab, and 77% of tissue samples were positive for ≥1 virus. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) were most common. Overall, swabs were positive for 74% of virus infections, and facial tissues were positive for 58%. Sensitivity ranged from 17 to 94% for swabs and 33 to 84% for tissues. Sensitivity was highest for RSV (94% swabs and 84% tissues). Specificity was ≥95% for all viruses except HRV for both collection methods. Sensitivity of anterior nare swabs and facial tissues in the detection of respiratory viruses by multiplex PCR varied by virus type. Given its simplicity and specificity, non-invasive sampling for PCR testing may be useful for conducting epidemiologic or surveillance studies in settings where invasive testing is impractical or not feasible.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2011; 52(3):210-4. · 3.12 Impact Factor
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    ABSTRACT: The feasibility of non-pharmacologic interventions to prevent influenza's spread in schools is not well known. To determine the acceptability of, adherence with, and barriers to the use of hand gel and facemasks in elementary schools. Intervention: We provided hand gel and facemasks to 20 teachers and their students over 4 weeks. Gel use was promoted for the first 2 weeks; mask use was promoted for the second 2 weeks. Outcomes: Acceptability, adherence, and barriers were measured by teachers' responses on weekly surveys. Mask use was also measured by observation. The weekly survey response rate ranged from 70% to 100%. Averaged over 2 weeks, 89% of teachers thought gel use was not disruptive (week 1--17/20, week 2--16/17), 95% would use gel next winter (week 1--19/20, week 2--16/17), and 97% would use gel in a pandemic (week 1--20/20, week 2--16/17). Averaged over 2 weeks, 39% thought mask use was not disruptive (week 1--6/17, week 2--6/14), 35% would use masks next winter (week 1--5/17, week 2--6/14), and 97% would use masks in a pandemic (week 1--16/17, week 2--14/14). About 70% estimated that their students used hand gel ≥ 4 x/day for both weeks (week 1--14/20, week 2--13/17). Students' mask use declined over time with 59% of teachers (10/17) estimating regular mask use during week 1 and 29% (4/14) during week 2. By observation, 30% of students wore masks in week 1, while 15% wore masks in week 2. Few barriers to gel use were identified; barriers to mask use were difficulty reading facial expressions and physical discomfort. Hand gel use is a feasible strategy in elementary schools. Acceptability and adherence with facemasks was low, but some students and teachers did use facemasks for 2 weeks, and most teachers would use masks in their classroom in a pandemic.
    Influenza and Other Respiratory Viruses 07/2010; 4(4):223-9. · 1.47 Impact Factor
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    ABSTRACT: Identify parental beliefs and barriers related to influenza immunization of school-aged children and acceptance of school-based influenza immunization. We conducted a cross-sectional survey of parents of elementary school-aged children in November 2008. Outcomes were receipt of influenza vaccine, acceptance of school-based immunization, and barriers to immunization. Response rate was 65% (259/397). Parents reported that 26% of children had received the vaccine and 24% intended receipt. A total of 50% did not plan to immunize. Factors associated with receipt were belief that immunization is a social norm (adjusted odds ratios [AOR], 10.8; 95% CI, 2.8-41.8), belief in benefit (AOR, 7.8; CI, 1.8-33.8), discussion with a doctor (AOR, 7.0; CI, 2.9-16.8), and belief that vaccine is safe (AOR, 4.0; CI, 1.0-15.8). A total of 75% of parents would immunize their children at school if the vaccine were free, including 59% (76/129) who did not plan to immunize. Factors associated with acceptance of school-based immunization were belief in benefit (AOR, 6.1; 95% CI, 2.7-14.0), endorsement of medical setting barriers (AOR, 3.7; 95% CI, 1.3-10.3), and beliefs that immunization is a social norm (AOR, 3.3; 95% CI, 1.4-7.6) and that the child is susceptible to influenza (AOR, 2.6; 95% CI, 1.2-5.7). Medical setting barriers were competing time demands, inconvenience, and cost; school barriers were parents' desire to be with children and competence of person delivering the vaccine. School-based immunization programs can increase immunization coverage by targeting parents for whom time demands and inconvenience are barriers, demonstrating that immunization is a social norm, and addressing concerns about influenza vaccine benefit and safety.
    The Pediatric Infectious Disease Journal 03/2010; 29(8):751-5. · 3.57 Impact Factor
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    ABSTRACT: We assessed urgent care providers' knowledge about public health reporting, guidelines, and actions for the prevention and control of pertussis; attitudes about public health reporting and population-based data; and perception of reporting practices in their clinic. We identified the 106 providers (95% are physicians) employed in 28 urgent care clinics owned by Intermountain Healthcare located throughout Utah and Southern Idaho. We performed a descriptive, cross-sectional survey and assessed providers' knowledge, attitudes, beliefs, and behaviors associated with population-based data and public health mandates and recommendations. The online survey was completed between November 1, 2007, and February 29, 2008. Among 63 practicing urgent care providers (60% response rate), 19 percent knew that clinically diagnosed pertussis was reportable, and only half (52%) the providers correctly responded about current pertussis vaccination recommendations. Most (35%-78%) providers did not know the prevention and control measures performed by public health practitioners after reporting occurs, including contact tracing, testing, treatment, and prophylaxis. Half (48%) the providers did not know that health department personnel can prescribe antibiotics for contacts of a reported case, and only 22 percent knew that health department personnel may perform diagnostic testing on contacts. Attitudes about reporting are variable, and reporting responsibility is diffused. To improve our ability to meet public health goals, systems need to be designed that engage urgent care providers in the public health process, improve their knowledge and attitude about reporting, and facilitate the flow of information between urgent care and public health settings.
    Journal of public health management and practice: JPHMP 10/2009; 15(6):471-8. · 0.96 Impact Factor
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    ABSTRACT: To assess whether pediatric practices with a system to identify and recall children with high-risk conditions (HRCs) could maintain high influenza vaccination coverage levels among these children during a vaccine shortage year. Observational study using data from a computerized billing database and an electronic immunization information system. Four Denver pediatric practices during the 2003-2004 and 2004-2005 influenza seasons. Children aged 24 to 72 months with and without HRCs. Main Exposure The vaccine shortage of the 2004-2005 influenza season. Proportion of children with and without HRCs who were immunized and the timing of influenza immunization in nonshortage (2003-2004) and shortage (2004-2005) seasons. In the 2003-2004 season, 770 of 1166 children with HRCs (66.0%) were immunized and, in the 2004-2005 season, 656 of 1053 (62.3%) were immunized. Although vaccination coverage did not significantly decrease for children with HRCs during the 2004-2005 season (P = .07), coverage for healthy children decreased from 43.8% (4435/10 117) to 29.5% (3066/10 387) (P < .001). After the priority group recommendation in October 2004, the practices provided few vaccines to healthy children, whereas children with HRCs continued to receive the vaccine. Pediatric practices with a system to identify and recall children with HRCs can target these children for receipt of the influenza vaccine and maintain high vaccination coverage, despite a vaccine shortage that may result in decreased vaccine coverage in healthy children.
    JAMA Pediatrics 05/2009; 163(5):426-31. · 4.28 Impact Factor
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    ABSTRACT: Front line health care providers (HCPs) play a central role in endemic (pertussis), epidemic (influenza) and pandemic (avian influenza) infectious disease outbreaks. Effective preparedness for this role requires access to and awareness of population-based data (PBD). We investigated the degree to which this is currently achieved among HCPs in Utah by surveying a sample about access, awareness and attitudes concerning PBD in clinical practice. We found variability in the number and nature (national vs. local, pushed vs. pulled) of PBD sources accessed by HCPs, with a subset using multiple sources and using them frequently. We found that HCPs believe PBD improves their clinical performance and that they cannot rely on their own practice to remain informed. These findings suggest that an integrated system, which interprets PBD from multiple sources and optimizes the delivery of PBD may facilitate preparedness of HCPs through the application of PBD in routine clinical practice.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2008;
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    ABSTRACT: We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients. In this retrospective cohort study we used Denver Health electronic medical chart data, the Denver Health immunization registry, and Denver Public Schools enrollment data for the period from August 1, 2002, to July 31, 2003. The cohort included all 14- to 17-year-old Denver Public Schools high school enrollees who were active Denver Health patients and were either uninsured or insured by Medicaid or the State Children's Health Insurance Program. "School-based health center users" were those who had used a Denver Health school-based health center; "other users" were those who had used a Denver Health community clinic but not a school-based health center. Markers of quality included having a health maintenance visit and receipt of an influenza vaccine, tetanus booster, and hepatitis B vaccine if indicated. Multiple logistic regression analysis that controlled for gender, race/ethnicity, insurance status, chronic illness, and visit rate was used to compare school-based health center users to other users. Although school-based health center users (n = 790) were less likely than other users (n = 925) to be insured (37% vs 73%), they were more likely to have made > or = 3 primary care visits (52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%). These findings suggest that, within a safety-net system, school-based health centers augment access to care and quality of care for underserved adolescents compared with traditional outpatient care sites.
    PEDIATRICS 10/2007; 120(4):e887-94. · 4.47 Impact Factor
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    ABSTRACT: To assess the clinical effectiveness of influenza vaccine in preventing influenza-like illness (ILI) office visits. We analyzed billing and immunization registry data for healthy 6- to 21-month-olds from 5 Denver, Colorado pediatric practices (n = 5193). ILI and pneumonia/influenza (a subset of ILI) were defined from International Classification of Diseases, Ninth Revision, Clinical Modification codes for office visits occurring during peak influenza season. Partially vaccinated (PV) and fully vaccinated (FV) patients were defined as having 1 shot and 2 shots, respectively, more than 14 days before the first ILI visit. The likelihood of an ILI visit was determined using a Cox proportional hazards model accounting for patient characteristics, practice site, and immunization status. A total of 28% of the patients had an ILI office visit, and 5% had a pneumonia/influenza visit. Hazard ratios (HRs) for FV versus UV were 0.31 (95% confidence interval [CI] = 0.3 to 0.4) for ILI and 0.13 (95% CI = 0.1 to 0.2) for pneumonia/influenza, corresponding to a vaccine effectiveness (1 - HR x 100) of 69% for ILI and 87% for pneumonia/influenza. The corresponding HRs for PV versus UV were 1.0 (95% CI = 0.9 to 1.2) and 1.1 (95% CI = 0.8 to 1.5). Although 2 doses of vaccine were 69% effective against ILI office visits and 87% effective against pneumonia/influenza office visits, 1 dose did not prevent office visits during the 2003-2004 influenza season.
    Journal of Pediatrics 01/2007; 149(6):755-762. · 4.04 Impact Factor
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    ABSTRACT: In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds. Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings.
    Academic pediatrics 13(5):466-74.
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    ABSTRACT: During public health emergencies, office-based frontline clinicians are critical partners in the detection, treatment, and control of disease. Communication between public health authorities and frontline clinicians is critical, yet public health agencies, medical societies, and healthcare delivery organizations have all called for improvements. Describe communication processes between public health and frontline clinicians during the first wave of the 2009 novel influenza A(H1N1) pandemic; assess clinicians' use of and knowledge about public health guidance; and assess clinicians' perceptions and preferences about communication during a public health emergency. During the first wave of the pandemic, we performed a process analysis and surveyed 509 office-based primary care providers in Utah. Public health and healthcare leaders from major agencies involved in emergency response in Utah and office-based primary care providers located throughout Utah. Communication process and information flow, distribution of e-mails, proportion of clinicians who accessed key Web sites at least weekly, clinicians' knowledge about recent guidance and perception about e-mail load, primary information sources, and qualitative findings from clinician feedback. The process analysis revealed redundant activities and messaging. The 141 survey respondents (28%) received information from a variety of sources: 68% received information from state public health; almost 100% received information from health care organizations. Only one-third visited a state public health or institutional Web site frequently enough (at least weekly) to obtain updated guidance. Clinicians were knowledgeable about guidance that did not change during the first wave; however, correct knowledge was lower after guidance changed. Clinicians felt overwhelmed by e-mail volume, preferred a single institutional e-mail for clinical guidance, and suggested that new information be concise and clearly identified. : Communication between public health, health care organizations and clinicians was redundant and overwhelming and can be enhanced considering clinician preferences and institutional communication channels.
    Journal of public health management and practice: JPHMP 17(1):36-44. · 0.96 Impact Factor

Publication Stats

121 Citations
60.56 Total Impact Points


  • 2012–2013
    • Children's Hospital Colorado
      Aurora, Colorado, United States
  • 2007–2013
    • University of Colorado
      • Department of Pediatrics
      Denver, Colorado, United States
  • 2007–2011
    • University of Utah
      • • Department of Pediatrics
      • • Department of Biomedical Informatics
      Salt Lake City, UT, United States