Factors associated with in-office influenza vaccination by U.S. pediatric providers

Abstract

BackgroundIn the United States, influenza vaccination is recommended for all children 6 months and older; however, vaccination rates are below target levels. A broad sample of U.S. pediatric offices was assessed to determine factors that influence in-office influenza vaccination rates.MethodsOffices (N = 174) were recruited to participate in an observational study over three influenza seasons (2008–2009, 2009–2010, 2010–2011). Only data from the first year of an office’s participation in the study were used. Associations of coverage and 2-dose compliance rates with office characteristics and selected vaccination activities were examined using univariate regression analyses and linear regression analyses using office characteristics identified a priori and vaccination activities with P values ≤0.10 in univariate analyses.ResultsInfluenza vaccination coverage for children 6 months to 18 years of age averaged 25.2% (range: 2.0%–69.1%) and 2-dose compliance for children <9 years of age averaged 53.4% (range: 5.4%–96.2%). Factors associated with increased coverage were non-rural site (P = 0.025), smaller office size (fewer than 5000 patients; P < 0.001), use of evening and weekend hours to offer influenza vaccine (P = 0.004), a longer vaccination period (P = 0.014), and a greater influenza vaccine coverage rate among office staff (P = 0.012). Increased 2-dose compliance was associated with smaller office size (P = 0.001) and using patient reminders (P = 0.012) and negatively related to use of electronic provider reminders to vaccinate (P = 0.003).ConclusionsTo maximize influenza vaccine coverage and compliance, offices could offer the vaccine during evening and weekend hours, extend the duration of vaccine availability, encourage staff vaccination, and remind patients that influenza vaccination is due. Additional efforts may be required in large offices and those in rural locations.

Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016

“…For HCPs, the results are rather inconclusive, with one study reporting increased size as a barrier (1/117 [ 343 ]) and 2 studies reporting it as a promoter (2/117 [ 438 , 439 ]). For patients and residents, an increased size of care facility was consistently noted as a barrier (Elderly 1/62 [ 302 ]; Public 2/191 [ 440 , 441 ]).…”

Trends in compliance with two-dose influenza vaccine recommendations in children aged 6 months through 8 years, 2010–2015

“…Clinical decision support functions in IIS and other electronic health systems can also make recommendations to providers on patients’ vaccine needs. In addition, patient reminders can also be considered as they are positively associated with in-office influenza vaccination [17]. Lastly, the lags observed in the timing of dose administration among children who required two doses and received only one dose, compared with the timing of first dose administration among children who required and received two doses, might reflect a subset of the population with differing access to vaccination services, knowledge of vaccination recommendations, or motivation to receive influenza vaccination for their children, but the reasons for this delay would require further investigation beyond the scope of this analysis.…”

Provider Focused Interventions to Improve Child and Adolescent Vaccination Rates

“…Because flu vaccine is given annually, and not throughout the year, it requires specific strategies that differ from other vaccinations. Offering flu vaccination for longer in the season leads to higher immunization rates, 61 as does having weekend/evening clinics for vaccination. 62 One study showed improved rates for infants and children with asthma by making appointments for "flu clinics" year round.…”