Improving Influenza Vaccination Rates of High-Risk Inner-City Children Over 2 Intervention Years

Abstract

PURPOSE Infl uenza immunization rates among children with high-risk medical conditions are disappointingly low, and relatively few data are available on raising rates, particularly over 2 years. We wanted to determine whether interventions tailored to individual practice sites improve infl uenza immunization rates among high-risk children in inner-city health centers over 2 years.METHOD A before-after trial to improve infl uenza immunization of children was conducted at 5 inner-city health centers (residencies and faith-based). Sites selected interventions from a menu (eg, standing orders, patient and clinician reminders, education) proved to increase vaccination rates, which were directed at children aged 2 to 17 years with high-risk medical conditions. Intervention infl uenza vaccination rates and 1 and 2 years were compared with those of the preintervention year (2001)(2002) and of a comparison site.RESULTS Infl uenza vaccination rates improved modestly from baseline (10.4%) to 13.1% during intervention year 1 and to 18.7% during intervention year 2 (P <.001), with rates reaching 31% in faith-based practices. Rates increased in all racial and age-groups and in Medicaid-insured children. The increase in rates was signifi cantly greater in intervention health centers (8.3%) than in the comparison health center (0.7%; P <.001). In regression analyses that controlled for demographic factors, vaccination status was associated with intervention year 1 (odds ratio [OR], 1.9; 95% confi dence interval [CI], 1.6-2.2) and with intervention year 2 (OR, 2.8; 95% CI, 2.3-3.4), as well as with practice type. Adolescents had lower vaccination rates than children 2 to 6 years old (OR, 0.6; 95% CI, 0.5-0.7).CONCLUSIONS Tailored interventions selected from a menu of interventions modestly increased infl uenza vaccination rates over 2 years at health centers serving children from low-income families. We recommend this strategy for faith-based practices and residencies with 1 practice site, but further research is needed on multisite practices and to achieve higher infl uenza vaccination rates.

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

“…This strategy may be more effective if it was coupled with other strategies, such as year-round scheduling of influenza vaccination visits for the fall. 30 One practice strategy, standing orders, is recommended by experts [31][32][33] and has been associated with increased vaccine coverage in adult studies; [34][35][36][37] however, in our study, it was not associated with increased numbers of complete vaccinations. This paradoxical result likely reflects the inconsistent interpretation of the definition of standing orders, 38 the ineffective coupling with other strategies, and/or inability of standing orders to overcome the uncertainty about how many doses each child needed to be completely vaccinated.…”

“…Since this study was performed in urban and suburban settings, the generalizability of the results to rural counties is unknown. Race is frequently an important variable in vaccination status, 18,36,43 however there is a paucity of data about racial/ethnic differences in influenza vaccination status among children. As in many practice-based studies, race was not obtainable from most charts and thus was not included in this study.…”

Interventions to increase influenza vaccination rates in children with high-risk conditions—A systematic review

“…The studies examined various types of interventions, including multi-component strategies [11][12][13], letter reminders [14][15][16][17][18], telephone recall [19,20], and a combination of letters and telephone calls [21]. One author [22,23] used an Electronic Health Record (EHR) plus letter reminder and/or phone calls and an Asthma Education Tool (AET) in two separate studies.…”

A Prospective Observational Study of US In-office Pediatric Influenza Vaccination During the 2007 to 2009 Influenza Seasons: Use and Factors Associated With Increased Vaccination Rates

“…Strategies proposed to increase vaccine uptake include standing orders, reminder/recall systems, after-hours and weekend vaccination clinics, offering influenza vaccination to parents, and parent/patient letters, posters, flyers, phone calls, text messages 7 and Emails. 2,[8][9][10] Increased knowledge of the various tactics actually used by pediatric offices to deliver the influenza vaccine to children may help inform national recommendations by organizations such as the US Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics. The objectives of this study were to prospectively document pediatric influenza vaccine use in pediatricians' offices over 2 influenza seasons and to examine how office characteristics and vaccination-related activities relate to increased vaccine delivery.…”