In-Office Influenza Vaccination by US Pediatric Providers Varies Greatly and Is Higher Among Smaller Offices

Toback, Seth; Rothstein, Edward; Bhatt, Praful; Carr, William; Ambrose, Christopher S.

doi:10.1177/0009922812443731

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…The effect of age on vaccination rates seems to be consistent across studies including the present study, with younger children more likely to be vaccinated than older children [3, 25, 28]. Medicaid-insured children have been reported as more likely to be vaccinated than privately insured or uninsured children at community health centers [29], but were less likely to be vaccinated in the present study, which included some community health centers and may be due to later delivery of VFC vaccines to Control sites.…”

Section: Discussionsupporting

confidence: 69%

“…We speculate that practices with a high pre-intervention rate viewed themselves as already doing all that was feasible to vaccinate against influenza. Few studies have reported overall vaccination rates above 50%, with one observational study [25] reporting a maximum of 60% among 118 pediatric and family practices across the country. Thus, it may be difficult to achieve the 70% national goal by relying solely on primary care practices to vaccinate.…”

Section: Discussionmentioning

confidence: 99%

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Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Zimmerman¹,

Nowalk²,

Lin³

et al. 2014

Vaccine

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Purpose To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial. Methods Twenty primary care practices treating children (range for n=536-8,183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months-18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010-2011 and 2011-2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes. Results Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P<0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1,390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms - 8/10 Intervention (P<0.001) and 7/10 Control sites (P-values 0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23-1.34), having commercial insurance (OR=1.30; 95%CI=1.25-1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16-1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01-1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates. Conclusions Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Zimmerman¹,

Nowalk²,

Lin³

et al. 2014

Vaccine

View full text Add to dashboard Cite

show abstract

“…Little research has been performed on factors associated with 2-dose influenza vaccination compliance. In an earlier analysis of the 2010–2011 results from the current study, Toback et al [ 17 ] found that 2-dose compliance was higher in smaller offices and in offices with video reminder messages in waiting rooms. Other research among 6–23-month-old children found only visits between October and January related to increased levels of compliance [ 11 ].…”

Section: Discussionmentioning

confidence: 59%

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

Lin

Nowalk

Toback³

et al. 2013

BMC Pediatr

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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.

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“…One 30 found that paediatricians vaccinated children with intermittent asthma four times more often and children with severe asthma fourteen times more often than family doctors did. The other 31 study identified no differences between anti‐flu vaccination rates of healthy and high‐risk children when treated by family doctors or paediatricians.…”

Section: Discussionmentioning

confidence: 87%

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review

et al. 2020

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Aim The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. Methods MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. Results Fifty‐four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. Conclusion According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

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In-Office Influenza Vaccination by US Pediatric Providers Varies Greatly and Is Higher Among Smaller Offices

Cited by 9 publications

References 21 publications

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

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

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review

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