Tuesday, March 18, 2008

Late-Season Influenza Vaccination: Practice and Barriers

Lon McQuillan1, Matthew F. Daley2, Lori A. Crane3, Pascale M. Wortley4, Brenda L. Beaty5, Jennifer Barrow5, Christine Babbel5, Miriam Dickinson6, and Allison Kempe2. (1) Department of Pediatrics, University of Colorado Denver, Mailstop F443, Bldg 406, 12477 E. 19th Ave, PO Box 6508, Aurora, CO, USA, (2) Children's Outcomes Research Program, The Children's Hospital, Dept. of Pediatrics, University of Colorado Denver, (3) Preventive Medicine & Biometrics, University of Colorado Denver, (4) Health Services Research & Evaluation Branch, National Immunization Program, CDC, (5) Colorado Health Outcomes Program, University of Colorado Denver, (6) Department of Family Medicine, University of Colorado Denver

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to identify barriers to late-season influenza vaccination (LSV).

Although LSV becomes particularly important when vaccine is not received early in the season, existing national data suggest that little influenza vaccination is actually occurring after December.

To describe among primary care physicians nationally: 1) LSV practices; 2) barriers to LSV; and 3) factors associated with LSV.

Survey administered 3/2007-6/2007 to 1,269 primary care physicians participating in a national network representative of the memberships of the American Academy of Pediatrics, College of Physicians, and Academy of Family Physicians.

Response rate was 74% (n=940). When asked about vaccination practices, if supplies are inadequate/delayed, 3% stop vaccinating in November/December, 13% in January, 36% in February, and 48% in March. Seventy percent feel LSV is clinically beneficial but 90% feel LSV compromises patient care. Major identified barriers to LSV include: difficulty administering a second dose in children if the first is given late in the season (91%); providers/patients forgetting about the need for vaccination later in the season (77%); and difficulty persuading patients to accept later vaccination (65%). In multivariate analyses, the following were associated with vaccinating into Feb/Mar during a shortage/delay year: believing that LSV is clinically beneficial (OR 3.12, 95% CI 2.11-4.61); having ≥10% unused vaccine left at the end of the season (OR 1.90, 95% CI 1.18-3.06); and referring <10% of patients elsewhere for vaccination (OR 1.83, 95% CI 1.23-2.72).

Most providers report willingness to perform late-season influenza vaccination despite existing data demonstrating that little late-season vaccination currently occurs. If providers are accurately reporting willingness, other identified barriers to late-season vaccination need to be more effectively addressed. Our data also highlight the need for education about the continued benefit of vaccination late in the season.