Factors associated with Immunization Information System (IIS) participation among Rural Practitioners, Oregon, 2005-06: Successes with VFC, Challenges and More Opportunities
James A. Gaudino, Oregon Immunization Program, State of Oregon Department of Human Services, 800 NE Oregon Street, Suite 370, Portland, OR, USA, Lyle J. Fagnan, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L222, Portland, OR, USA, Andrew Sussman, Department of Family and Community Medicine, University of New Mexico, 1 University of New Mexico, MSC09 5040, Albuquerque, NM, USA, Scott Shipman, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, HB 7251, 35 Centerra Parkway, Lebanon, NH, USA, Jennifer Holub, Clinical Outcomes Research Initiative, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA, and Jo Mahler, Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L222, Portland, OR, USA.
Learning Objectives for this Presentation: By the end of the presentation participants will be able to -Describe rural clinician IIS use. -Discuss factors associated with ALERT participation. -Identify opportunities to increase use.
Background: Little is known about the challenges and successes of rural Western clinicians using IIS.
Objectives: To assess rural Oregon clinicians' ALERT IIS participation and to identify factors associated with non-use.
Methods: From 2005-2007, state and research network collaborators surveyed 1158 rural clinicians providing care for <3 year olds by mail and telephone. Then, we conducted mixed-method assessments with 11 family medicine (FM) practices and county health departments (CHDs). We controlled for ten factors with adjusted odds ratios (ORs).
Results: The unadjusted response rate was 58%, with 382 ineligibles and 289 with unknown eligibility. Of 335 clinicians providing immunizations, significantly more practicing pediatrics (Peds) than FM or general practice (FM/GP) submitted data (91.8 vs. 66.0%) and accessed ALERT (93.4 vs. 58.7%). Compared to clinicians in larger VFC participating practices with < 25% private insurance patients (PIPs), clinicians significantly not likely to submit were not VFC participants [OR= 82.8; 95% confidence interval (CI) 18.1 377.9]; not aware about VFC participation [OR=4.7; 95% CI 0.9 24.5]; were in solo practice [OR=8.6; 95% CI 2.0 37.5] or in 2-4 clinician practices [OR= 2.8; 95% CI 0.8 9.6]; had >50% PIPs [OR= 9.0; 95% CI 1.2 67.9]; or 26-50% PIPs [OR= 8.9; 95% CI 1.6 49.7]. Clinicians not accessing ALERT were not VFC participants [OR=17.7; 95% CI 5.1 61.5]; not aware about VFC participation [OR=3.4; 95% CI 1.3 9.4]; were FM/GPs [OR=8.1; 95% CI 2.1 31.5]; and not those with CHDs vaccinating in their communities [OR= 0.2; 95% CI 0.1 0.5]. Clinicians in the 11 practices recognized ALERT's potential to improve coordination with CHDs, but did not fully understand its potential uses.
Conclusions: Findings support bundling ALERT with VFC without requiring participation. Smaller clinics need alternatives addressing capacity. Recruiting private insurance plans to promote ALERT may provide needed incentives.