Factors associated with Immunization Information System (IIS) participation among Rural Practitioners, Oregon, 2005-06: Successes with VFC, Challenges and More Opportunities

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.