Evaluation of a Legislatively-Mandated Influenza Vaccination Program for Adults in Rhode Island

Background:
A state legislation was passed in July 2006 that mandates the Rhode Island (RI) Department of Health (DOH) to include the purchase and distribution of influenza vaccine for adults in its immunization program. In response, the DOH initiated a statewide adult influenza vaccination program in 2007. The cost of the vaccine is underwritten by insurance companies and by contributions from Medicare, Medicaid, and Medicare Managed Care. Participating providers receive influenza vaccines free of charge from the DOH and bill insurers for vaccine administration costs. Adults aged ≥19 years with health insurance are eligible to receive vaccination under the program.

Objectives:
To evaluate the first year of the program.

Methods:
We surveyed all 412 participating providers. We estimated influenza vaccination rates for adults aged ≥65 years using Behavioral Risk Factor Surveillance System data for December 2007, and compared it to rates for the prior year using December 2006 data.

Results:
The provider survey response rate was 35% (144/412). A high proportion of respondents reported favorable experience with the online enrollment process (93%), receipt of information about the program administration and vaccine storage and management (97%), and receipt of the amount of vaccine ordered (97%). 80% were satisfied with the uniform vaccination start date of October 17, 2007, and 71% reported that the program paperwork was reasonable. 30% reported difficulties in receiving reimbursement. 94% expressed overall satisfaction with the program, 98% planned to enroll for the second year, and 95% would encourage other providers to enroll. The RI statewide vaccination rate among persons aged ≥65 years was 83.2% (95% CI: 75.5, 88.8), compared to 80.7% (95% CI: 70.7, 87.9) for the prior year. The corresponding vaccination rates for the entire U.S. were 70.3% and 67.5%.

Conclusions:
Respondents were highly satisfied with RI's innovative and unique program for adult influenza vaccination.