Primary Care Physicians' Attitudes about School-Based Influenza Vaccine Delivery

Background:In the effort to fully implement ACIP recommendations for influenza vaccination of all children 6 mos. to 18 yrs. old, school-based delivery has been proposed as an adjunct to practice-based delivery.

Objectives:To assess among Pediatricians (Peds) and Family Medicine (FM) physicians: 1) attitudes about school-based influenza vaccine delivery and 2) factors associated with being in favor of influenza vaccine availability at school.

Methods:Nationally representative surveys of Peds and FM physicians conducted 7/2009-10/2009.

Results:Response rates were 79% for Peds and 70% for FM (N=628). Among respondents, 91% thought that influenza vaccination at school would increase vaccination rates among their patients and 76% that it would be more convenient for their patients to be vaccinated at school. However, physicians also expressed concerns about: the belief that parents would prefer their child be vaccinated at the practice (74%); the difficulty of estimating vaccine supplies at the practice if patients received vaccine at school (80%); transfer of immunization records to the practice (78%); not thinking children with chronic health conditions should be vaccinated at school (50%); and losing income if large numbers of children were vaccinated at school (40%).  Factors associated with being strongly in favor of having influenza vaccine available in schools included practicing in an HMO or public setting as compared to private setting [RR1.59, 95% CI (1.37-1.85)], seeing 10% of patients with Medicaid or SCHIP insurance [RR1.22, 95% CI (1.02-1.46)] and providing influenza without appointments in the practice [RR1.22, 95% CI (1.03-1.45)].

Conclusions:The vast majority of physicians reported being in favor of having influenza vaccine available to their patients at school. Concerns raised by physicians underscore the need for thoughtful planning in order to effectively target subgroups for school vaccination and to avoid problems such as record scatter and lost income for providers who overestimate their vaccine supply needs.