Factors Associated with Increased In-Office Influenza Vaccine Coverage and Two-Dose Compliance Among US Pediatricians

Background: Effective delivery of influenza vaccines is critical in order to maximize vaccination rates.

Objectives: To evaluate characteristics that correlate with vaccination coverage and 2-dose compliance in pediatric offices.

Methods:  A prospective observational study was conducted during the 2008–2009 and 2009–2010 influenza seasons in 130 unique offices in the United States.  Staff recorded seasonal influenza vaccinations (excluding H1N1) and activities to increase vaccine uptake. Coverage was calculated by dividing the number of children vaccinated by the total number of children under the office’s care; 2-dose compliance was the rate of receipt of a second dose in children identified as needing two vaccinations. First, Kolmogorov-Smirnov tests were used to examine the distribution of each outcome variable.  Next, individual associations between the outcome variables and each covariate were examined. Then, linear regression analyses were performed using office characteristics and those variables with p values ≤0.10. 

Results: The mean coverage was 25.5% (range: 2.1–79.0%); mean compliance was 54.6% (range: 5.4–100%). Vaccination coverage increased with increased ratio of staff per 1000 patients (p<0.01), duration of vaccine availability (p=0.041), and offering weekend hours for vaccination (p<0.01).  Larger offices (p<0.01) and those located in rural areas (p=0.035) had lower vaccine coverage.  Two-dose compliance increased with the offering of weekend vaccination hours and email reminders with borderline significance (p<0.10). Offices with a higher percentage of Medicaid patients had lower compliance rates (p<0.10).

Conclusions:  To maximize vaccine coverage, offices should offer vaccine during weekend hours and extend the duration of vaccine availability. Offices may also be able to achieve higher influenza vaccination coverage with a higher staff to patient ratio.  Patient reminder systems should be employed to help maximize 2-dose compliance. Additional efforts may be required in large offices, rural offices, and those with more Medicaid patients. Sponsored by MedImmune.