Costs of School-Located Influenza Vaccination Clinics in Maine During the 2009-2010 H1N1 Pandemic
ABSTRACT This study retrospectively estimated costs for a convenience sample of school-located vaccination (SLV) clinics conducted in Maine during the 2009-2010 influenza season. Surveys were developed to capture the cost of labor including unpaid volunteers as well as supplies and materials used in SLV clinics. Six nurses from different school districts completed a clinic day survey on staff time; four of the six also provided data for materials and supplies. For all clinics, average per-dose labor cost was estimated at $5.95. Average per-dose material cost, excluding vaccine, was $5.76. From the four complete clinic survey responses, total per-dose cost was estimated to be an average of $13.51 (range = $4.91-$32.39). Use of donated materials and uncompensated volunteer staff could substantially reduce per-dose cost. Average per-dose cost could also be lowered by increasing the number of doses administered in a clinic.
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ABSTRACT: School-located vaccination (SLV) has a long history in the United States and has successfully contributed to lower morbidity and mortality due to vaccine-preventable diseases.(1) Historically, SLV efforts, which tended to be single-vaccine programs intended to provide catch-up immunization to a defined school-age cohort or were implemented in response to an outbreak, were unfunded, funded by local health department, or were funded by industry or federal grants. The growing palette of vaccines recommended for routine use in adolescents along with limited success of office-based adolescent immunization create a compelling argument for the creation of financially sustainable SLV programs. An arguably significant barrier to both office-based and school-located adolescent immunization is the modest reimbursement rates afforded to immunizers. Because the immunization promotion and consent process is expensive, these costs must be reduced to a minimum to reach financial viability. Although there are challenges to creating a financially sustainable SLV program coordinated by an academic medical center, (AMC), the ability of AMCs to bill private and public insurers, the nonprofit status of medical centers, the allowances for faculty for academic pursuit, and the substantial infrastructure already present make AMCs a potentially practical site for the administration of SLV programs. Alternatively, as health departments throughout the nation continue to explore methods for billing private insurance, we may find health departments to be uniquely suited for coordinating the administration and billing of these services.Pediatrics 09/2014; 134(4). DOI:10.1542/peds.2014-1339 · 5.47 Impact Factor
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ABSTRACT: Context and objective: Maine implemented a statewide pre-K through 12-school vaccination program during the 2009-2010 H1N1 influenza pandemic. The main objective of this study was to determine which school, nurse, consent form, and clinic factors were associated with school-level vaccination rates for the first dose of the 2009 H1N1 pandemic vaccine. Methods: In April 2010, school nurses or contacts were e-mailed electronic surveys. Generalized linear mixed regression was used to predict adjusted vaccination rates using random effects to account for correlations within school districts. Elementary and secondary (middle and high) schools were analyzed separately. Results: Of 645 schools invited to participate, 82% (n = 531) completed the survey. After excluding schools that were ineligible or could not provide outcome data, data for 256 elementary and 124 secondary public schools were analyzed and included in the multivariable analyses. The overall, unadjusted, vaccination rate was 51% for elementary schools and 45% for secondary schools. Elementary schools that had 50 or fewer students per grade, had availability of additional nursing staff, which did not require parental presence at the H1N1 clinic or disseminated consent forms by mail and backpack (compared with backpack only) had statistically significant (P < .05) higher (adjusted) vaccination rates. For secondary schools, the vaccination rate for schools with the lowest proportion of students receiving subsidized lunch (ie, highest socioeconomic status) was 58% compared with 37% (P < .001) for schools with the highest proportion receiving subsidized lunch. Conclusions: Several factors were independently associated with vaccination rates. For elementary schools, planners should consider strategies such as providing additional nursing staff and disseminating consent forms via multiple methods. The impact of additional factors, including communication approaches and parent and student attitudes, needs to be investigated, especially for secondary schools.Journal of public health management and practice: JPHMP 10/2014; 21(2). DOI:10.1097/PHH.0000000000000156 · 1.47 Impact Factor