Impact of a Severe Influenza Vaccine Shortage on Primary Care Practice
ABSTRACT Because of influenza vaccine shortages during the 2004-2005 influenza season, vaccine was targeted for high-risk priority groups.
To assess among primary care physicians: (1) ability to identify priority patients; (2) extent of shortages; and (3) effects of shortages on vaccine redistribution, patient referral and future plans for vaccine delivery.
Mailed surveys of pediatric (Peds), family medicine (FM), and general internal medicine (GIM) physicians randomly selected from the American Medical Association master file.
Response rate was 37% and the study population included 377 Peds, 319 FM, and 251 GIM physicians. Seventy-five percent of Peds, 58% of FM and 60% of GIM had some method to identify priority patients, although only 39%, 21%, and 18%, respectively, had a computerized method. Forty-five percent of Peds, 73% of FM, and 75% of GIM experienced shortages, for a median of 2-3 months. Approximately 48%-50% of Peds, FM, and GIM obtained additional influenza doses; among these, 53% received vaccine from a public health entity. Fifty-one percent of Peds, 79% of FM, and 80% of GIM referred high-risk patients for immunization, 94% of the time to a public health clinic. More than 95% planned to administer influenza vaccine next season.
The majority of physicians experienced influenza vaccine shortages for prioritized patients, especially those providers caring for adults. There was significant vaccine redistribution and patient referral, primarily involving the public health system. Enhancing methods of targeting priority patients and increasing cooperation with public health entities should be priorities in dealing with future influenza vaccine shortages.
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ABSTRACT: There have been disruptions in influenza vaccine supply in the United States during the 2000-2001, 2001-2002, 2004-2005, and 2005-2006 influenza seasons. Some providers received limited or no vaccine, while others obtained their order in full, depending on with whom the order was placed. A state law was passed that mandates the Rhode Island Department of Health to include the purchase and distribution of influenza vaccine for adults in its immunization program. To evaluate the first 2 years of the statewide adult influenza immunization program. We conducted key informant interviews of 25 providers in 2008 and surveyed all enrolled providers in 2008 (year 1) and 2009 (year 2). State of Rhode Island. Physician practices and facilities that provide influenza vaccination to adults, including private practices, nursing homes, health centers, urgent care facilities, hospitals, mass immunizers, and businesses. Enrolled providers received influenza vaccines free and billed insurers, Medicare, and Medicaid for vaccine administration costs. Provider satisfaction with different program components and overall satisfaction. For year 1, there was higher satisfaction with enrollment, training, vaccine ordering, and vaccine shipment than with paperwork and claims. Of the survey respondents, 71% reported that the program paperwork was reasonable and 30% reported difficulties in receiving reimbursement. Satisfaction with the vaccination start date of October 17, 2007, was 80%. There was high overall satisfaction (94%). In response to streamlining of reporting requirements and setting an earlier start date of October 7, 2008, for year 2, there was a significant increase in satisfaction with paperwork (89%) and with vaccination start date (90%). The findings may be useful in guiding the development of vaccination programs to provide influenza and other vaccines for adults at the state or national level.Journal of public health management and practice: JPHMP 01/2010; 16(5):E01-8. DOI:10.1097/PHH.0b013e3181c60ed4 · 1.47 Impact Factor
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ABSTRACT: Adaptive array weight adjustment algorithms are described by time varying stochastic differential equations. A new method employing a two-variable perturbation analysis is used to investigate the effects of the weight fluctuations on the Applebaum algorithm performance in the presence of multiple jammers. An explicit solution of the directivity pattern in the direction of the jammers for the two-jammer problem is derived. An improved formula for the output signal-to-interference plus noise ratio (SINR) is obtained. It is shown as expected that the greater the number of signals at the array input the greater the degradation in the directivity pattern in the direction of the interfering signals and the greater the degradation in the output SINR. In addition, we show that the performance degrades uncontrollably when the number of independent jammers approaches the number of array elements. A comparison is made of the new results and those obtained using standard approximations. Substantial differences are caused by first-order terms in the perturbation.Military Communications Conference, 1985. MILCOM 1985. IEEE; 11/1985
Conference Paper: Evaluation of ad hoc networking over the fixed 3G backbone[Show abstract] [Hide abstract]
ABSTRACT: The Ad hoc Networking Over UTRA-TDD Protocol (Barnawi and Gardiner (2003)) (ANOUP) was introduced by our research group as a protocol to combine ad hoc networking with the fixed wireless infrastructure. The aim of that combination is to improve the capacity and coverage of the cellular system. In this paper we evaluate the impact of ANOUP on the system's performance. It is shown that at a fairly good link capacity, coverage improvement of 100 % is quite achievable.Electrical and Computer Engineering, 2004. Canadian Conference on; 06/2004