Influenza vaccination of high-risk children - What the providers say

National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
American Journal of Preventive Medicine (Impact Factor: 4.28). 03/2006; 30(2):111-8. DOI: 10.1016/j.amepre.2005.10.016
Source: PubMed

ABSTRACT Despite a longstanding national recommendation to administer influenza vaccine to children at high risk for disease complications, physicians' adherence remains low. This study evaluated physicians' perspectives on previously documented and persistent under-utilization of influenza vaccine for high-risk children.
A cross-sectional survey mailed in 2001-2002 to a nationally representative sample of 1460 U.S. physicians in four key medical specialties. The primary outcome was whether the physician provided annual influenza vaccine to children with asthma or other cardiopulmonary diseases. The hypothesis was that factors predicting reported use would fall into four categories: (1) physician knowledge, (2) physician endorsement of recommendation, (3) perceived barriers, and (4) practice patterns.
The overall response rate was 55% (n=600), but differed by specialty. Most physicians were knowledgeable about the recommendation, but collectively tended to overestimate their own achievements in immunizing high-risk children. Adherence varied by physician specialty, endorsement of recommendation, perceived barriers (including difficulty identifying subpopulations of high-risk children and confusion about who should vaccinate those receiving care from multiple providers), and under-utilization of strategies known to improve vaccination rates.
Better communication strategies are needed to resolve confusion about providing influenza vaccine to high-risk children in subspecialty settings. Because of the difficulties in selectively identifying high-risk patient subgroups, research is needed to assist in putting support strategies into practice. Findings from research in promising areas of practice-based quality improvement may be particularly applicable.

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    • "We found substantial discrepancies between measured and reported delivery of PCV7 to healthy children, with many physicians overestimating their deferral rates (i.e., compliance with CDC recommendations) for third and fourth doses. This finding is consistent with other studies showing that physicians overestimate their compliance with immunization recommendations [28] [29] [30]. Because surveys are much less expensive than medical record reviews and information may be obtained more quickly, public health officials rely heavily on survey data to ascertain behavior during vaccine shortages [13] [14] [16] [31]. "
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    ABSTRACT: BACKGROUND: The United States has experienced two shortages of heptavalent pneumococcal conjugate vaccine (PCV7). National guidelines called for deferring the third and fourth PCV7 doses from healthy children during these shortages. However, recommendations were not the same during the first and second shortages, and recommendations changed over time during each of the shortages as shortages worsened. OBJECTIVES: To measure PCV7 immunizing behavior for healthy children during shortage and non-shortage periods and assess the accuracy of the physicians' reported immunizing behavior when compared to their actual immunizing behavior. METHODS: We reviewed medical records in 14 randomly selected practices to measure actual immunizing behavior during shortage and non-shortage periods. We surveyed pediatricians in the Greater Cincinnati area to ascertain reported immunizing behavior. Actual and reported immunizing behaviors were compared. RESULTS: 2888 medical records were reviewed; surveys were obtained from 51 pediatricians (65% response rate). During periods of non-shortage, 74% of healthy children received their first two doses of PCV7 on time, whereas during periods of shortage, only 66% of healthy children received their first two doses of PCV7 on time. Compared with measured immunizing behavior from chart reviews, 54-76% of the pediatricians overestimated their compliance with guidelines to defer the fourth PCV7 dose while only 5-20% underestimated their compliance. CONCLUSIONS: Physicians often overestimated the percentage of children whose vaccine doses they deferred during vaccine shortages. Despite these findings, physicians were able to maintain high coverage with the first two PCV7 doses among healthy children.
    Vaccine 03/2013; DOI:10.1016/j.vaccine.2013.02.038 · 3.49 Impact Factor
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