Improving Influenza Vaccination Rates of High-Risk Inner-City Children Over 2 Intervention Years

Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
The Annals of Family Medicine (Impact Factor: 5.43). 11/2006; 4(6):534-40. DOI: 10.1370/afm.612
Source: PubMed


Influenza immunization rates among children with high-risk medical conditions are disappointingly low, and relatively few data are available on raising rates, particularly over 2 years. We wanted to determine whether interventions tailored to individual practice sites improve influenza immunization rates among high-risk children in inner-city health centers over 2 years.
A before-after trial to improve influenza immunization of children was conducted at 5 inner-city health centers (residencies and faith-based). Sites selected interventions from a menu (eg, standing orders, patient and clinician reminders, education) proved to increase vaccination rates, which were directed at children aged 2 to 17 years with high-risk medical conditions. Intervention influenza vaccination rates and 1 and 2 years were compared with those of the preintervention year (2001-2002) and of a comparison site.
Influenza vaccination rates improved modestly from baseline (10.4%) to 13.1% during intervention year 1 and to 18.7% during intervention year 2 (P <.001), with rates reaching 31% in faith-based practices. Rates increased in all racial and age-groups and in Medicaid-insured children. The increase in rates was significantly greater in intervention health centers (8.3%) than in the comparison health center (0.7%; P <.001). In regression analyses that controlled for demographic factors, vaccination status was associated with intervention year 1 (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.6-2.2) and with intervention year 2 (OR, 2.8; 95% CI, 2.3-3.4), as well as with practice type. Adolescents had lower vaccination rates than children 2 to 6 years old (OR, 0.6; 95% CI, 0.5-0.7).
Tailored interventions selected from a menu of interventions modestly increased influenza vaccination rates over 2 years at health centers serving children from low-income families. We recommend this strategy for faith-based practices and residencies with 1 practice site, but further research is needed on multisite practices and to achieve higher influenza vaccination rates.

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    • "Although immunisation uptake is high for most routine immunisations in western countries, yet high risk groups, including children with underlying diseases, have often low immunisation coverage [1]. Chronic diseases such as neurological and cardiovascular disorders are associated with high hospitalisation rates [2,3], and some immunisations including influenza and conjugate pneumococcal vaccines may prevent admission into hospital, medical visits, and other negative effects in these patients [4,5]. Despite mathematical models suggest that focusing immunisations on high risk groups may be suitable [6,7], parents of children at risk may underestimate incidence and severity of vaccine preventable diseases and may not be appropriately informed about safety and efficacy of available vaccines [7-10]. "
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    ABSTRACT: Improving immunisation rates in risk groups is one of the main objectives in vaccination strategies. However, achieving high vaccination rates in children with chronic conditions is difficult. Different types of vaccine providers may differently attract high risk children. To describe the characteristics of two populations of children who attended a private and a public immunisation provider in the same area. Secondarily, to determine if prevalence of patients with underlying diseases by type of provider differs and to study if the choice of different providers influences timeliness in immunisation. We performed a cross-sectional study on parents of children 2-36 months of age who attended a private hospital immunisation service or a public immunisation office serving the same metropolitan area of Rome, Italy. Data on personal characteristics and immunisation history were collected through a face to face interview with parents of vaccinees, and compared by type of provider. Prevalence of underlying conditions was compared in the two populations. Timeliness in immunisation and its determinants were analysed through a logistic regression model. A total of 202 parents of children 2-36 months of age were interviewed; 104 were in the public office, and 98 in the hospital practice. Children immunised in the hospital were more frequently firstborn female children, breast fed for a longer period, with a lower birthweight, and more frequently with a previous hospitalisation. The prevalence of high risk children immunised in the hospital was 9.2 vs 0% in the public service (P = 0.001). Immunisation delay for due vaccines was higher in the hospital practice than in the public service (DTP, polio, HBV, and Hib: 39.8% vs 22.1%; P = 0.005). Anyway multivariate analyses did not reveal differences in timeliness between the public and private hospital settings. Children with underlying diseases or a low birthweight were more frequently immunised in the hospital. This finding suggests that offering immunisations in a hospital setting may facilitate vaccination uptake in high risk groups. An integration between public and hospital practices and an effort to improve communication on vaccines to parents, may significantly increase immunisation rates in high risk groups and in the general population, and prevent immunisation delays.
    Full-text · Article · Feb 2008 · BMC Public Health
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    Preview · Article · Nov 2006 · The Annals of Family Medicine
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    ABSTRACT: To increase adult immunizations at inner-city health centers serving primarily minority patients. A before-after trial with a concurrent control. Five inner-city health centers. All adult patients at the health centers eligible for influenza and pneumococcal vaccines. Four intervention sites chose from a menu of culturally appropriate interventions based on the unique features of their respective health centers. Immunization and demographic data from medical records of a random sample of 568 patients aged 50 and older who had been patients at their health centers since 2000. The preintervention influenza vaccination rate of 27.1% increased to 48.9% (P<.001) in intervention sites in Year 4, whereas the concurrent control rate remained low (19.7%). The pneumococcal polysaccharide vaccine (PPV) rate in subjects aged 65 and older increased from 48.3% to 81.3% (P<.001) in intervention sites in Year 4. Increase in PPV in the concurrent control was not significant. In logistic regression analysis, the likelihood of influenza vaccination was significantly associated with the intervention (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.77-2.41) and with age of 65 and older (OR=2.0, 95% CI=1.62-2.48) but not with race. Likelihood of receiving the pneumococcal vaccination was also associated with older age and, to a lesser degree, with intervention. Culturally appropriate, evidence-based interventions selected by intervention sites resulted in increased adult vaccinations in disadvantaged, racially diverse, inner-city populations over 2 to 4 years.
    Full-text · Article · Jun 2008 · Journal of the American Geriatrics Society
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