Tailored interventions to introduce influenza vaccination among 6- to 23-month-old children at inner-city health centers.

BACKGROUND: Because of high rates of hospitalization for influenza infections among very young children (< 2 years), the Advisory Committee on Immunization Practices initiated a new policy in 2002 that encouraged vaccination of healthy children aged 6 to 23 months against influenza. OBJECTIVE: To evaluate the effectiveness of implementing tailored interventions to introduce influenza vaccination of children 6 to 23 months of age in inner-city practices. STUDY DESIGN: A before-after trial with historical and concurrent controls was conducted in 6 health centers in low-income urban locations. METHODS: Intervention sites were selected, and interventions (directed at 1534 patients who were 6 to 23 months old) were implemented from a menu of strategies. Vaccination rates were measured from medical record reviews. Focus groups of nursing staffs provided evaluative information on strategies. RESULTS: Influenza vaccination rates improved significantly at the intervention health centers compared with the control center. Preintervention (2001-2002) rates ranged from 0% to 7.6%, and intervention (2002-2003) rates ranged from 15.2% to 49.2% (P < .001). The number of interventions ranged from 6 to 11. Sites that used more interventions (odds ratio, 1.24; 95% confidence interval, 1.15-1.34) and had staff support of the vaccination effort (odds ratio, 1.91; 95% confidence interval, 1.40-2.60) had higher vaccination rates. CONCLUSIONS: Tailored interventions resulted in successful introduction of influenza vaccination of 6- to 23-month-old children in inner-city health centers. More strategies and enthusiastic staff support may result in higher vaccination rates.

Missed opportunities to vaccinate older adults in primary care.

OBJECTIVE: During the 2000 to 2001 influenza season, distribution of influenza vaccine was delayed, and national self-reported vaccination rates declined. The purposes of this study were to characterize missed opportunities for adult vaccinations and assess the impact of the vaccine delay on missed opportunities for influenza vaccination as recorded in medical records. METHODS: In a cross-sectional analysis, medical record data from 217 adult patients aged > or =65 years in primary care practices that received influenza vaccine supplies late in 2000 were used to assess rates and missed opportunities to vaccinate. Missed opportunities were defined as visits in which there was no record that vaccine had been given, discussed, or refused by the patient. RESULTS: During the mean study period of 37.1 +/- 5.7 months, patients averaged 12.1 +/- 5.9 visits to their primary care physician's office. Medical records indicated that 75% of patients had received pneumococcal polysaccharide vaccine (PPV) and 30% had received tetanus toxoid from 1991 to 2001; 81% had received at least one influenza vaccine in the previous 4 seasons. During the 2000 to 2001 influenza season, influenza vaccination rates declined significantly to 41% from 57% in 1999 to 2000. Overall missed opportunities to vaccinate during the study period averaged 3.4 +/- 3.0 for influenza vaccine, 10.7 +/- 7.3 for pneumococcal vaccine, and 10.8 +/- 5.9 for tetanus toxoid. During the delay season, the number of visits increased, but missed opportunities to vaccinate also increased significantly, even after vaccine supplies had been received. CONCLUSIONS: Missed opportunities to vaccinate occur frequently and vaccine shortages create additional challenges to adult vaccination. Missed opportunities may be minimized and maintenance of accurate adult immunization records may be achieved by assessing and recording vaccination status at each visit, regardless of vaccine availability. By so doing, providers can easily convey the message to their patients that immunizations are an important part of their care.