Major Finding: Some 65% of pediatricians and 35% of family medicine physicians reported adhering to expanded ACIP recommendations to immunize all children 6 months to 18 years of age against influenza.
Data Source: A national survey of 330 pediatricians and 298 family medicine physicians.
Disclosures: Dr. O'Leary reported that he had no conflicts of interest related to the study.
VANCOUVER, B.C. — In the year after national recommendations for yearly influenza vaccination were expanded to include all children aged 6 months to 18 years, about half of primary care physicians who see children reported following this practice, new data show.
In a national survey, 65% of pediatricians and 35% of family medicine physicians said that they routinely immunized all children this in this age-group during the 2008-2009 season, according to results reported in a poster session.
However, the physicians' reported rates of routine immunization specifically for 5- to 18-year-olds—the newest age-group to be included with the expansion—were two to four times higher than this group's actual rate of vaccine receipt, as assessed from surveillance data in the general population.
“Our thought is that the discrepancy between the reported practice and the actual rate is because a lot of these kids just aren't coming in,” which suggests that innovative immunizations strategies are called for, lead investigator Dr. Sean O'Leary said in an interview.
“Maybe we need a real focused effort on school-based immunization, public-private collaborations with health departments and VNAs [Visiting Nurses Associations], or something like that,” he commented.
In the survey, the investigators polled a national sample of 628 pediatric primary care providers about their immunization practices during the 2008-2009 flu season, the first one after the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for annual influenza vaccination to include all children between the ages of 6 months and 18 years.
A total of 330 pediatricians and 298 family medicine physicians completed questionnaires online or by mail, reported Dr. O'Leary, who is a pediatric infectious disease fellow and a primary care research fellow at the University of Colorado in Denver.
When it came to specific age-groups, 70% of pediatricians and 43% of family physicians, respectively, reported routinely immunizing 5- to 18-year-olds—values that are much higher than the 21% rate of actual vaccine receipt seen in this age-group during the same flu season from surveillance data (MMWR 2009;58:1091-5).
To implement influenza vaccination, many pediatricians and family medicine physicians displayed posters and pamphlets in their office (89% of each specialty), held dedicated flu vaccination clinics after hours or on weekends (57% and 41%, respectively), added extra staff for vaccine-only visits during regular office hours (56% and 53%), and offered vaccination without an appointment (48% and 79%).
However, Dr. O'Leary noted, “one of the big things that came out of our survey was that some of the proven methods are not being used.”
Specifically, only small minorities of pediatricians and family physicians used ongoing tracking of influenza vaccine receipt (30% and 23%, respectively) and written, telephone, or e-mail reminders (23% and 14%) for all children covered by the expanded recommendations.
In adjusted analyses, physicians were more likely to report routinely immunizing all children aged 6 months to 18 years if they had dedicated influenza vaccination clinics after hours or on weekends (risk ratio, 1.26), used reminders for all children in this age-group (risk ratio, 1.28), or rated themselves as expending intense effort on this objective (risk ratio, 1.43).
On the other hand, rural physicians were less likely to report routinely immunizing all children in this age-group relative to their urban counterparts (risk ratio, 0.79), as were family medicine physicians compared with pediatricians (risk ratio, 0.67).
The reason for the difference between specialties is unclear, according to Dr. O'Leary.
“It may be that because it was the first year of the recommendation, the family medicine physicians had ordered a certain amount of the vaccine, and they needed to prioritize their older-than-65-year-old patients, as opposed to these healthy 5- to 18-year-olds,” he speculated.