Effectiveness of improved targeting efforts for influenza immunization in an ambulatory care setting

Annual vaccination programs against influenza are aimed at decreasing the morbidity and mortality associated with an infection. Recent epidemics have resulted in 40,000 excess deaths reported. The success of an immunization program depends both on the composition of the annual vaccine and the targeting efficacy of the program. National estimates of targeting efficacy are reported at 20%. An evaluation performed in the author's ambulatory care practice in the spring of 1984 yielded an overall efficacy of 24% in targeting activities. Efforts to improve the targeting practices included enhanced practitioner and patient education about the vaccine, flagging of medication records for patients at risk, and adoption of CDC guidelines for categorizing patients based on the degree of risk. A subsequent evaluation in 1986 showed a significant improvement in targeting efficacy (40%; P less than .001). Subgroup analysis indicated that the targeting efficacy of the program was greatest for the high-risk patients (P less than .025). An overall immunization rate of at least 80% of patients at risk is our desired goal.