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Influenza vaccination of high-risk children: what the providers say
Donna Rickert1, Jeanne Santoli, Abigail Shefer
1National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. drickert@cdc.gov
Insights
Physicians often fail to vaccinate high-risk children against influenza, despite recommendations. This under-utilization stems from perceived barriers and inconsistent practice patterns, highlighting a need for improved communication and support strategies.
Area of Science:
- Pediatrics
- Public Health
- Vaccinology
Background:
- National recommendations exist for vaccinating high-risk children against influenza.
- Physician adherence to these recommendations for influenza vaccination in high-risk children remains suboptimal.
- This study investigates physician perspectives on the under-utilization of influenza vaccines in this population.
Purpose of the Study:
- To evaluate physicians' perspectives on the persistent under-utilization of influenza vaccine for high-risk children.
- To identify factors influencing influenza vaccine administration in pediatric populations with asthma or other cardiopulmonary diseases.
- To understand physician knowledge, endorsement of recommendations, perceived barriers, and practice patterns related to influenza vaccination.
Main Methods:
- A cross-sectional survey was distributed to a nationally representative sample of 1460 U.S. physicians in four key medical specialties.
- The survey, mailed in 2001-2002, assessed whether physicians provided annual influenza vaccine to children with asthma or other cardiopulmonary diseases.
- Data analysis focused on physician knowledge, endorsement of recommendations, perceived barriers, and practice patterns as predictors of reported vaccine use.
Main Results:
- The study achieved a 55% response rate (n=600), with variations across specialties.
- Most physicians were knowledgeable about influenza vaccination recommendations but overestimated their own adherence rates.
- Adherence was influenced by physician specialty, endorsement of recommendations, perceived barriers (e.g., identifying high-risk groups, care coordination), and under-utilization of vaccination improvement strategies.
Conclusions:
- Improved communication strategies are essential to address confusion regarding influenza vaccination for high-risk children, particularly in subspecialty care.
- Further research is needed to develop practical support strategies for identifying high-risk pediatric subgroups and implementing vaccination.
- Practice-based quality improvement research holds promise for enhancing influenza vaccination rates in high-risk children.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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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