Objectives: To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and,among unimmunized children in that group, to explore parent-re...Objectives: To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and,among unimmunized children in that group, to explore parent-reported reasons for not vaccinating their child. Design: Prospective cohort study. Data were obtained from billing and immunization registry databases and telephone interviews of parents. Setting: Four pediatric practices in metropolitan Denver, Colo, during the 2002-2003 influenza season. Participants: Children aged 6 to 72 months with 1 or more chronic medical conditions. Main Outcome Measure: A missed opportunity for influenza immunization, defined as having a billed encounter, being eligible for immunization, and not receiving vaccine. Subjects with asthma were analyzed separately from those with other conditions. Results: We identified 926 children with chronic conditions: 820 (89% )-with asthma only and 106 (11% ) with other conditions. Missed opportunities occurred at 78% of all vaccine-eligible visits for children with asthma and 74% of all visits for children with other conditions. For children with asthma, 92% of vaccine-eligible visits in December and January resulted in a missed opportunity vs 69% in October and November; for children with other conditions, corresponding frequencies were 86% vs 68% , respectively. For children with asthma, 86% of non-well-child visits resulted in a missed opportunity, compared with 62% of well-child visits; similar frequencies were seen among children with other chronic conditions. Parents of unimmunized children reported lack of a physician recommendation and low perceived susceptibility to influenza as the primary reasons for not immunizing their child. Conclusion: Missed opportunities contribute significantly to low influenza immunization rates among children with chronicmedical conditions.展开更多
Background. An Advisory Committee on Immunization Practices policy of encouraging influenza vaccination for healthy 6-to 23-month-old children was in effect during the 2003-2004 influenza season,which was unusually se...Background. An Advisory Committee on Immunization Practices policy of encouraging influenza vaccination for healthy 6-to 23-month-old children was in effect during the 2003-2004 influenza season,which was unusually severe in Colorado. We collaborated with 5 pediatric practices to attempt universal influenza immunization in this age group. Objectives. The objectives were (1) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice settings, (2) to evaluate the efficacy of registry-based reminderrecall for influenza vaccination, and (3) to describe methods used by private practices to implement the recommendations. Methods. The study was conducted in 5 private pediatric practices in Denver, Colorado, with a common billing system and immunization registry. Although recommendations by the Advisory Committee on Immunization Practices included children who were 6 to 23 months of age at any point during the influenza season, our practices chose not to recall children 22 to 23 months of age, because they would have become > 24 months of age during the study period. Therefore, our study population consisted of all healthy children 6 to 21 months of age from the 5 practices (N = 5193), who were randomized to intervention groups (n = 2595) that received up to 3 reminderrecall letters or to control groups (n = 2598) that received usual care. The primary outcome was receipt of ≥1 influenza immunization, as noted either in the immunization registry or in billing data. Results. Immunization rates for ≥1 dose of influenza vaccine for the intervention groups in the 5 practices were 75.9%, 75.4%, 68.1%, 55.6%, and 44.3%at the end of the season. Overall, 62.4%of children in the intervention groups and 58.0%of children in the control groups were immunized (4.4%absolute difference), with absolute differences, compared with control values, ranging from 1.0%to 9.1%according to practice. However, before intensive media coverage of the influenza outbreak began (November 15, 2003)-, absolute differences, compared with control values, ranged from 5.1%to 15.3%and were 9.6%overall. Before November 15, significant effects of recall were seen for children in the intervention groups, in both the 12-to 21-month age category (10.4%increase over control) and the 6-to 11-month category (8.1%increase over control); at the end of the season, however, significant effects of recall were seen only for the older age group (6.2%increase over control). The rates of receipt of 2 vaccine doses ≥1 month apart for eligible children ranged from 21%to 48%among the practices. Four of the 5 practices held influenza immunization clinics during office hours, evenings, or weekends, and these clinics achieved higher coverage rates. Conclusions. These results demonstrated that, in an epidemic influenza year, private practices were able to immunize the majority of 6-to 21-month-old children in a timely manner. Although media coverage regarding the epidemic blunted the effect of registry-based recall, recall was effective in increasing rates early in the epidemic, especially for children between 1 and 2 years of age. The practices that achieved the highest immunization rates were proactive in planning influenza clinics to handle the extra volume of immunizations required.展开更多
文摘Objectives: To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and,among unimmunized children in that group, to explore parent-reported reasons for not vaccinating their child. Design: Prospective cohort study. Data were obtained from billing and immunization registry databases and telephone interviews of parents. Setting: Four pediatric practices in metropolitan Denver, Colo, during the 2002-2003 influenza season. Participants: Children aged 6 to 72 months with 1 or more chronic medical conditions. Main Outcome Measure: A missed opportunity for influenza immunization, defined as having a billed encounter, being eligible for immunization, and not receiving vaccine. Subjects with asthma were analyzed separately from those with other conditions. Results: We identified 926 children with chronic conditions: 820 (89% )-with asthma only and 106 (11% ) with other conditions. Missed opportunities occurred at 78% of all vaccine-eligible visits for children with asthma and 74% of all visits for children with other conditions. For children with asthma, 92% of vaccine-eligible visits in December and January resulted in a missed opportunity vs 69% in October and November; for children with other conditions, corresponding frequencies were 86% vs 68% , respectively. For children with asthma, 86% of non-well-child visits resulted in a missed opportunity, compared with 62% of well-child visits; similar frequencies were seen among children with other chronic conditions. Parents of unimmunized children reported lack of a physician recommendation and low perceived susceptibility to influenza as the primary reasons for not immunizing their child. Conclusion: Missed opportunities contribute significantly to low influenza immunization rates among children with chronicmedical conditions.
文摘Background. An Advisory Committee on Immunization Practices policy of encouraging influenza vaccination for healthy 6-to 23-month-old children was in effect during the 2003-2004 influenza season,which was unusually severe in Colorado. We collaborated with 5 pediatric practices to attempt universal influenza immunization in this age group. Objectives. The objectives were (1) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice settings, (2) to evaluate the efficacy of registry-based reminderrecall for influenza vaccination, and (3) to describe methods used by private practices to implement the recommendations. Methods. The study was conducted in 5 private pediatric practices in Denver, Colorado, with a common billing system and immunization registry. Although recommendations by the Advisory Committee on Immunization Practices included children who were 6 to 23 months of age at any point during the influenza season, our practices chose not to recall children 22 to 23 months of age, because they would have become > 24 months of age during the study period. Therefore, our study population consisted of all healthy children 6 to 21 months of age from the 5 practices (N = 5193), who were randomized to intervention groups (n = 2595) that received up to 3 reminderrecall letters or to control groups (n = 2598) that received usual care. The primary outcome was receipt of ≥1 influenza immunization, as noted either in the immunization registry or in billing data. Results. Immunization rates for ≥1 dose of influenza vaccine for the intervention groups in the 5 practices were 75.9%, 75.4%, 68.1%, 55.6%, and 44.3%at the end of the season. Overall, 62.4%of children in the intervention groups and 58.0%of children in the control groups were immunized (4.4%absolute difference), with absolute differences, compared with control values, ranging from 1.0%to 9.1%according to practice. However, before intensive media coverage of the influenza outbreak began (November 15, 2003)-, absolute differences, compared with control values, ranged from 5.1%to 15.3%and were 9.6%overall. Before November 15, significant effects of recall were seen for children in the intervention groups, in both the 12-to 21-month age category (10.4%increase over control) and the 6-to 11-month category (8.1%increase over control); at the end of the season, however, significant effects of recall were seen only for the older age group (6.2%increase over control). The rates of receipt of 2 vaccine doses ≥1 month apart for eligible children ranged from 21%to 48%among the practices. Four of the 5 practices held influenza immunization clinics during office hours, evenings, or weekends, and these clinics achieved higher coverage rates. Conclusions. These results demonstrated that, in an epidemic influenza year, private practices were able to immunize the majority of 6-to 21-month-old children in a timely manner. Although media coverage regarding the epidemic blunted the effect of registry-based recall, recall was effective in increasing rates early in the epidemic, especially for children between 1 and 2 years of age. The practices that achieved the highest immunization rates were proactive in planning influenza clinics to handle the extra volume of immunizations required.
