Influenza immunization of high-risk adults: Current trends in specialty care offices

Influenza vaccine is indicated for patients with conditions such as pregnancy, asthma, and cardiovascular disease. High-risk adults often see specialist physicians more often than primary care providers, making specialty practices ideal settings for vaccination. Previous studies determined that specialists are knowledgeable about and hold positive attitudes toward influenza vaccination, but knowledge and positive attitudes are not always sufficient for action. As the business models for medical practices change, decisions to offer services may not be made by the physicians. The Philadelphia Department of Public Health (PDPH) operates influenza vaccination clinics annually and noted that many clients were high-risk adults referred to the clinics by their specialist. PDPH was interested in examining the influenza immunization practices (and barriers to practice) and Philadelphia Immunization Coalition members collaborated to design and implement this study. Practice managers at Philadelphia, PA-based cardiology (52), pulmonology (19) and obstetrics/gynecology (71) practices were mailed a survey to determine practice characteristics, influenza vaccination-related activities, barriers to vaccination, and interest in administering influenza vaccine. Sixty percent of practices responded. Of the respondents, 53% responded “yes” when asked if they ever offered influenza vaccine, 47% plan to vaccinate in 2009-2010, and 24% of non-vaccinators considered vaccinating. Pulmonology practices were more likely to vaccinate (90 %) than Ob/gyn (50%) and cardiology (43%) practices. Within those vaccinating practices, vaccine was targeted to all patients (59%), only high-risk patients (31%), or those requesting vaccination (13%). Practices administered other vaccines: pneumococcal vaccine (13%), HPV (37%), HBV (6%), tetanus (6%), meningococcal disease (6%), and shingles (3%). Use of these vaccines and other immunization-related activities varied significantly by specialty type. Non-vaccinating practices refer patients to primary care providers (56%), pharmacies (26%), and health clinics, city health centers, and vaccination clinics (45%). Barriers to or issues impacting vaccination were primarily administrative (ordering/obtaining vaccine, billing, and staffing, storage) or financial (reimbursement), and, to a lesser extent, patient-related (“not at-risk”, patient refusal, or vaccinated elsewhere). While specialty practices are ideal settings for adult influenza vaccination, less than half of respondents plan to vaccinate patients and those planning to vaccinate will not vaccinate all patients. Since most specialists believe vaccination is important and few report patient refusal, practice management issues are preventing implementation. Lack of implementation is putting added burden on the public health safety net. Helping practices overcome barriers is essential if we are to reach the Healthy People goals for influenza vaccination of high risk adults.