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Improving influenza immunization rates in the uninsured

Falcone, Aimee L. BS, BSN, RN

Journal of the American Association of Nurse Practitioners: July 2019 - Volume 31 - Issue 7 - p 391–395
doi: 10.1097/JXX.0000000000000166
Review - Systematic

Background and Purpose: Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population.

Methods: Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews.

Conclusions: Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques.

Implications for practice: To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.

College of Nursing, Medical University of South Carolina, Charleston, South Carolina

Correspondence: Aimee L. Falcone, Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC 29425. E-mail:,

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Competing interests: The author reports no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received July 22, 2018

Accepted October 24, 2018

© 2019 American Association of Nurse Practitioners
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