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Influenza Vaccination and Its Association With Clinic Use of Evidence-Based Practices and Individual Patient Characteristics, San Diego County, 2009

McAuliffe, Kathryn MPH; Peddecord, K. Michael DrPH; Wang, Wendy MPH; Ralston, Kimberly MPH; Deguire, Michelle MPH, MSW, CCRC; Waters-Montijo, Karen MPH; Sawyer, Mark H. MD

Journal of Public Health Management and Practice: March/April 2013 - Volume 19 - Issue 2 - p 178–186
doi: 10.1097/PHH.0b013e318259e735
Original Articles

Context: In 2008, about 40% of the US population eligible for influenza vaccine was vaccinated, which was below Healthy People 2020 goals. Little emphasis has been put on late-season vaccination efforts by medical providers.

Objective: Evaluate use of evidence-based practices (EBP) and their association with influenza vaccination for children younger than 5 years and adults aged 50 years and older.

Design: Patient surveys and medical clinic information were collected between January and April 2009. Influenza coverage rates and logistic regressions are used to measure associations.

Setting: Nineteen medical clinics serving children, adults, or both in San Diego County participated.

Participants: Parents of children aged 6 months to 5 years and adults aged 50 years and over seen by a primary care provider during January through March 2009.

Main Outcome: Influence of clinic EBP use on child and adult influenza vaccination status.

Measures: Patient-reported influenza vaccination and clinic coverage rates and clinics' use of EBP and patient demographic characteristics.

Results: Coverage rates varied by clinic; 50% to 82% (children) and 48% to 85% (adults). Child clinics using the immunization registry, or those that were private practices or medical groups and adult clinics that used influenza vaccination clinics, provider prompts, or electronic medical records had higher coverage. Surveys from 831 children and 1038 adults documented influenza vaccination rates of 64% and 63% respectively. Receiving a reminder or having two or more visits during influenza season was positively associated with child and adult influenza vaccination. Child vaccination was associated with children younger than 2 years. Adult vaccination was associated adults aged 65 years or older, having a high-risk condition, or being female.

Conclusions: Given the low use of EBP, clinics have opportunities to implement EBP appropriate for their settings and patient populations. Along with other strategies, public health departments and medical groups should encourage medical providers to implement EBP to improve influenza vaccination rates.

This study describes baseline medical practice and individual patient characteristics that are associated with influenza vaccination.

Epidemiology and Immunization Services Branch, County of San Diego Health and Human Services Agency, San Diego, California (Ms McAuliffe, Dr Peddecord, Ms Wang, Ms Ralston, Ms Deguire, Ms Waters-Montijo, and Dr Sawyer); Graduate School of Public Health, San Diego State University, San Diego, California (Ms McAuliffe and Dr Peddecord); Division of Infectious Disease, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California (Dr Peddecord, Ms Wang, Ms Ralston, and Dr Sawyer).

Correspondence: K. Michael Peddecord, DrPH, Immunization Branch, 3851 Rosecrans Street, MS-P573, San Diego, CA 92110 (

This study was funded by the US Centers for Disease Control and Prevention (CDC) Cooperative agreement: 5U01IP000189.

The authors thank the following staff for their support in completion of this project: Michelle Rubio, Adrienne Collins-Yancey, Jennifer Sterling, Everardo Aguilar, Daniel Wurm, Jae Hansen, Naomi Katzir, and Nancy Knickerbocker. The authors also thank Pascale Wortley, MD, at CDC for her oversight of the cooperative agreement and all clinic partners who aided in the completion of this project. This report benefited from the suggestions from anonymous reviewers.

The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.