Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Jan-Dec:10:2150132719853061.
doi: 10.1177/2150132719853061.

Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice

Lloyd N Werk  1   2 , Maria Carmen Diaz  3   4 , Adriana Cadilla  1   2 , James P Franciosi  1   2 , Md Jobayer Hossain  5   6
Affiliations
Randomized Controlled Trial

Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice

Lloyd N Werk et al. J Prim Care Community Health. 2019 Jan-Dec.

Abstract

Objectives: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence.

Methods: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]).

Results: During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P < .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P < .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes.

Conclusions: Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate.

Keywords: computerized clinical decision support; influenza vaccination; practice variation; quasi-experimental design; web-based training.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Influenza vaccination, adherence with dosing, and missed opportunities among primary care clinicians in the primary care practices.
Figure 2.
Figure 2.
Odds ratios of influenza vaccination adherence by intervention arms.
Figure 3.
Figure 3.
Run charts with composite median line and monthly average of all PRACTICE sites separated by arm.
See this image and copyright information in PMC

References

    1. Committee on Infectious Diseases; American Academy of Pediatrics. Recommendations for prevention and control of influenza in children, 2014-2015. Pediatrics. 2014;134:e1503-e1519. doi:10.1542/peds.2014-2413 - DOI - PubMed
    1. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep. 2015;64:818-825. - PMC - PubMed
    1. Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2017-2018. Pediatrics. 2017;140:e20172550. doi:10.1542/peds.2017-2550 - DOI - PubMed
    1. Kostova D, Reed C, Finelli L, et al. Influenza illness and hospitalizations averted by influenza vaccination in the United States, 2005-2011. PLoS One. 2013;8:e66312. doi:10.1371/journal.pone.0066312 - DOI - PMC - PubMed
    1. Wong KK, Cheng P, Foppa I, Jain S, Fry AM, Finelli L. Estimated paediatric mortality associated with influenza virus infections, United States, 2003-2010. Epidemiol Infect. 2015;143:640-647. doi:10.1017/S0950268814001198 - DOI - PMC - PubMed

Publication types

MeSH terms

Substances