Influenza vaccine use in family medicine: 2004-2006 Jonathan L. Temte, MD/PhD AAFP Liaison to the Advisory Committee on Immunization Practices Herbert F. Young, MD, MA, FAAFP Bellinda K. Schoof, MHA, CPHQ AAFP Division of Scientific Activities

Acknowledgements AAFP immunization surveys were conducted through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Supported in part by Cooperative Agreement No. U66/CCU723242-02 from the CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC

Context American Academy of Family Physicians 94,000 members Spectrum of care spans from the prenatal period into old age Family physicians are an essential component of primary medical care and vaccine delivery system in the United States

Background Family Physicians provide influenza vaccine to millions of American children and adults each year Moreover, they directly experience the practice-centered issues associated with vaccine shortages and delays

Vaccine Shortages and Delays

Purpose To better define usual administration of influenza vaccine and problems encountered while providing this service, the AAFP—through a CDC cooperative agreement—conducted three annual membership surveys Appropriate venues for vaccination Problems in acquisition and distribution General attitudes toward influenza vaccine

Setting: United States American Academy of Family Physicians Annual Surveys of Immunization Practices Design: Cross-sectional mailed surveys Non-responders received up to two additional mailings Summary statistics were evaluated Approaches were compared between years and among demographic groups using chi square and ANOVA as appropriate Setting: United States all 50 states plus District of Columbia

American Academy of Family Physicians Annual Surveys of Immunization Practices Participants: Randomly selected clinically-active AAFP members 2004 (n=4185), 2005 (n=4720), 2006 (n=5000) Instrument: mailed surveys in 2004, 2005, and 2006, respectively Outcome Measures: spectrum of care current provision of vaccines clinical approaches to immunizations sources of immunization recommendations

Results

Response Rates Modest return rates were achieved 2004: 46.5% n = 1,946 2005: 48.3% n = 2,278 2006: 52.4% n = 2,619 Analysis limited to FP's who spend ≥80% of their time in direct patient care ~ 90.4% of respondents

2006 Survey Respondents Most physicians intended to provide vaccine for the 2006-2007 season. 90.1% No change from the previous season (90.0%) Multiple reasons for 9.1% not willing to vaccinate

“Any service provided at a loss multiplied by volume is bankruptcy.” Joseph Atkins "Joe" Leming, MD, FAAFP Prime Care Family Practice Colonial Heights, Virginia

Appropriateness of venue for Influenza Vaccination (2006)

One-third (32%) of Family Physicians had unused influenza vaccine in 2005-2006

Tim Tobolic MD Byron Family Medicine, PC Byron Center, MI “Our office of 5 family physicians ordered 2000 doses this year… We have been keeping a "flu list" as we have in the past, which is a time consuming task. Living in Michigan, a large number of our senior citizens leave for Florida or other places south, many by November 1. Monday Oct 30, received [our first allotment of] 700 doses. We estimate we lose well in excess of 200-300 potential flu vaccine patients by this migration before we received additional vaccine.” Tim Tobolic MD Byron Family Medicine, PC Byron Center, MI

Slight Changes in Routine Provision of Influenza Vaccine

Slight but significant decline (P<0 Slight but significant decline (P<0.001) in offering influenza vaccine to clinic staff 2004 Survey 2005 Survey 2006 Survey Shortage Year

Despite Experience with Shortages and Delays… a majority and increasing percentage of family physicians favor a recommendation for universal influenza vaccination if supplies are adequate and assured 2005: 67.6% vs. 2006: 69.5%;P<0.001 Moreover, fewer family physicians had concerns regarding thimerosal in 2006 compared to 2005 2005: 21.0% vs 2006: 18.0%; P<0.001

Conclusions Family physicians are supportive of influenza vaccination policy and are an essential component of the influenza prevention system They are, however, highly susceptible to the effects of delays and shortages These effects may have subtle and negative effects on primary care immunization practice