1. 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

2. 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/CCU from the CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC

3. 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

4. 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

5. Vaccine Shortages and Delays

6. 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

7. 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

8. 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

9. Results

10. 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

11. 2006 Survey Respondents
Most physicians intended to provide vaccine for the season.
90.1%
No change from the previous season (90.0%)
Multiple reasons for 9.1% not willing to vaccinate

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

13. Appropriateness of venue for Influenza Vaccination (2006)

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

15. 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 potential flu vaccine patients by this migration before we received additional vaccine.”
Tim Tobolic MD
Byron Family Medicine, PC
Byron Center, MI

16. Slight Changes in Routine Provision of Influenza Vaccine

17. 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

18. 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

19. 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