Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

ABSTRACT Background: More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents. Methods: We analyzed 2014-2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three groups. We examined three NH-level outcomes: percentage of residents assessed and appropriately provided the influenza vaccine, receiving influenza vaccine, and refusing influenza vaccine. Results: There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n=4131 NHs), moderate (3.4% to 18.6%; n=4127 NHs) and high (>18.6%; n=4126 NHs). Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.7%, P<0.0001), or high (3.1%, P<0.0001) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (-3.1%, P<0.0001), or high (-4.6% P<0.0001) MA compared with NHs with the lowest prevalence of MA. Among 753,616 short-stay residents in 12,205 NHs, there was no association between MA concentration and influenza vaccination receipt but vaccine refusal was greater in NHs with higher MA prevalence (high or moderate vs. low MA: 5.2%, P<0.0001). Conclusion: The relationship between MA concentration and influenza vaccination measures varied among post-acute and long-term NH residents. As MA takes a larger role in the Medicare program, and more MA beneficiaries enter NHs, there is need to consider how managed care can be leveraged to improve the delivery of preventive services such as influenza vaccinations in NH settings.

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Influenza Vaccination in Massachusetts Jails: A Mixed-Methods Analysis

Public Health Reports ◽

10.1177/00333549211041659 ◽

2021 ◽

pp. 003335492110416

Author(s):

Sarah Khorasani ◽

Julia Zubiago ◽

Jac Carreiro ◽

Rubeen Guardado ◽

Alysse G. Wurcel

Keyword(s):

Public Health ◽

Health Care ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Summary Statistics ◽

Vaccination Rates ◽

Delivery Practices ◽

County Jails ◽

Influenza Vaccinations ◽

Health Administrators

Objectives Influenza infects millions of people each year and contributes to tens of thousands of deaths annually despite the availability of vaccines. People most at risk of influenza complications are disproportionately represented in people incarcerated in US prisons and jails. The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. Methods In April 2020, we administered surveys to the health services administrators in Massachusetts’ 14 county jails to gather information about influenza vaccination policies and delivery practices. To calculate influenza vaccination rates for each facility, we obtained data on influenza vaccine orders from the Massachusetts Department of Public Health for each county in Massachusetts for influenza seasons 2013-2020. We calculated summary statistics for each reporting facility and each year, conducted a Kruskal–Wallis analysis to compare vaccination rates between years, and used a linear regression model to identify predictors of vaccination rates. Results Influenza vaccination rates in Massachusetts jails ranged from 1.9% to 11.8%. We found no significant differences in vaccination rates between years. Influenza vaccine ordering and delivery practices varied by jail, and respondents had high levels of confidence in influenza policies and vaccine delivery practices. Conclusions Influenza vaccination rates in Massachusetts jails are low, and delivery practices in jails vary. Lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. Further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.

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Structural inequities in seasonal influenza vaccination rates

BMC Public Health ◽

10.1186/s12889-021-11179-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lara I. Brewer ◽

Mark J. Ommerborn ◽

Augustina Le Nguyen ◽

Cheryl R. Clark

Keyword(s):

Primary Care ◽

Health Insurance ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

American Indian ◽

Low Socioeconomic Status ◽

Behavioral Risk ◽

Vaccination Rates ◽

Access To Primary Care ◽

Structural Inequities

Abstract Background Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine. Methods We analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, history of delaying care due to cost, and comorbidities such as: asthma, cardiovascular disease, hypertension, body mass index, cancer and diabetes. Results Non-Hispanic White (46.5%) and Asian (44.1%) participants are more likely to receive the influenza vaccine compared to Non-Hispanic Black (36.7%), Hispanic (33.9%), American Indian/Alaskan Native (36.6%), and Native Hawaiian/Other Pacific Islander (37.9%) participants. We found persistent structural inequities that predict influenza vaccination, within and across racial and ethnic groups, including not having health insurance [OR: 0.51 (0.47–0.55)], not having regular access to primary care [OR: 0.50 (0.48–0.52)], and the need to delay medical care due to cost [OR: 0.75 (0.71–0.79)]. Conclusion As COVID-19 vaccination efforts evolve, it is important for physicians and policymakers to identify the structural impediments to equitable U.S. influenza vaccination so that future vaccination campaigns are not impeded by these barriers to immunization.

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Influenza vaccine uptake among adults living with young children

Journal of Epidemiological Research ◽

10.5430/jer.v4n1p41 ◽

2018 ◽

Vol 4 (1) ◽

pp. 41 ◽

Cited By ~ 1

Author(s):

Nirma Khatri Vadlamudi ◽

Fawziah Marra

Keyword(s):

Young Children ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Perceived Health ◽

Canadian Community Health Survey ◽

Demographic Characteristics ◽

Vaccine Uptake ◽

Vaccination Programs ◽

Vaccination Rates ◽

Vaccination Uptake

Background: Many studies report vaccine uptake among young adults aged 18 to 49 years is low. In Canada, the National Advisory Committee on Immunization (NACI) recommends influenza vaccination for adults in contact with young children, however vaccination rates for this specific population are missing. An estimate is required to identify appropriate public health interventions. The objective of this study was to describe recent trends in influenza vaccination uptake among Canadian adults aged 18 to 49 years old living with or without young children.Methods: The Canadian Community Health Survey (2013-2014) dataset, available for public use was used after grouping individuals by influenza vaccination uptake within the past year in adults aged 18 to 49 years. The relationship between living in a household with young children and influenza vaccination uptake was examined using a multivariable logistic regression model.Results: Among Canadian adults aged 18 to 49 years, the influenza vaccination uptake was 24.1% in adult household contacts with young children compared to 18.2% in those without young children (p<.0001). After adjusting for socio-demographic characteristics and self-perceived health, we determined that vaccine uptake was associated with living in a household with young children (adjusted OR: 1.30 [95%CI: 1.17-1.44]). While socio-demographic characteristics and self-perceived health greatly influenced influenza vaccination uptake, we also found marital status was a strong influencer of influenza vaccine uptake (adjusted OR: 1.31 [95%CI: 1.16-1.48]). Conclusion: Overall, influenza vaccination uptake among caregiving adults is low. Increased vaccine uptake was associated with living in a household with one or more young children. Targeted education and vaccination programs are required to improve uptake of the influenza vaccine in this age group.

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A Meta-Analysis of Influenza Vaccination Following Correspondence: Considerations for COVID-19

10.1101/2021.06.10.21258685 ◽

2021 ◽

Author(s):

Robert P Murphy ◽

Carol Taaffe ◽

Elayne Ahern ◽

Grace McMahon ◽

Orla Muldoon

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Publication Bias ◽

English Language ◽

Meta Analysis ◽

Group Analysis ◽

Vaccine Uptake ◽

Vaccination Rates ◽

Health Authorities ◽

Direct Correspondence

Background: High vaccination rates are needed to protect against influenza and to end the COVID-19 pandemic. Health authorities need to know if supplementing mass communications with direct correspondence to the community would increase uptake. Objectives: The primary objective is to determine if sending a single written message directly to individuals increases influenza vaccine uptake, and a secondary objective is to identify any identified content shown to increase influenza vaccine uptake. Methods: PubMed, PsycInfo and Web of Science were searched for English language RCTs testing a single correspondence for members of the community in OECD countries to obtain influenza vaccination. A meta-analysis with inverse-variance, random-effects modelling was used to estimate a mean, weighted risk ratio effect size measure of vaccine uptake. Studies were quality assessed and analysis was undertaken to account for potential publication bias. Results: Twenty-two randomized controlled trials were included covering 37 interventions. Of the 37 interventions, 32 (86%) report an increase in influenza vaccination rates. A formal meta-analysis shows that sending a single written message increases influenza vaccine uptake by 18% (RR = 1.18, 95%CI [1.13-1.22], Z = 8.56, p < .001) relative to the no contact comparator group. Analysis shows that the intervention is effective across correspondence type, age group, time, and location, and after allowing for risk of publication bias. Limitations: The review was restricted to English language publications, and the generalizability of results across the OECD may be questioned. Conclusions and implications: The implication for public health authorities organizing vaccination programs for influenza, and arguably also for COVID-19, is that sending written vaccination correspondence to members of the community is likely to increase uptake. Keywords: vaccine uptake, COVID-19, influenza, direct correspondence, meta-analysis.

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Factors That Influenced Rates of Influenza Vaccination Among Employees of Wisconsin Acute Care Hospitals and Nursing Homes During the 2005-2006 Influenza Season

Infection Control and Hospital Epidemiology ◽

10.1086/523866 ◽

2007 ◽

Vol 28 (12) ◽

pp. 1398-1400 ◽

Cited By ~ 20

Author(s):

Gwen Borlaug ◽

Alexandra Newman ◽

John Pfister ◽

Jeffrey P. Davis

Keyword(s):

Nursing Homes ◽

Influenza Vaccination ◽

Acute Care ◽

Influenza Season ◽

Acute Care Hospitals ◽

Vaccination Programs ◽

Vaccination Rates

Hospitals and nursing homes were surveyed in 2006 to obtain information on employee influenza vaccination programs and baseline rates of influenza vaccination among employees. Results were used to make recommendations for improving employees' 2007 influenza vaccination rates. Facilities should continue to provide convenient and free vaccination programs, offer education to promote vaccination, and use signed declination forms.

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The influence of a community intervention on influenza vaccination knowledge and behavior among diabetic patients

BMC Public Health ◽

10.1186/s12889-019-8101-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Lili Tao ◽

Ming Lu ◽

Xiaoning Wang ◽

Xiaoyan Han ◽

Shuming Li ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Community Intervention ◽

Vaccination Rate ◽

Control Group ◽

Diabetic Patients ◽

Vaccination Rates ◽

Significant Difference ◽

The Impact ◽

Experimental Group

Abstract Background This study was conducted to evaluate the impact of a comprehensive community intervention on cognition and inoculation behaviors of diabetic patients immunized with influenza vaccine. Methods A total of 1538 diabetic patients aged 35 years and above for outpatient visits and follow-up treatments were selected from six community health service centers (three for the experimental group, and the other three for the control group) in Chaoyang District, Beijing. Comprehensive interventions applied to the experimental group include patient intervention and community climate interventions. We compared the total awareness of influenza vaccine knowledge and influenza vaccination rates between the two groups before and after the intervention. Results Before the intervention, the total awareness rate of influenza vaccine in the experimental group and the control group was similar (50.6 and 50.2%, respectively. P = 0.171). After the intervention, the awareness rate of influenza vaccine in the experimental group and the control group increased. The amplitude of the increase was similar (70.3 and 70.1%, respectively. P = 0.822,). Before the intervention, there was no significant difference in the influenza vaccination rate between the experimental group and the control group (29.0 and 26.8%, respectively. P = 0.334). After the intervention, the vaccination rate of the experimental group was higher than that of the control group. The difference was statistically significant (The vaccination rate 45.8 and 27.4% for the experimental group and the control group, respectively. P < 0.001). Conclusion Comprehensive community interventions had a positive effect on vaccination in diabetic patients. Trial registration ChiCTR1900025194, registered in Aug,16th, 2019. Retrospectively registered.

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Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial

Journal of Occupational Medicine and Toxicology ◽

10.1186/s12995-020-00285-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Michael Currat ◽

Catherine Lazor-Blanchet ◽

Giorgio Zanetti

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Vaccination Campaign ◽

Intervention Group ◽

Vaccination Rate ◽

Health Check ◽

Control Group ◽

Vaccination Rates ◽

Newly Hired

Abstract Background Vaccination is the most effective prevention of seasonal influenza. Despite its recommendation and active promotion, vaccination coverage remains low among healthcare staff. The goal of the study was to test if a pre-employment health check is a good opportunity to promote future vaccination against influenza among healthcare workers newly hired by a university hospital. Methods All new hospital employees active at the bedside who underwent a pre-employment health check between the end of 2016’s influenza epidemic and the start of the next influenza vaccination campaign were randomly allocated to a control group or an intervention group. The intervention consisted of a semi-structured dialog and the release of an information leaflet about influenza and influenza vaccination during the check-up, and the shipment of a postcard reminder 2 weeks before the next vaccination campaign. Vaccination rates during the campaign were compared among the two groups. Results Three hundred fifty-seven employees were included. Vaccination rates were similar in both groups: 79/172 (46%) in the control and 92/185 (50%) in the intervention group. A significantly higher rate of vaccination was noted among physicians (70/117, 60%) than among other employees (101/240, 42%, p = 0.001). In a pre-defined exploratory analysis among physicians, the vaccination rate was higher in the intervention group (36/51, 71%) than in the control group (34/65, 52%, p = 0.046). Conclusions Promotion of the influenza vaccine during pre-employment health check did not improve the vaccination rate of newly hired hospital healthcare workers overall during the next influenza vaccination campaign. Results suggest a favourable impact on the vaccination rate of physicians. Thus, there may be an interest in using communication strategies tailored to the different categories of healthcare workers to promote the influenza vaccine during pre-employment health check. Trial registration ClinicalTrials, NCT02758145. Registered 26 April 2016.

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Influenza Vaccination Rates and Motivators Among Healthcare Worker Groups

Infection Control and Hospital Epidemiology ◽

10.1086/511796 ◽

2007 ◽

Vol 28 (2) ◽

pp. 171-177 ◽

Cited By ~ 91

Author(s):

Amanda Banks Christini ◽

Kathleen A. Shutt ◽

Karin E. Byers

Keyword(s):

Medical Students ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Tertiary Care ◽

Teaching Hospitals ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Influenza Like Illness ◽

Vaccination Rates ◽

Nursing Aides

Background.The rate of influenza vaccination among healthcare workers (HCWs) is approximately 40%. Differences in vaccination rates among HCW groups and reasons for accepting or rejecting vaccination are poorly understood.Objectives.To determine vaccination rates and motivators among different HCW groups during the 2004-2005 influenza season.Design.Cross-sectional survey conducted between July 10 and September 30, 2005.Setting.Two tertiary care teaching hospitals in an urban center.Participants.Physicians, nurses, nursing aides, and other staff. Surveys were collected from 1,042 HCWs (response rate, 42%).Results.Sixty-nine percent of physicians (n = 282) and 63% of medical students (n = 145) were vaccinated, compared with 46% of nurses (n = 336), 42% of nursing aides (n = 135), and 29% of administrative personnel (n = 144). Physicians and medical students were significantly more likely to be vaccinated than all other groups (P < .0001). Pediatricians (84%) were more likely than internists (69%) and surgeons (43%) to be vaccinated (P < .0001). Among the HCWs who were vaccinated, 33.4% received the live attenuated influenza vaccine (LAIV) and 66.6% received trivalent inactivated influenza vaccine (TIV). Vaccinated HCWs were less likely than unvaccinated HCWs to report an influenza-like illness (P = .03). Vaccination with LAIV resulted in fewer episodes of influenza-like illness than did receiving no vaccine (P = .03). The most common reason for rejecting vaccination was a concern about availability. Understanding that HCWs may transmit the virus to patients correlated with vaccine acceptance (P = .0004).Conclusions.Significant differences in vaccination exist among physician specialties and employee groups, and there are inadequate vaccination rates among those with the greatest amount of patient contact, potentially providing a basis for group-specific interventions.

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Impact of Severe Acute Respiratory Syndrome and the Perceived Avian Influenza Epidemic on the Increased Rate of Influenza Vaccination Among Nurses in Hong Kong

Infection Control and Hospital Epidemiology ◽

10.1086/527507 ◽

2008 ◽

Vol 29 (3) ◽

pp. 256-261 ◽

Cited By ~ 20

Author(s):

Dennise K. P. Tam ◽

Shui-Shan Lee ◽

Sing Lee

Keyword(s):

Hong Kong ◽

Avian Influenza ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Influenza Infection ◽

Vaccination Rate ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Major Barrier ◽

Vaccination Rates

Objective.To determine the rate of influenza vaccination and the factors associated with the vaccination's acceptance among nurses in Hong Kong.Design.Cross-sectional survey.Participants.Nurses practicing between 2003 and 2007.Methods.A questionnaire was sent to all nurses registered with any of the 3 nursing associations that participated in this study.Results.A total of 941 completed questionnaires were available for analysis, though not all nurses responded to every question (response rate, 33.5%-36.3%). Vaccination rates in 2006 and 2007 were 57.2% and 46.2%, respectively. Nurses who were vaccinated in 2006 were more likely to get vaccinated in 2007 (P<.01); 56% of the nurses perceived influenza vaccine as being effective against influenza. The perceived effectiveness of influenza vaccine was a consistent predictor of rates of vaccination in 2006 (odds ratio [OR], 8.47 [95% confidence interval {CI}, 6.13-11.70];P<.01) and 2007 (OR, 6.05 [95% CI, 3.79-9.67];P<.01). Concern about contracting avian influenza was a predictor of the vaccination rate in 2006 but not in 2007 (OR, 1.47 [95% CI, 1.03-2.09];P<.05), as was the perceived lack of control over avian influenza infection (OR, 1.52 [95% CI, 1.06-2.18];P<.05).Conclusions.The overall influenza vaccination rate for nurses in Hong Kong was about 50%. It was affected by the perceived threat of an impending outbreak. The attitudes of nurses toward the effectiveness of and rationale for vaccination were a major barrier to increasing the rate of vaccination.

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Effect of Personalized Messages Sent by a Health System’s Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial

Journal of General Internal Medicine ◽

10.1007/s11606-021-07023-w ◽

2021 ◽

Author(s):

Peter G. Szilagyi ◽

Christina S. Albertin ◽

Alejandra Casillas ◽

Rebecca Valderrama ◽

O. Kenrik Duru ◽

...

Keyword(s):

Older Adults ◽

Young Adults ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Health System ◽

Behavioral Science ◽

Patient Portal ◽

Vaccination Rates ◽

Loss Frame ◽

Gain Frame

Abstract Background Adult influenza vaccination rates are low. Tailored patient reminders might raise rates. Objective Evaluate impact of a health system’s patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults. Design Pragmatic 6-arm randomized trial across a health system during the 2019–2020 influenza vaccination season. The setting was one large health system—53 adult primary care practices. Participants All adult patients who used the patient portal within 12 months, stratified by the following: young adults (18–64 years, without diabetes), older adults (≥65 years, without diabetes), and those with diabetes (≥18 years). Interventions Patients were randomized within strata to either (1) pre-commitment reminder alone (1 message, mid-October), (2) pre-commitment + loss frame messages, (3) pre-commitment + gain frame messages, (4) loss frame messages alone, (5) gain frame messages alone, or (6) standard of care control. Patients in the pre-commitment group were sent a message in mid-October, asking if they planned on getting an influenza vaccination. Patients in loss or gain frame groups were sent up to 3 portal reminders (late October, November, and December, if no documented influenza vaccination in the EHR) about importance and safety of influenza vaccine. Main Measures Receipt of 1 influenza vaccine from 10/01/2019 to 03/31/2020. Key Results 196,486 patients (145,166 young adults, 29,795 older adults, 21,525 adults with diabetes) were randomized. Influenza vaccination rates were as follows: for young adults 36.8%, for older adults 55.6%, and for diabetics 60.6%. On unadjusted and adjusted (for age, gender, insurance, race, ethnicity, and prior influenza vaccine history) analyses, influenza vaccination rates were not statistically different for any study group versus control. Conclusions Patient reminders sent by a health system’s patient portal that were tailored to patient demographics (young adults, older adults, diabetes) and that incorporated two behavioral economic messaging strategies (pre-commitment and loss/gain framing) were not effective in raising influenza vaccination rates. Trial Registration This trial was registered with ClinicalTrials.gov (NCT04110314).

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