Evaluation of a simple office-based strategy for increasing influenza vaccine administration and the effect of differing reimbursement plans on the patient acceptance rate.

Abstract

To study an office-based strategy for increasing influenza vaccine delivery to high-risk patients at a university hospital general medicine practice. Historically controlled study of physician practices in an outpatient general medicine setting. A group practice with two separate offices: a fee-for-service (FFS) office, where the patients pay the cost of immunizations, and a health maintenance organization (HMO)-styled office, where the costs for immunizations are fully covered by the insurer. All outpatients seen at each practice setting from October to December, 1991. For each patient visit, a simple reminder data sheet was completed by the clinician detailing the vaccination eligibility (Centers for Disease Control and Prevention criteria) and status of the patient, the reasons for failure to vaccinate eligible patients, and 1990 vaccination information. During the study period, 511 patients were seen by the practice (353 in the FFS office, 158 in the HMO office). 297 patients (58%) were eligible for vaccination; 219 in the FFS office, 78 in the HMO office (p < 0.01). At the end of the study period, 73% of all the eligible patients were vaccinated: 67% of the FFS patients vs 90% of the HMO patients (p < 0.01). 22% of the eligible patients refused vaccination: 27% in the FFS office vs 9% in the HMO office (p < 0.01). 11% of the eligible FFS patients vs 0% of the eligible HMO patients refused vaccination due to vaccine cost (p < 0.05). Of the eligible patients seen at the two offices in both 1990 and 1991. 50% were vaccinated in 1990 (preintervention) vs 66% in 1991 (postintervention) (p < 0.01). As shown in this study, a simple, low-cost office-based reminder system can significantly increase the influenza vaccination rate for high-risk outpatients and can help meet national vaccination rate goals. Vaccine cost to patients may be a barrier to vaccine acceptance, in some cases.