Author Affiliations: RAND Health, RAND Corporation, Arlington, Virginia.
Despite broad recommendations and substantial evidence regarding effectiveness and safety, influenza vaccine uptake among US adults falls short of targeted rates.1,2 Rigorously designed studies have shown that patient reminders are highly effective in improving influenza immunization rates.3,4 Yet, there are no nationally representative data concerning the share of adults who currently receive influenza vaccination reminders, and there is no evidence regarding the targeting of these reminders toward patients recommended for vaccination.1 We present herein nationally representative estimates of self-reported receipt of a reminder to be vaccinated against influenza among US adults and show how reminder receipt varies by recommendation status.
We analyzed data from a nationally representative survey of US adults 18 years and older (N = 5105) fielded by Knowledge Networks (Menlo Park, California) between March 4 and April 7, 2009. Knowledge Networks operates an online panel of households that covers both the online and offline population.5 Sixty-nine percent of sampled panelists responded to the survey.
The survey asked respondents about receipt of a postcard, letter, e-mail, or telephone call reminder concerning influenza vaccination from (1) a physician, (2) a nurse, physician's assistant, or other health care provider, (3) a health insurance or health plan, (4) a health department, or (5) an employer during the last fall season, allowing for multiple responses. We merged categories (1) and (2) into a combined category “health care provider.”
We assessed membership in a subgroup for whom vaccination against seasonal influenza is specifically recommended using measures of self-reported age (50 years and older), health conditions (diabetes, heart disease, chronic lung disease, asthma, immune system problems, kidney disease, and sickle cell disease or hemophilia), informal caregiving (to seriously ill persons or children younger than 5 years) or health care worker status derived from occupation information.1 All data were weighted to be nationally representative by using poststratification weights that account for sample design effects and the oversampling of health care workers. All calculations were performed using STATA SE version 10.1 statistical software (StataCorp, College Station, Texas).
The Table presents estimates of influenza vaccination reminder receipt among US adults both overall and by recommendation status and reminder source. Of the US adult population, 23.2% received an influenza vaccination reminder during the 2008-2009 vaccination season. Overall, employers were the most important source of vaccination reminders, reaching 10.3% of all adults, which was ahead of health care providers and health insurance companies, reaching 8.4% and 6.3% of adults, respectively.
Reminder receipt does not appear to be systematically higher among subpopulations specifically recommended for vaccination. Health care workers are an important exception, with 36.8% reporting the receipt of a vaccination reminder. The higher rate of reminder receipt among health care workers, in turn, reflects a higher propensity of reminder use among their employers.
Health care providers and health plans appear to target patients at risk for influenza-related complications (50 years and older and the presence of high-risk health conditions). The targeting of high-risk subpopulations, however, does not translate into a higher overall rate of reminder receipt among those groups, since high-risk individuals are less likely to receive a vaccination reminder from their employer.
Only approximately 1 in 4 US adults reported receipt of a vaccination reminder during the 2008-2009 vaccination season, despite their well-documented effectiveness in improving immunization rates. Thus, our results highlight the large potential of more widespread use of vaccination reminders to increase influenza vaccine uptake. Moreover, the relatively low share of adults receiving vaccination reminders from health care providers and the limited variation of reminder receipt by health risk factors suggest that primary care providers could make better use of patients' medical records in order to effectively target influenza immunizations according to need.
Correspondence: Dr Maurer, RAND Health, RAND Corporation, 1200 S Hayes St, Arlington, VA 22202 (firstname.lastname@example.org).
Author Contributions:Study concept and design: Maurer and Harris. Acquisition of data: Maurer and Harris. Analysis and interpretation of data: Maurer and Harris. Drafting of the manuscript: Maurer and Harris. Critical revision of the manuscript for important intellectual content: Maurer and Harris. Statistical analysis: Maurer. Obtained funding: Harris. Administrative, technical, and material support: Maurer. Study supervision: Harris.
Financial Disclosure: None reported.
Funding/Support: This study was supported by GlaxoSmithKline.
Role of the Sponsor: The sponsor had no role in the research design or in the preparation, review, or approval of the manuscript.
Disclaimer: The study design, data management, analysis, and opinions expressed herein are solely those of the authors and do not represent those of RAND or GlaxoSmithKline.
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