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Do providers differentially recommend influenza vaccinations to certain patient groups?
Seasonal influenza infections cause thousands of excess deaths per year in the United States (US) and are associated with substantial hospitalizations and medical costs. Provider recommendations are consistently recognized as an important contributor to increasing influenza vaccination rates. However, patients receiving a provider recommendation, and subsequently an influenza vaccination, may be different from patients not receiving a provider recommendation. This endogeneity exists because sick patients may perceive a higher value of seeking provider counseling on influenza infections.
Objective
Examine the effects of patient characteristics on provider recommendations for influenza vaccinations. This study tests the hypothesis that providers differentially targeted their influenza vaccine recommendations to certain patient groups. This study focuses on equity issues (racial disparities in provider recommendation rates) and efficiency issues (whether providers are more likely to recommend vaccinations to high priority groups).
Methods
The National 2009 H1N1 Flu Survey (NHFS) provides the largest and most comprehensive data available to study the role of provider recommendations in influenza vaccinations. The NHFS surveyed households in all 50 states and the District of Columbia conducted from October 2009 through June 2010. The NHFS asked questions on the following topics: seasonal and H1N1 influenza vaccination status, influenza-related behaviors, opinions about influenza vaccine safety and effectiveness, and household and individual demographic characteristics.
This study analyzed provider recommendation rates among nationally representative adults 18 to 65+ years of age (unweighted N=23358) and children 6 months to <18 years of age (unweighted N=5088). The primary outcome measure is the survey respondent’s response to whether their provider personally recommended they receive a flu vaccination during the 2009-10 flu season. A series of multivariate regression models compared changes in provider recommendations within patient sociodemographic groups.
Results
Preliminary analyses show 36.1% and 26.9% of all US adults received a provider recommendation for seasonal and H1N1 flu vaccinations during the 2009-2010 flu season after visiting their provider, respectively. Similarly, 46.4% and 44.6% of all US children received a provider recommendation for seasonal and H1N1 flu vaccination for the same time period, respectively. Multivariate analyses of adults and children found significant (P <0.05) associations between provider recommendations and high priority groups (i.e., infant children, elderly adults, and chronically ill patients). Unlike the adult population, racial disparities exist where minority children are more likely to receive a provider recommendation. Moreover, disparities exist between child insurance status and provider recommendations for seasonal and H1N1 flu vaccinations. Among US adults, significant associations between provider recommendations and self-perceived poor vaccine effectiveness and safety effects suggest providers are less likely to target these patient groups.
Conclusion
The likelihood of a provider recommendation for flu vaccination demonstrates expected patterns by age and health status for US adults and children. Among US adults, the self-perceived vaccine effectiveness and safety effects suggest providers may need to engage such individuals of the benefits of immunization. Among children, racial and socioeconomic disparities in provider recommendations merit further consideration in empirical work.