Attending Physician Seasonal Influenza Vaccine Rates and Practice Settings

Background: Factors that influence whether an attending physician (MD) reports receiving seasonal influenza vaccine (Fluvac) are not readily known.  Many facilities have focused efforts on compliance by paid employees.  Under the California SB 739, Fluvac was first reportable during the 2007-2008 season and non-employee physicians were added in subsequent years.  Hospitals have challenges in collecting required data on MD Fluvac rates.

Objective: Compare MD Fluvac rates during the 2009-2010 flu season in two hospitals with differing characteristics.  Hospital A is a 408 bed non-profit community hospital located in downtown Los Angeles.  MDs are self-employed in private practice and see patients in multiple facilities. The facility’s service lines include a 23 bed Level II NICU, but no pediatric units.  Hospital B is a 238 bed free standing, tertiary, academic Children’s hospital with a level III/IV NICU located in Orange County, Ca.  Twenty five percent of MDs practice exclusively at this facility, another 25% practice the majority of their time at this facility and the remaining 50% are self-employed private practice community pediatricians who see patients in multiple facilities.

Methods: Fluvac was offered free to MDs in both facilities in similar promotional programs; grand rounds, Fluvac clinics and mobile carts.  A combination of self-reporting forms and documented vaccine administration were used.  Hospital A sent notices tied to medical staff dues while Hospital B sent notices separately. At both facilities, MDs were asked to document whether they took Fluvac at the facility or elsewhere or if they declined, reason for declination. Hospital B asked all staff and physicians who declined Fluvac to mask from 12/1-3/31. 

Results: At both hospitals response forms were tabulated by infection prevention staff.   Hospital A’s  compliance was 43% (N=600) with 9.3% (N=56) declining vaccine for various reasons. At Hospital B compliance was 61% (N=667) with 0.9% (N=6) declinations.  Conversely, the medical residents who are handled as employees obtained 100% compliance. A higher than expected number of physicians did not return form/no response; for Hospital A, 48% (N=287) and Hospital B 39% (N=257).

Conclusions: Reasons for MD non-compliance included; too busy to respond, no consequences for non-compliance, or do not view themselves at risk for acquisition or transmission of influenza.  The higher Fluvac rate at Hospital B may reflect the MD’s increased concern for transmission of influenza to the pediatric population; increased severity of H1N1 disease in pediatric patients and/or the requirement of masking for those who declined vaccine.    In addition, it may be more meaningful, although labor intensive, to collect data based on who provides patient care, administrative roles and those who have little contact during the influenza season.  This risk assessment may help focus vaccination efforts and improve compliance rates.