1. Influenza Information Needs of Primary Care Physicians
Sarah Clark
Child Health Evaluation and Research (CHEAR) Unit
University of Michigan
National Immunization Conference
March 30, 2011

2. Funding Statement
Collaborators: Anne Cowan, University of Michigan, and Pascale Wortley, CDC
No financial disclosures
This study was funded by a cooperative agreement with the Centers for Disease Control and Prevention, in conjunction with the Association of Prevention Teaching and Research. The findings are those of the authors, and do not represent an official viewpoint of the CDC.

3. Background
An estimated 2/3 of influenza vaccine is administered in medical settings
Likely a substantial proportion is given by primary care providers.
Influenza vaccination can be tricky!
Changing recommendations
Dealing with shortages, delayed shipments, and new products

4. Objective
To understand the information needs of primary care providers related to influenza vaccination

5. Methods – Study Design Cross-sectional mailed survey
Fielded July-September 2010
National random sample of
1500 Family Practice(FPs)
1500 General Internal Medicine (IMs)
1500 Pediatrics (PDs)
included office-based physicians
excluded specialists, age >70 years, currently in residency training, not providing direct patient care

6. Methods – Survey Instrument
plans for providing flu vaccine for the influenza season
provision of H1N1 vaccine during the influenza season
priority rating (high/medium/low) for additional guidance on influenza-related issues
practice setting
membership in professional medical society (AAFP, ACP, AAP)

7. Results Response Rate: 70% overall
(70% FPs, 63% IMs, 77% PDs)
Included in Analysis: 2,447 respondents who provide outpatient primary care, including immunization services
(856 FPs, 625 IMs, 966 PDs)

8. Results - DemographicsFP IM PD
Practice setting *
Private independent practice / Network
Hospital / Health system
Public clinic / Community health center
70%
19%
11%
74% 7%
80%
13%
Member of professional medical society (AAP, AAFP, ACP)*
Member
Non-member
82%
18%
55%
45%
88%
12%
* Differences between specialty groups significant at p<0.0001

9. Results – Flu Vaccine in PracticeFP IM PD
Plan to offer influenza vaccine for season
Injectable vaccine
Intranasal vaccine (LAIV)*
99%
44%
24%
90%
* Differences between specialty groups significant at p<0.001

10. Results - LAIV LAIV least available in private practice
FP: 40% private, 50% hospitals, 62% public clinics
IM: 22% private, 31% hospitals, 33% public clinics
PD: 88% private, 95% hospitals, 97% public clinics

11. Results – H1N1 Vaccine FP IM PDFP IM PD
Participation in H1N1 vaccination in *
Offered vaccine in practice
Agreed to participate but no vaccine
Did not agree/know to participate
82% 7%
11%
74% 9%
17%
93% 2% 5%
* Differences between specialty groups significant at p<0.001

12. Results – Information Priorities
“Please prioritize your needs for additional guidance on the following.”

13. Subpopulations to prioritize if flu vaccine is limited

14. Associations: Subpopulations
Highest priority information need for all three primary care groups
No consistent patterns of association by age, gender, practice setting, board certification, or specialty society membership

15. When to use injectable vs. intranasal vaccine

16. Associations: When to use LAIV
Higher priority if LAIV offered in practice
FP: 29% vs 11%
IM: 28% vs 13%
PD: 22% vs 16%
Over half of physicians who don’t have LAIV say it’s a low priority to know when to use it
Makes sense
How to get it on radar?

17. Staff education on administration of LAIV vaccine

18. Associations: Staff LAIV Education
Higher priority if LAIV offered in practice
FP: 29% vs 18%
IM: 32% vs 21%
PD: 23% vs 15%
Higher priority among physicians who are NOT board certified

19. Optimal timing of flu vaccination for pregnant women

20. Associations: Pregnant Women
Not a big priority for PDs
No consistent patterns of association by age, gender, practice setting, board certification, or specialty society membership

21. Number of doses needed for children
Not asked of IMs

22. Associations: Child Doses
Higher priority for older PDs
PDs <40 yrs: 32%
PDs yrs: 32%
PDs >55 yrs: 43%
No other patterns of association

23. Use of higher dose formulation for elderly
Not asked of PDs

24. Associations: Higher Dose for Elderly
Higher priority for females
FP: 55% female, 43% male
IM: 59% female, 46% male
Higher priority for older FPs, not IMs
FPs <40 yrs: 41%
FPs yrs: 47%
FPs >55 yrs: 54%

25. Limitations Response bias
Data are reported information. May not translate to:
Information-seeking behaviors
Receptiveness to education

26. Conclusions
Primary care providers recognize several information priorities around flu vaccine
Subpopulations to prioritize in shortage situation
Use of higher-dose formulation for elderly
Lack of priority for LAIV issues is significant
Suggests that promoting increased use of LAIV will be a challenge
Further work is warranted, if goal is universal influenza vaccination

27. Contact
Sarah Clark