Prenatal care providers and influenza prevention and treatment: lessons from the field.

To better understand the knowledge, attitudes, and behaviors of providers regarding influenza infection and vaccination in pregnancy, fourteen focus groups were conducted among 92 providers in Atlanta, GA; Dallas, TX; and Portland, OR in late 2009. NVivo 8.0 was used for analysis. Most providers had no experience with pregnant women severely affected by influenza. Many perceived the 2009 H1N1 pandemic to be limited and mild. Providers knew that pregnant women should receive the 2009 H1N1 vaccine and reported plans to vaccinate more patients than the previous season. Most knew CDC guidelines for antiviral treatment and prophylaxis, but some reported hesitancy with presumptive treatment. Although awareness of influenza's potential to cause severe illness in pregnant women was observed, providers' experience and comfort with influenza prevention and treatment was suboptimal. Sustained efforts to educate prenatal care providers about influenza in pregnancy through trusted channels are critical.

Pregnant and recently pregnant women's perceptions about influenza a pandemic (H1N1) 2009: implications for public health and provider communication.

The objective of this study was to explore pregnant and recently pregnant women's perceptions of influenza vaccine and antivirals during the 2009 H1N1 pandemic. We conducted 18 focus groups with pregnant and recently pregnant women in three US cities in September 2009. Participants were segmented into groups by insurance status (no or public insurance vs. private insurance), vaccine attitudes (higher vs. lower likelihood of acceptance of any vaccines, not only influenza vaccines), and parity (first child vs. other children in the home) based on information they provided on the screening questionnaire at the time of recruitment. We found that women are not well informed about influenza vaccinations and antiviral medicine and have significant concerns about taking them during pregnancy. An interest in their infant's well-being, however, can be strong motivation to adopt preventive recommendations, including vaccination. A woman's health care provider is a highly trusted source of information about the 2009 H1N1. Pregnant women have unique communication needs for influenza. Messages directing pregnant women to adopt public health recommendations, particularly for vaccination or prophylactic medication should include a detailed description of the benefits or lack of risk to the fetus and the safety of breastfeeding. Additionally, messages should recognize that pregnant women are taught to be selective about taking medication and provide a clear rationale for why the medicine or vaccine is necessary.

Prospective cost-benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking.

In the United States recording accurate vaccine lot numbers in immunization records is required by the National Childhood Vaccine Injury Act and is necessary for public health surveillance and implementation of vaccine product recalls. However, this information is often missing or inaccurate in records. The Food and Drug Administration (FDA) requires a linear barcode of the National Drug Code (NDC) on vaccine product labels as a medication verification measure, but lot number and expiration date must still be recorded by hand. Beginning in 2011, FDA permitted manufacturers to replace linear barcodes with two-dimensional (2D) barcodes on unit-of-use product labels. A 2D barcode can contain the NDC, expiration date, and lot number in a symbol small enough to fit on a unit-of-use label. All three data elements could be scanned into a patient record. To assess 2D barcodes' potential impacts, a mixed-methods approach of time-motion data analysis, interview and survey data collection, and cost-benefit analysis was employed. Analysis of a time-motion study conducted at 33 practices suggests scanning 2D-barcoded vaccines could reduce immunization documentation time by 36-39 s per dose. Data from an internet survey of primary care providers and local health officials indicate that 60% of pediatric practices, 54% of family medicine practices, and 39% of health departments would use the 2D barcode, with more indicating they would do so if they used electronic health records. Inclusive of manufacturer and immunization provider costs and benefits, we forecast lower-bound net benefits to be $310-334 million between 2011 and 2023 with a benefit-to-cost ratio of 3.1:1-3.2:1. Although we were unable to monetize benefits for expected improved immunization coverage, surveillance, or reduced medication errors, based on our findings, we expect that using 2D barcodes will lower vaccine documentation costs, facilitate data capture, and enhance immunization data quality.

Health plan use of immunization information systems for quality measurement.

OBJECTIVE: To evaluate a health plan's business case for using a state immunization information system (IIS) as the primary data source for members' immunization histories. STUDY DESIGN: Case study of Priority Health, a Michigan managed care organization, to investigate use of IIS data for Healthcare Effectiveness Data and Information Set (HEDIS) compliance, quality measurement, and a provider incentive program. METHODS: Primary data were collected through key informant interviews and group discussions with Priority Health and IIS managers. Priority Health's information systems were populated with claims data and supplemental data, before chart reviews, to simulate immunization and health plan quality measures for 2004 to 2007 in the absence of IIS data. Simulated rates were compared with historical rates that included IIS data. The study included a cost-benefit analysis. RESULTS: For 2007, IIS data increased observed immunization rates from 6.49 to 54.13 percentage points for childhood immunizations and 57.63 to 77.97 percentage points for adolescent immunizations. The HEDIS administrative rate for childhood immunizations doubled from 43.38% in 2003 to 88.08% in 2007. The most significant source of savings was in administration of the health plan's Physician Incentive Program, which saw 18,881 fewer chart reviews from 2004 to 2007 when IIS data were used compared with when they were not used. Total costs of using IIS data were estimated to be $14,318 and net benefits were $107,854 -- corresponding to a benefit-to-cost ratio of 8.06. CONCLUSIONS: Health plans using a state IIS as a single point of data entry may realize cost savings and have improved assurance of immunization coverage.

State plans for containment of pandemic influenza.

This review assesses differences and similarities of the states in planning for pandemic influenza. We reviewed the recently posted plans of 49 states for vaccination, early epidemic surveillance and detection, and intraepidemic plans for containment of pandemic influenza. All states generally follow vaccination priorities set by the Advisory Committee on Immunization Practices. They all also depend on National Sentinel Physician Surveillance and other passive surveillance systems to alert them to incipient epidemic influenza, but these systems may not detect local epidemics until they are well established. Because of a lack of epidemiologic data, few states explicitly discuss implementing nonpharmaceutical community interventions: voluntary self-isolation (17 states [35%]), school or other institutional closing (18 [37%]), institutional or household quarantine (15 [31%]), or contact vaccination or chemoprophylaxis (12 [25%]). This review indicates the need for central planning for pandemic influenza and for epidemiologic studies regarding containment strategies in the community.