Evaluation of a legislatively mandated influenza vaccination program for adults in Rhode Island, USA.

CONTEXT: There have been disruptions in influenza vaccine supply in the United States during the 2000-2001, 2001-2002, 2004-2005, and 2005-2006 influenza seasons. Some providers received limited or no vaccine, while others obtained their order in full, depending on with whom the order was placed. A state law was passed that mandates the Rhode Island Department of Health to include the purchase and distribution of influenza vaccine for adults in its immunization program. OBJECTIVE: To evaluate the first 2 years of the statewide adult influenza immunization program. DESIGN: We conducted key informant interviews of 25 providers in 2008 and surveyed all enrolled providers in 2008 (year 1) and 2009 (year 2). SETTING: State of Rhode Island. PARTICIPANTS: Physician practices and facilities that provide influenza vaccination to adults, including private practices, nursing homes, health centers, urgent care facilities, hospitals, mass immunizers, and businesses. INTERVENTION: Enrolled providers received influenza vaccines free and billed insurers, Medicare, and Medicaid for vaccine administration costs. MAIN OUTCOME MEASURES: Provider satisfaction with different program components and overall satisfaction. RESULTS: For year 1, there was higher satisfaction with enrollment, training, vaccine ordering, and vaccine shipment than with paperwork and claims. Of the survey respondents, 71% reported that the program paperwork was reasonable and 30% reported difficulties in receiving reimbursement. Satisfaction with the vaccination start date of October 17, 2007, was 80%. There was high overall satisfaction (94%). In response to streamlining of reporting requirements and setting an earlier start date of October 7, 2008, for year 2, there was a significant increase in satisfaction with paperwork (89%) and with vaccination start date (90%). CONCLUSIONS: The findings may be useful in guiding the development of vaccination programs to provide influenza and other vaccines for adults at the state or national level.

Influenza vaccination concerns among older blacks: a randomized controlled trial.

CONTEXT: Vaccination can decrease the morbidity and mortality caused by influenza, yet vaccination rates remain low, especially among minority groups. Previous studies have found that important barriers to vaccination include the fear of adverse reactions and concern that the vaccine causes influenza. BACKGROUND: This research aimed to assess the effects of messages designed to address concerns about the safety and effectiveness of vaccination among blacks aged >or=50 years. DESIGN: In a randomized controlled trial conducted in 2007 with pre-exposure and post-exposure measurements, participants were randomly assigned to read either the vaccine safety messages (VSM) developed for the study (treatment condition) or the vaccine information statement (VIS) currently given to those getting the vaccine (control condition). SETTING/PARTICIPANTS: A total of 108 participants participated in the study. Data were collected in either participants' residences, community settings, or university conference rooms. MAIN OUTCOME MEASURES: Influenza vaccine-related beliefs and intention to receive vaccination were assessed. RESULTS: Data analysis in 2007 and 2008 found that the randomization hypotheses of equal groups were retained. Participants exposed to the VSM showed greater improvement in post-exposure beliefs about how the vaccine works (p=0.0006) and the transmission of the flu (p=0.0034) as well as greater post-exposure disagreement with the belief that the vaccine causes influenza (p=0.0411). CONCLUSIONS: The VSM affected beliefs about vaccine safety and effectiveness to a greater degree than did the VIS. These findings show that VSM are effective in changing beliefs empirically linked with influenza vaccination and vaccination disparities. The dissemination of VSM to older blacks may increase vaccination rates and reduce vaccination disparities.