EVALUATION OF A SIMPLE OFFICE-BASED STRATEGY FOR INCREASING INFLUENZAVACCINE ADMINISTRATION AND THE EFFECT OF DIFFERING REIMBURSEMENT PLANS ON THE PATIENT ACCEPTANCE RATE

Objective: To study an office-based strategy for increasing influenza vaccine delivery to high-risk patients at a university hospital genera l medicine practice. Design: Historically controlled study of physicia n practices in an out-patient general medicine setting. Setting: A gro up practice with two separate offices: a fee-for-service (FFS) office, where the patients pay the cost of immunizations, and a health mainte nance organization (HMO)-styled office, where the costs for immunizati ons are fully covered by the insurer. Patients: All outpatients seen a t each practice setting from October to December, 1991. Intervention: For each patient visit, a simple reminder data sheet was completed by the clinician detailing the vaccination eligibility (Centers for Disea se Control and Prevention criteria) and status of the patient, the rea sons for failure to vaccinate eligible patients, and 1990 vaccination information. Results: During the study period, 511 patients were seen by the practice (353 in the FFS office, 158 in the HMO office), 297 pa tients (58%) were eligible for vaccination; 219 in the FFS office, 78 in the HMO office (p < 0.01). At the end of the study period, 73% of a ll the eligible patients were vaccinated: 67% of the FFS patients vs 9 0% of the HMO patients (p < 0.01), 22% of the eligible patients refuse d vaccination: 27% in the FFS office vs 9% in the HMO office (p < 0.01 ), 11% of the eligible FFS patients vs 0% of the eligible HMO patients refused vaccination due to vaccine cost (p < 0.05). Of the eligible p atients seen at the two offices in both 1990 and 1991, 50% were vaccin ated in 1990 (preintervention) vs 66% in 1991 (postintervention) (p < 0.01). Conclusions: As shown in this study, a simple, low-cost office- based reminder system can significantly increase the influenza vaccina tion rate for high-risk outpatients and can help meet national vaccina tion rate goals. Vaccine cost to patients may be a barrier to vaccine acceptance, in some cases.