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Implications for Universal Influenza Vaccination

Peter G. Szilagyi, MPH, MD; Marika K. Iwane, MPH, PhD; Sharon E. Humiston, MPH, MD; Stanley Schaffer, MS, MD; Thomas McInerny, MD; Laura Shone, MSW; Jacqueline Jennings, RPA-C; Michael L. Washington, PhD; Ben Schwartz, MD

Arch Pediatr Adolesc Med. 2003;157:191-195.

Objective  To measure the time currently spent by primary care practice personnel, and the examination room occupancy time for childhood influenza vaccination visits, to assess the practicality of annual influenza vaccination of all preschool children.

Setting  Seven primary care practices serving one fourth of the children living in Rochester, NY.

Patients  Ninety-two children seen for influenza vaccination visits in the 2000-2001 vaccination season.

Methods  Using a standardized protocol, practice staff measured the time spent on check-in, nurse or physician examination, and the actual influenza vaccination process. Waiting and "hands-on" times were determined, as well as total visit and room occupancy times. Nonparametric tests and multivariable models were used to analyze the time spent for components of the visits and to compare time spent by different age groups and practice types (suburban or urban).

Results  The median duration of the influenza vaccination visit was 14 minutes (25th to 75th percentiles range, 9-25 minutes) across the 7 practices, with visits to urban practices being longer (22 minutes) than visits to suburban practices (9 minutes). Eighty percent of patient time involved waiting, primarily in examination rooms. The major components of influenza vaccination visits included waiting room time (4 minutes in suburban practices vs 8 minutes in urban practices; P<.01), and time in the examination room (5 minutes vs 14 minutes, respectively; P<.001), during which only 1 to 2 minutes (for both suburban and urban practices) were for hands-on vaccinations. Only 5% of visits were examined by a physician or nurse practitioner. Visit times did not vary by age.

Conclusions  Although the personnel time for influenza vaccination visits was short, there was substantial patient waiting and long occupancy of examination rooms. If universal influenza vaccination is to be efficiently managed in primary care practices, it may be necessary to implement "vaccination clinics" or sessions in which large numbers of children are scheduled for influenza vaccinations at times when adequate rooms and dedicated nursing staff are available.

From the New Vaccine Surveillance Network (Drs Szilagyi, Iwane, Humiston, Schaffer, McInerny, Washington, and Schwartz, and Mss Shone and Jennings); the Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY (Drs Szilagyi, Humiston, Schaffer, and McInerny, and Mss Shone and Jennings); and the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Iwane, Washington, and Schwartz).

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