Physician barriers in recommending flu vaccine to healthy pregnant women

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Arao, Robert F.
Oregon Health & Science University
Immunization; Physician and patient; Physicians -- Attitudes; Prenatal care; Influenza vaccines; Physician-Patient Relations; Culture; Attitude of Health Personnel; Prenatal Care; Influenza Vaccines
thesis / dissertation description
Background: Pregnancy is an immunosuppressed state which develops so that a woman may tolerate a genetically different fetus. This suppressed state poses an increased risk of infections such as influenza among pregnant women. In fact, several established organizations including the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Advisory Committee of Immunization Practices (ACIP) have proposed that all women who are pregnant during the influenza season should be vaccinated [superscript 1-5]. Despite federal and state recommendations, only 51% of surveyed pregnant women in the US were estimated to have received the influenza vaccine during the 2009-2010 influenza season [superscript 6]. Objective: The main purpose of this study is to determine if a physician’s specialty background and practice location affect routine recommendation (i.e. 91-100% of the time) of flu vaccine to healthy pregnant women. In addition, this study aims to identify physician barriers to offering flu vaccine to pregnant patients. These barriers include beliefs, lack of proper storage facilities, cost, and whether or not offering flu vaccine to pregnant patients is part of routine patient-care activities. Study Design: A cross-sectional survey of Obstetrics and Gynecology (OB/GYN) and Family Medicine (FM) physicians who have active licenses with Oregon’s Board of Medical Examiners (BME) and have provided prenatal care within the last 12 months. Methods: This study uses a mixed-mode design. A self-administered, paper survey was initially sent out to 1,114 physicians with an attached cover letter and a pre-paid return envelope. These physicians were given an option to return the questionnaire through regular mail, on-line internet form, fax, or email. Two weeks after the initial mail-out, reminder postcards were sent out to non-responders. Final reminders were done by telephone communication and occurred four weeks after the initial mail-out. Analysis: Responses to each question were compared by specialties (OB/GYN vs. FM) and location (rural vs. urban) using Yates Corrected χ[superscript 2] or Fishers Exact Test when more than 25% of the cells had expected counts less than 5. All p-values were compared to an alpha significance level of .05. All statistical analysis, tables and figures were done using SAS v9.3 and Stata/IC 11.2. Results: Of the 1,114 providers surveyed, 496 (44.5%) completed the survey. Twenty-nine subjects were either unreachable or inactive and were dropped from the study producing an adjusted response rate of 45.7%. Among the 496 completed surveys, 187 (37.7%) provided prenatal care