Missed opportunities for influenza vaccination in children with chronic medical conditions.

OBJECTIVES To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and, among unimmunized children in that group, to explore parent-reported reasons for not vaccinating their child. DESIGN Prospective cohort study. Data were obtained from billing and immunization registry databases and telephone interviews of parents. SETTING Four pediatric practices in metropolitan Denver, Colo, during the 2002-2003 influenza season. PARTICIPANTS Children aged 6 to 72 months with 1 or more chronic medical conditions. Main Outcome Measure A missed opportunity for influenza immunization, defined as having a billed encounter, being eligible for immunization, and not receiving vaccine. Subjects with asthma were analyzed separately from those with other conditions. RESULTS We identified 926 children with chronic conditions: 820 (89%) with asthma only and 106 (11%) with other conditions. Missed opportunities occurred at 78% of all vaccine-eligible visits for children with asthma and 74% of all visits for children with other conditions. For children with asthma, 92% of vaccine-eligible visits in December and January resulted in a missed opportunity vs 69% in October and November; for children with other conditions, corresponding frequencies were 86% vs 68%, respectively. For children with asthma, 86% of non-well-child visits resulted in a missed opportunity, compared with 62% of well-child visits; similar frequencies were seen among children with other chronic conditions. Parents of unimmunized children reported lack of a physician recommendation and low perceived susceptibility to influenza as the primary reasons for not immunizing their child. CONCLUSION Missed opportunities contribute significantly to low influenza immunization rates among children with chronic medical conditions.