Physician perspectives regarding annual influenza vaccination among children with asthma

Objective.-National guidelines have historically varied for influenza vaccination of children with asthma, depending on asthma severity. This study aims to explore perspectives of primary care physicians regarding influenza vaccination practices for children with persistent versus intermittent asthma. Methods.-A cross-sectional survey was mailed to general pediatricians (n = 300) and family physicians (n = 300) in primary care offices in Michigan in 2006. The main outcome measures included physicians' influenza vaccination recommendations and reasons for nonadministration of influenza vaccine to children with asthma for the 2005-2006 influenza season. Results.-Ninety-six percent of respondents (N = 320) reported routinely recommending influenza vaccination for children with persistent asthma; fewer (82%) reported routinely recommending influenza vaccination for those with intermittent asthma. The adjusted odds of recommending influenza vaccination for intermittent asthma patients was significantly higher among pediatricians versus family physicians (adjusted odds ratio 3.49, 95% confidence interval, 1.68-7.22), controlling for other practice characteristics. Regardless of specialty, physicians with more than 25 asthma patients were more likely than those with fewer asthma patients to routinely recommend influenza vaccination. Physicians who do not routinely recommend influenza vaccination to children with intermittent asthma were more likely to cite overlooking discussion of influenza vaccine during the visit (50% vs 13%, respectively P <.0001) as a reason for lack of vaccination. Conclusions.-Influenza vaccination practices of primary care physicians reflect the inconsistencies historically found in national recommendations. Further research is warranted to determine whether the recent clarification of recommendations of the National Asthma Education and Prevention Program (NAEPP) to remove distinctions by asthma severity is associated with a reduction in missed opportunities to vaccinate.