Evaluation of a legislatively mandated influenza vaccination program for adults in Rhode Island, USA.

CONTEXT: There have been disruptions in influenza vaccine supply in the United States during the 2000-2001, 2001-2002, 2004-2005, and 2005-2006 influenza seasons. Some providers received limited or no vaccine, while others obtained their order in full, depending on with whom the order was placed. A state law was passed that mandates the Rhode Island Department of Health to include the purchase and distribution of influenza vaccine for adults in its immunization program. OBJECTIVE: To evaluate the first 2 years of the statewide adult influenza immunization program. DESIGN: We conducted key informant interviews of 25 providers in 2008 and surveyed all enrolled providers in 2008 (year 1) and 2009 (year 2). SETTING: State of Rhode Island. PARTICIPANTS: Physician practices and facilities that provide influenza vaccination to adults, including private practices, nursing homes, health centers, urgent care facilities, hospitals, mass immunizers, and businesses. INTERVENTION: Enrolled providers received influenza vaccines free and billed insurers, Medicare, and Medicaid for vaccine administration costs. MAIN OUTCOME MEASURES: Provider satisfaction with different program components and overall satisfaction. RESULTS: For year 1, there was higher satisfaction with enrollment, training, vaccine ordering, and vaccine shipment than with paperwork and claims. Of the survey respondents, 71% reported that the program paperwork was reasonable and 30% reported difficulties in receiving reimbursement. Satisfaction with the vaccination start date of October 17, 2007, was 80%. There was high overall satisfaction (94%). In response to streamlining of reporting requirements and setting an earlier start date of October 7, 2008, for year 2, there was a significant increase in satisfaction with paperwork (89%) and with vaccination start date (90%). CONCLUSIONS: The findings may be useful in guiding the development of vaccination programs to provide influenza and other vaccines for adults at the state or national level.