title: Effectiveness of primary care-public health collaborations in the delivery of influenza vaccine: a cluster-randomized pragmatic trial.
abstract: OBJECTIVE
  To assess effectiveness and feasibility of public-private collaboration in delivering influenza immunization to children.
  
  
  METHODS
  Four pediatric and four family medicine (FM) practices in Colorado with a common public health department (PHD) were randomized at the beginning of baseline year (10/2009) to Intervention (joint community clinics and PHD nurses aiding in delivery at practices); or control involving usual care without PHD. Generalized estimating equations compared changes in rates over baseline between intervention and control practices at end of 2nd intervention year (Y2=5/2011). Barriers to collaboration were examined using qualitative methods.
  
  
  RESULTS
  Overall, rates increased from baseline to Y2 by 9.2% in intervention and 3.2% in control (p<.0001), with significant increases in both pediatric and FM practices. The largest increases were seen among school-aged and adolescent children (p<.0001 for both), with differences for 6-month-old to 5-year-old children and for children with high-risk conditions not reaching significance. Barriers to collaboration included uncertainty regarding the delivery of vaccine supplies, concerns about using up all purchased vaccine by practices, and concerns about documentation of vaccination if collaboration occurred.
  
  
  CONCLUSIONS
  In spite of barriers, public-private collaboration resulted in significantly higher influenza immunization rates, particularly for older, healthy children who visit providers less frequently.
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA; Department of Pediatrics, University of Colorado, Aurora, CO, USA; The Colorado Health Outcomes Program, University of Colorado, Aurora, CO, USA. Electronic address: allison.kempe@childrenscolorado.org.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA; The Colorado Health Outcomes Program, University of Colorado, Aurora, CO, USA; Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA; Department of Pediatrics, University of Colorado, Aurora, CO, USA.
authors.forename: S
authors.initials: S
authors.lastname: O'Leary
authors.affiliation: National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Kolasa
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Juliana
authors.initials: J
authors.lastname: Barnard
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Deidre
authors.initials: D
authors.lastname: Kile
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Lockhart
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA; Department of Family Medicine, University of Colorado, Aurora, CO, USA.
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Doron
authors.initials: D
authors.lastname: Shmueli
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Babbel
authors.affiliation: Children's Outcomes Research Program, The Children's Hospital, Aurora, CO, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barrow
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D003299:Cooperative Behavior; D005194:Family Practice; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D010372:Pediatrics; D011320:Primary Health Care / Q000458:organization & administration*; D011635:Public Health Administration
chemical_list: D007252:Influenza Vaccines
keywords: Immunization delivery; Influenza vaccine; Preventive health