Why are influenza vaccination rates low and Tdap vaccination rates average in a large military treatment facility? Survey results from providers and patients

Objective: The study objective was to determine why vaccination rates in a Military Treatment Facility, where patients have ready access to care at no cost, differ from the general population. Methods: Influenza and Tdap vaccination rates for pregnant women were analyzed at Womack Army Medical Center from October 1, 2015 to September 30, 2018. Provider and patient surveys were conducted to evaluate barriers. All analyses were descriptive and conducted using SAS 9.4 (SAS Institute, Cary NC) or SPSS 25 (IBM Corp, Armock NY). Results: 9,448 pregnancies were included. The influenza vaccination rate was 36.7% and 56.4% for Tdap. Providers reported offering vaccinations at >90% of visits, whereas only 60% of patients reported being offered vaccination. 73.4% and 64.4% of patients declining vaccination reported the risks and benefits were not discussed for influenza and Tdap, respectively. Patients reported “provider recommendation” was the most important factor when choosing to receive vaccinations. Conclusion: Our influenza vaccination rate was lower and Tdap rate was average compared to the general population. The surveys suggest that provider and patient communication is a significant barrier to vaccination during pregnancy. Providers lending strong support to vaccinations during pregnancy and taking time to address concerns may be key to improving vaccination rates. *Correspondence to: Megan Pagan, MD, University of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 4301 W. Markham Street, Little Rock, AR 72202, USA, E-mail: mpagan@uams.edu