Clinical study
What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and veterans affairs practices

https://doi.org/10.1016/S0002-9343(02)01421-3Get rights and content

Abstract

Background

Despite strong evidence of the effectiveness of influenza vaccination, immunization rates have reached a plateau that is below the 2010 national goals. Our objective was to identify facilitators of, and barriers to, vaccination in diverse groups of older patients.

Methods

A survey was conducted in 2000 by computer-assisted telephone interviewing of patients from inner-city health centers, Veterans Affairs (VA) outpatient clinics, rural practices, and suburban practices. The inclusion criteria were age ≥66 years and an office visit after September 30, 1998.

Results

Overall, 1007 (73%) interviews were completed among 1383 patients. Influenza vaccination rates were 91% at VA clinics, 79% at rural practices, 79% at suburban practices, and 67% at inner-city health centers. There was substantial variability in vaccination rates among practices, except at the VA. Nearly all persons who were vaccinated reported that their physicians recommended influenza vaccinations, compared with 63% of unvaccinated patients (P <0.001). Thirty-eight percent of unvaccinated patients were concerned that they would get influenza from the vaccine, compared with only 6% of vaccinated persons (P <0.001). Sixty-three percent of those vaccinated, in contrast with 22% of unvaccinated persons, thought that an unvaccinated person would probably contract influenza (P <0.001).

Conclusion

Older patients need intentional messages from physicians that recommend vaccination. Furthermore, more patient education is needed to counter myths about adverse reactions.

Section snippets

Subjects

We selected patients using a two-stage, stratified, random cluster sampling method (11). In the rural and suburban strata, random samples of practices were selected. All inner-city and VA practices were selected because of small numbers. From each selected practice, all eligible physicians were included; eligibility criterion was having a practice consisting of >50% primary care patients. This resulted in a sample of eight rural practices with 15 clinicians, nine suburban practices with 19

Results

We sent requests for participation to 1642 persons and found 259 to be ineligible or with invalid telephone numbers, leaving 1383 potential respondents. When we concluded interviewing, we had 1007 completed interviews (Table 1), 227 refusals, and 149 persons whom we were unable to contact, which yielded a response rate of 73%.

Nine respondents reported not knowing their vaccination status and were excluded from analyses on vaccination status. Overall, 79% (n = 787) of respondents reported being

Discussion

Nearly every elderly person who was vaccinated in the 1999-2000 season said that they planned to be vaccinated the next year, compared with only one quarter of those who were not vaccinated. We found that intention was the strongest predictor of behavior. Other key factors were knowledge of Medicare payment for the vaccine, belief that being vaccinated was a wise decision, belief in the vaccine’s efficacy, and belief that others (especially one’s doctor) recommended vaccination. Economics,

Acknowledgements

We thank Seymour Grufferman, MD, DrPH, for his advice and guidance on this project.

This paper was presented in part at the Distinguished Papers Session, Research Forum, Society of Teachers of Family Medicine Annual Meeting, San Francisco, April 27–May 1, 2002.

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    Funded by HS09874 from the Agency for Healthcare Research and Quality, Rockville, Maryland.

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