This study sought: to describe influenza vaccination coverages among COPD patients treated in a primary-care setting; and to analyse the factors linked to compliance with vaccination recommendations. This was a descriptive study in a primary-care (PC) setting. Each of the 2422 randomly selected medical practitioners included in the study was required to recruit five COPD patients. Information was drawn from patients' clinical histories and personal interviews. As the dependent variable, we took the answer (yes or no) to the question, "did you have an influenza vaccination in the most recent campaign?"; and as independent variables, we analysed socio-demographic data, health-status related variables, lifestyles and history of pneumococcal vaccination. A total of 10,711 patients were enrolled 87.2% reported having been vaccinated in the most recent campaign. In conclusion, Spanish COPD patients treated in a primary-care setting can be said to enjoy good vaccine coverages against the influenza virus. More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably, and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles.
"Over 10 000 patients, 87% reported having been vaccinated in the most recent influenza campaign, therefore a rate comparable to that found in our study in the ≥65 only. Beside socio-demographic data, health-status related variables, and lifestyles analysis, authors found that the factor that was most strongly associated with influenza vaccination was a precedent vaccination against pneumococcal infection . Similarly, in diabetic patients, we report seasonal vaccine coverages of 53-57% in <65 and 81% in ≥65 patients, whereas in Spanish diabetic adults, VC were estimated at 57% in 2003  and only 34% among those aged <65 years in 2009–2010 . "
[Show abstract][Hide abstract] ABSTRACT: Background
Three main categories of persons are targeted by the French influenza vaccination strategy: all persons aged 65 years or over, those aged less than 65 years with certain underlying medical conditions and health care workers. The main objective of this study was to estimate rates of influenza immunization in these target groups attending a medical consultation for two consecutive influenza seasons: 2009–2010 (seasonal and pandemic vaccines) and 2010–2011 (seasonal vaccine).
A standardized questionnaire was mailed to 1323 general practitioners (GPs) of the Sentinelles Network, collecting data on all patients seen on a randomly assigned day. For every patient, following information was collected: age, gender, BMI, presence of any medical condition that increases risk of severe influenza illness, and vaccination status for the three vaccines mentioned.
Two hundred and three GPs agreed to participate and included 4248 patients. Overall, in persons with high risk of severe influenza, the estimated vaccine coverages (VC) were 60%, (95% CI = 57%; 62%) for the seasonal vaccine in 2010–2011, 61% (59%; 63%) for the seasonal vaccine in 2009–2010 and 23% (21%; 25%), for the pandemic vaccine in 2009–2010. Among people aged 65 years and over (N=1259, 30%) VC was estimated for seasonal vaccines at 72% (70%; 75%) in 2010–2011 and 73% (71%; 76%) in 2009–2010, and 24% (22%; 26%) for the pandemic vaccine. The lowest seasonal VC were observed in younger persons (<65 years) with underlying medical conditions, in particular pregnant women (<10%) and overweight persons (<30%).
Our study shows that influenza vaccination coverage among patients of the French Sentinelles general practitioners remains largely below the target of 75% defined by the 2004 French Public Health Law, and underscores the need for the implementation of public health interventions likely to increase vaccination uptake.
BMC Public Health 03/2013; 13(1):246. DOI:10.1186/1471-2458-13-246 · 2.26 Impact Factor
"The study also found that older adults who received influenza vaccinations at year 2004-2005 flu season were significantly more likely to receive vaccinations the following year, which is consistent with previous studies [18,19]. Based on these findings, it might be assumed that campaigns encouraging older adults to receive influenza vaccination may have a snowball effect, bringing about cumulative increase in vaccination rates year by year. "
[Show abstract][Hide abstract] ABSTRACT: Older adults, who often have more than one chronic disease, are at greater risk of influenza and its complications. However, because they often see physicians for other more pressing complaints, their physicians, focusing on one condition, may forget to suggest preventive measures for other diseases such as influenza. This study investigates what major factors affect an older adult with more than one chronic condition missing a vaccination opportunity.
Retrospectively reviewing a nationally representative random sample of medical claims from Taiwan's National Health Insurance Research Database during the period 2004 - 2006, we first identified patients sixty-five years or older who had visited physicians. Each patient was assigned a proxy for health status, the Charlson Comorbidity Index (CCI) score. An older claimant was defined has having "absence of a vaccination" when he or she had visited a physician during an influenza season but did not receive an influenza vaccination. Multivariate logistic regression was performed to estimate how likely it would be for older adults with various CCI scores to miss a vaccination.
Out of 200,000 randomly selected claims, 20,923 older adults were included in our final analysis. We found older adults with higher CCIs to be more likely to have an absence of vaccination (p < 0.01). Our multivariate logistic regression results revealed CCI to be the greatest predictor of absence of vaccination, after controlling for individual factors and medical setting. Older adults with CCI scores three or higher were nearly five times more likely to miss a vaccination than those with a CCI of zero [OR: 4.93 (95%CI, 4.47-5.42)]. Those with CCIs of one and two were 2.53 and 3.92 times more likely to miss vaccination than those with a CCI of zero [OR 2.53 (95%CI, 2.26-2.84) and OR 3.92 (95%CI, 3.51-4.38), respectively].
The greater the number of certain comorbid conditions, the greater the likelihood a flu vaccination will be missed. Physicians would be well advised to not let the presenting problems of older patients distract from other possible health problems that might also need attention, in this case influenza vaccinations.
BMC Public Health 10/2010; 10(1):603. DOI:10.1186/1471-2458-10-603 · 2.26 Impact Factor
"We also found frequency of outpatient visits for flu-like respiratory conditions during the previous influenza season and interim season to have had a significantly positive effect of the likelihood that people would obtain a vaccination. Some studies with similar findings have attributed this increase in vaccination rate with the increased attention and physician recommendations the patients receive during these visits [2,23-25]. Since influenza is well-known to exacerbate respiratory diseases, increase related hospitalization and morbidity rates  as well as carry some risk of mortality , the threat older adults perceive while being treated for respiratory conditions predispose them to obtaining influenza vaccinations. Therefore, our study used frequency of utilization of such services as proxy representing a participant's threat-responsiveness [14,15,17]. "
[Show abstract][Hide abstract] ABSTRACT: Although older adults are encouraged by government agencies to receive influenza vaccinations, many do not obtain them. In Taiwan, where universal health care coverage has significantly reduced the barriers of access to care, the health care system has provided free influenza vaccinations for people 65 years or older since 2001. Nevertheless, the numbers of people who use this service are much fewer than expected. The aim of this study was to explore major factors that might affect the decision to receive influenza vaccinations among older adults in Taiwan.
Using national representative health insurance medical claims from the National Health Insurance Research Database between 2002 and 2004, we investigated the role of threat-responsiveness, represented by prior vaccinations and prior physician visits for flu-like respiratory conditions, in the decisions of older adults to obtain vaccinations in Taiwan.
Among the sample of 23,023 older adults, the overall yearly vaccination rates in this study were 38.6%, 44.3% and 39.3% for 2002, 2003, and 2004, respectively. Adjusting for covariates of individual and health care facility characteristics, the multivariate logistic regression revealed that older adults who had had prior vaccinations were ten times more likely to be vaccinated during the following influenza season than those who had not (OR=10.22, 95%CI: 9.82-10.64). The greater the frequency of prior physician visits for flu-like respiratory conditions, the greater the likelihood that one would decide to be vaccinated. Visits during prior interim (non-epidemic) season exerted a stronger positive influence than prior influenza season on this likelihood (OR=1.59, 95% CI: 1.46-1.73 vs. OR=1.11 95% CI: 1.01-1.22, respectively).
Threat-responsiveness, or perceived risk, greatly influences influenza vaccination rates among the older adults in Taiwan. These findings can be used to help design public health campaigns to increase the influenza vaccination rate in this vulnerable group of citizens. Particularly, older adults who never had influenza vaccinations can be identified, educated, and encouraged to participate.
BMC Public Health 08/2009; 9(1):275. DOI:10.1186/1471-2458-9-275 · 2.26 Impact Factor
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