Factors associated with self-reported pneumococcal immunization among adults 65 years of age or older in the Minneapolis-St. Paul metropolitan area

Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review

BACKGROUND

Given increasing numbers of people experiencing transitions in health insurance due to declines in employer-sponsored insurance and changes in health policy, the understanding and application of health insurance terms and concepts (health insurance literacy) may be important for navigating use of health care. The study objective was to systematically review evidence on the relationship between health insurance literacy and health care utilization.

METHODS

Medline, SCOPUS, Web of Science, CINAHL, PsychInfo, Cochrane Library, and reference lists of published literature were searched in August 2019. Quantitative, qualitative, and intervention studies that assessed the association of health insurance literacy as the exposure and health care utilization as the outcome were identified, without language or date restrictions. Outcomes were independently assessed by 2-3 reviewers.

RESULTS

Twenty-one studies including a total of 62,416 subjects met inclusion criteria: three interventional trials, two mixed-methods studies, and sixteen cross-sectional studies. Ten of thirteen preventive care studies suggested that higher health insurance literacy was associated with greater utilization of primary care and other preventive services. Eight of nine studies of care avoidance demonstrated that individuals with lower health insurance literacy were more likely to delay or avoid care. A few studies had mixed results regarding the utilization of emergency department, inpatient, and surgical care.

DISCUSSION

The emerging literature in this area suggests that health insurance literacy is an important factor that can enable effective utilization of health care, including primary care and preventive services. However, the literature is limited by a paucity of studies using validated tools that broadly measure health insurance literacy (rather than testing knowledge of specific covered services). Improving health insurance literacy of the general public and increasing plain language communication of health insurance plan features at the point of health care navigation may encourage more effective and cost-conscious utilization.

Older adults' vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults' hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.

The relative burden of community-acquired pneumonia hospitalizations in older adults: a retrospective observational study in the United States

Background

The risk of community-acquired pneumonia (CAP) increases with age and significantly impacts morbidity and mortality in the elderly population. The burden of illness and cost of preventing CAP has not been compared to other serious diseases.

Methods

This retrospective analysis used claims data from 2014 to 2015 and compared hospitalizations for CAP, myocardial infarction (MI), stroke, and osteoporotic fractures (OF) in adults aged ≥65 years enrolled in a Medicare Advantage insurance plan. Individuals who had not already been hospitalized for one of these conditions and did not have evidence of long-term care were included in the study. Hospitalizations for each condition were described by length of stay, readmissions, mortality, and total costs. Preventive measures included vaccinations for CAP and medications for MI, stroke, and OF.

Results

A total of 1,949,352 individuals were included in the cohort. In 2015, the rate of CAP-related hospitalizations was the highest at 846.7 per 100,000 person-years compared to 405 for MI, 278.9 for stroke, and 343.9 for OF. Vaccination costs for CAP were $40.2 million including $14.1 million for pneumococcal and $26.1 million for influenza vaccines. The cost of preventive medications for MI and stroke reached over $661 million and OF totaled $169 million.

Conclusions

Although CAP has a higher burden of hospitalization and total costs than MI, stroke, and OF in the elderly population, prevention efforts were disproportionately smaller for CAP. Prioritization of CAP prevention is needed to substantially reduce the burden of CAP.

Epidemiological characteristics associated with uptake of pneumococcal vaccine among older adults living in the community in Singapore: Results from the National Health Surveillance Survey 2013

AIMS

In Singapore, pneumococcal vaccination is recommended for the elderly (i.e. those ≥65 years of age) and people with chronic medical conditions. We investigated epidemiological characteristics associated with the uptake of pneumococcal vaccine based on a nationally representative cross-sectional sample of community-living adults aged ≥50 years.

METHODS

The data were obtained from the National Health Surveillance Survey (NHSS) 2013. Associations between pneumococcal vaccination and sociodemographic and health-related variables were analysed using univariable and multivariable logistic regression models.

RESULTS

Among 3672 respondents aged ≥50 years in the NHSS, 7.8% had taken the pneumococcal vaccination. A higher level of education and higher monthly household income were sociodemographic characteristics independently associated with pneumococcal vaccine uptake. Health-related characteristics predictive of pneumococcal vaccine uptake were better self-rated health and having a regular family doctor/general practitioner. Among those who responded to the two questions on vaccinations, 3.9% had been vaccinated against both seasonal influenza and pneumococcal infection, while 11.1% had taken only seasonal influenza vaccination in the past year.

CONCLUSIONS

There is a need to boost pneumococcal vaccination coverage among community-dwelling older adults. These findings provide insights into reviewing and tailoring public-health strategies and programmes to increase vaccine uptake in at-risk population groups.

Factors affecting the uptake of vaccination by the elderly in Western society

OBJECTIVE

To present the results of a literature review on factors related to vaccine uptake by elderly persons.

METHODS

A systematic literature search was performed using Medline, Embase, and SciSearch to collect all publications available on factors related to vaccine uptake from 1966 until October 2012 for West European and North American societies. In total, 1001 articles were identified and 60 were included in the review.

RESULTS

We identified six main themes that influence the willingness to be vaccinated: 1) attitudes and beliefs regarding vaccination in general including positive and negative attitudes and beliefs; 2) perceived risk and severity including knowledge, perceived susceptibility and severity and personal experience; 3) vaccine characteristics including side-effects, effectiveness, content of the vaccine and knowledge; 4) advice and information including influence of the healthcare worker and relatives and the information source and format; 5) general health-related behavior including previous vaccinations, visiting GP or senior center and other preventive behaviors; and 6) accessibility and affordability including logistics, combinations of vaccines and costs.

CONCLUSION

The most important factors related to vaccine uptake are people's attitudes and beliefs regarding vaccination (especially their negative attitudes), recommendations of healthcare workers, side effects and effectiveness of the vaccine, and perceived susceptibility.

Knowledge, attitudes, beliefs and behaviours of older adults about pneumococcal immunization, a Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) investigation

BACKGROUND

Fewer Canadian seniors are vaccinated against pneumococcal disease than receive the influenza vaccine annually. Improved understanding of factors influencing pneumococcal vaccination among older adults is needed to improve vaccine uptake.

METHODS

A self-administered survey measuring knowledge, attitudes, beliefs and behaviours about pneumococcal vaccination was administered to a cohort of seniors participating in a clinical trial of seasonal influenza vaccines at eight centers across Canada. Eligible participants were ambulatory adults 65 years of age or older, in good health or with stable health conditions, previously given influenza vaccine. The primary outcome was self-reported receipt of pneumococcal vaccination. Multi-variable logistic regression was used to determine factors significantly associated with pneumococcal vaccine receipt.

RESULTS

A total of 863 participants completed questionnaires (response rate 92%); 58% indicated they had received the pneumococcal vaccine. Being offered the vaccine by a health care provider had the strongest relationship with vaccine receipt (AOR 23.4 (95% CI 13.4-40.7)). Other variables that remained significantly associated with vaccine receipt in the multivariable model included having heard of the vaccine (AOR 10.1(95% CI 4.7-21.7)), and strongly agreeing that it is important for adults > 65 to be vaccinated against pneumococcus (AOR 3.3 (95% CI 1.2-9.2)). Participants who were < 70 years of age were less likely to be vaccinated.

CONCLUSIONS

These results indicate healthcare recommendation significantly influenced vaccine uptake in this population of older adults. Measures to encourage healthcare providers to offer the vaccine may help increase coverage.

Comorbid risk, respondent characteristics and likelihood of pneumococcal vaccination versus no vaccination among older adults in Brazil

This study investigated predictors of pneumococcal polysaccharide vaccine (PPV) use among older adults in Brazil. Respondents aged ≥50 from 2011 National Health and Wellness Survey in Brazil who had ever (vs never) received PPV were compared on comorbid risk, sociodemographics and vaccination behaviors. Logistic regression and decision tree analyses predicted PPV receipt as a function of the measures. Among 3195 respondents, 8.7% reported ever receiving PPV (10.4% among those at risk). Adjusting for covariates, adults classified as high or moderate risk had significantly greater odds of pneumococcal vaccination (odds ratios [ORs]: 2.42 or 1.36, respectively), as were those who received flu vaccinations (OR: 2.21) or were parents/guardians of a vaccinated child (OR: 6.48). In Brazil, child vaccination appears to be the dominant predictor of adult PPV uptake, followed by influenza vaccination. Higher disease risk was a significant predictor, but most older at-risk adults (89.6%) did not receive PPV.

Strategies to overcome barriers to pneumococcal vaccination in older adults: an integrative review

Health care systems and policy changes have been critical in increasing pneumococcal vaccination rates to current levels. Still, numerous barriers to immunization persist. To assist clinicians caring for older adults, an integrative review of the literature was performed to examine interventions demonstrating efficacy in office settings. Within the 11 studies reviewed, immunization rates increased consistently when health care systems supported organizational changes in clinical procedures and staffing. Data supporting the use of provider reminders were inconsistent, but the availability of information technology to generate reminders and access clinical guidelines modestly increased vaccination rates. Patient reminders (telephone or mail) demonstrated efficacy in multiple studies. Not surprisingly, the literature also supported the nurse's role in enhancing vaccination rates. Findings of this review support the need for sustained organizational change; implications for clinical practice are apparent. Advanced practice nurses can assume leadership roles within change processes as the nation transitions to electronic medical records.

Pneumococcal vaccine in the elderly: a useful but forgotten vaccine

Pneumococcal disease in the elderly is a major concern emphasizing the need for prevention. The review focuses on a literature-based analysis of the efficacy ("does the vaccine works?") and/or the effectiveness ("does vaccination help older population?") of pneumococcal vaccines 14- or 23-valent (PPV23) in the elderly. In the setting of Streptococcus pneumoniae pneumonia, there is still no conclusive evidence decisively confirming the efficacy of pneumococcal vaccine against pneumococcal pneumonia in the elderly populations. However, the efficacy of pneumococcal vaccination has been demonstrated in the prevention of invasive pneumococcal disease (IPD) such as bacteremia, which is the main complication of pneumonia. In the setting of IPD in the elderly, analysis of the current literature provides evidence for both the efficacy and effectiveness of PPV23, but most of the clinical studies failed to demonstrate a substantial reduction in all-cause mortality rate. The community-acquired pneumonia guidelines in the industrialized countries include recommendations for pneumococcal vaccine by PPV23 for adults aged 65 years and over. Taking into account the preventive effect of PPV23 on IPD and the threat of a pandemic flu, the increase of PPV23 vaccination coverage in elderly patients should be strongly considered.

Determinants of influenza and pneumococcal vaccination in elderly people: a systematic review

OBJECTIVES

Despite strong national and international recommendations on immunization practices, rates for influenza (IV) and pneumococcal vaccinations (PV) are low. We aimed to review international immunization rates and to analyze attitudes and beliefs regarding IV and PV.

STUDY DESIGN

Systematic review.

METHOD

The MEDLINE database search comprised articles from 1966 to October 2005. Fourteen surveys evaluating a total number of 49292 participants in nine different countries were included into the analysis.

RESULTS

Vaccination rates among risk groups do vary significantly between different countries, reaching highest rates in the USA (IV, 82%; PV, 71%) and lowest in former West-Germany for IV (37%) and in Israel for PV (20%). Recommendations by doctors play a central role in promoting IV and PV. The main reason for not being vaccinated was lack of information.

CONCLUSION

Specific strategies targeted at groups are needed to increase the knowledge of IV and PV, and thereby decrease incidences of acute lung diseases.

Determinants of influenza and pneumococcal vaccination in patients with chronic lung diseases

Despite strong recommendations, immunization rates for influenza and pneumococci are low. We aimed to analyse the vaccination status and its determinants in patients with chronic lung diseases.

METHODS

Information about actual influenza (IV) and pneumococcal (PV) vaccination status was obtained by a standardised questionnaire from 2491 patients presenting to a specialised centre of respiratory medicine in Rotenburg/Wuemme (Germany). Bivariate and multivariate analyses were used to identify potential determinants of IV and PV.

RESULTS

Of 2131 patients with asthma and/or COPD, included into detailed analyses (52.0% male, mean age 56.6 years), 46.5% had received an IV and 14.6% a PV. Main reason for not being vaccinated was the lack of information, reaching 87.6% for PV (53.5% for IV); 37.0% saw no reason for an IV (PV 21.3%). Vaccination rates differed depending on the patients' age and education level.

CONCLUSION

The results indicate a marked information deficit on immunization which is explicitly higher for PV. Target-group-specific strategies should increase the knowledge on vaccinations in order to avoid the development or aggravation of acute and chronic lung diseases.

Lower respiratory tract infections: prevention using vaccines

In summary, vaccines are available to prevent two of the most common and most deadly causes of lower respiratory tract infections: pneumococcal disease and influenza. Pneumococcal polysaccharide vaccine prevents pneumococcal bacteremia; influenza vaccines prevent influenza as well as several complications of influenza. Despite all that is known about how well these vaccines work, influenza and pneumococcal vaccines are underused markedly, especially among some minority groups that are affected dis-proportionately by disease. Coverage also remains low among health care workers, although providing influenza vaccine to health care workers saves lives among patients. Tools such as standing orders can help clinicians increase vaccine coverage in their patient populations. While research for new and improved vaccines to prevent lower respiratory tract infections continues,focusing on simple measures for increasing vaccine use can help prevent morbidity and mortality now.

Characteristics of community dwelling elderly not vaccinated for pneumococcus in 1998 and 2001

BACKGROUND

We estimate proportions and numbers of elderly (>65 years old) not vaccinated for pneumococcus in 1998 and 2001 by ethnic group, socioeconomic status, health history, and access and use of health care.

METHODS

Self-reported lifetime pneumococcal vaccination and participant characteristics were obtained from 10,624 community dwelling elderly in the 1998 and 2001 National Health Interview Surveys (NHIS). Robust descriptive and inferential statistical analyses were fit. Outcome. Non-receipt of pneumococcal vaccination.

RESULTS

In 2001, about 13 million (or 45% of all) community dwelling elderly were unvaccinated against pneumococcus, including 11.5 million who saw a doctor at least once, 4 million who received an influenza vaccination and 2.3 million who were hospitalized, during the previous year. In 1998 and 2001 non-US born, Hispanic, African-American, and Medicaid recipient elderly were disproportionately un-vaccinated, with about 65% of each group not vaccinated in 2001.

CONCLUSIONS

In 2001, lifetime pneumonia vaccination of community dwelling elderly (55%) was below the goal (60%) for Healthy People 2000. While there has been important progress in improving overall vaccination rates, much more needs to be done to attain national goals and reduce large, persistent racial/ethnic and socioeconomic disparities. Lack of a usual source of healthcare and lower frequency of physician visits were among the factors associated with non-vaccination. However, most unvaccinated individuals had seen a physician in the last year, and many had received influenza vaccination or been hospitalized, suggesting the need for more consistent implementation and monitoring of guidelines for routine pneumococcal vaccination in healthcare settings.