Differences in attitudes, beliefs and knowledge of hospital health care workers and community doctors to vaccination of older people

Assessing interventions to encourage primary care health workers to recommend influenza vaccination and the impact on vaccination uptake for persons with Non-Communicable diseases in China

BACKGROUND

Influenza vaccination coverage is low among persons with non-communicable diseases (NCDs) in China. Chinese health workers (HWs) do not routinely recommend influenza vaccination despite evidence that recommendations increase vaccine uptake. This study aims to assess whether interventions increased primary care HWs' recommendation for influenza vaccination and measure their impact on influenza vaccine uptake in persons with NCDs.

METHODS

We conducted a cluster randomized controlled study in public primary healthcare clinics in Hubei from November 2018 through April 2019. In the intervention clinics, primary care HWs received training on the benefits of influenza vaccination and were asked to recommend influenza vaccine in routine primary healthcare for persons with NCDs. In the control clinics, primary care HWs did not receive training and provided standard services. We conducted questionnaire surveys before and after the intervention to collect information about recommendations made and receipt of influenza vaccines.

RESULTS

A total of 896 primary care HWs and 4552 persons with NCDs were included. After intervention, a higher percentage of HWs recommended influenza vaccines in intervention clinics compared to control clinics. Vaccinated primary care HWs were more likely to recommend vaccination. Persons with NCDs reported higher influenza vaccination coverage in intervention than control clinics, and primary care HWs' recommendation increased vaccination uptake among persons with NCDs.

CONCLUSIONS

Vaccinated primary care HWs were more likely to recommend influenza vaccination than unvaccinated HWs. Promoting primary care HWs' vaccination and encouraging them to recommend influenza vaccination during routine primary healthcare could increase influenza vaccine receipt among persons with NCDs. Registration number ChiCTR2200067140.

Can primary care physician recommendation improve influenza vaccine uptake among older adults? A community health centre-based experimental study in China

BACKGROUND

To promote influenza vaccination coverage, a Chinese megacity, Shenzhen provides free influenza vaccination to its residents aged 60 years and above through community health centres (CHCs) since October 2016. A community health centre-based experiment was conducted by asking primary care physicians (PCPs) working in the intervention health centres to proactively recommend influenza vaccination to their patients aged 60 and above during their patients' visits.

METHODS

This study used an experimental design and a survey design. The experimental design evaluated the effect of PCP recommendation on influenza vaccination. A total of 24 CHCs were randomly selected as the intervention (involving 3814 participants) and control (3072 participants) group evenly. The intervention study period was during the 2017-2018 flu season. The 2016-2017 flu season was considered as the baseline comparison. The survey design examined changes in knowledge, attitude, and practice of influenza vaccination among older participants before and after the free influenza vaccination implementation. We randomly invited 1200 participants aged 60 and above during their visits to CHCs in October 2016 and followed them up until October 2017; among them, 958 participants completed the follow-up survey using the same questionnaire.

RESULTS

In the 2017-2018 flu season, 1,100 more patients got vaccinated in the intervention group under PCP recommendation compared with the 2016-2017 flu season. Among the 958 older adults in the post-implementation period, 77.5% had heard about the influenza vaccine, which was 24.7% higher than in the pre-implementation period; 84.8% of participants were aware where to take influenza vaccines, with the most improvement of 37.2% among all knowledge related questions; 62.5% of them agreed that patients with chronic diseases should have influenza vaccine, which was 19.1% higher than those being surveyed before the implementation period. About 83.6% of participants agreed older adults should have influenza vaccine, but there were still 58.4% who considered themselves too healthy to get vaccinated.

CONCLUSION

PCP recommendation improved influenza vaccine uptake and knowledge, attitude, and practice levels regarding influenza vaccination among older adults. More health policies and health education should be made to raise vaccination willingness and improve vaccination coverage among older adults.

Self-reported vaccination-related behavior patterns among healthcare workers and the association with self-directed learning frequency: A nationwide cross-sectional survey

Background

Healthcare workers play an essential role in improving the public's vaccination uptake, but the full picture of such workers' engagement in vaccination-related behaviors has not been appropriately identified. According to the Integrated Theory of Health Behavior Change, self-directed learning may be a promising intervention for fostering engagement in vaccination-related behaviors, but the association between self-directed learning and such behaviors remains unclear. This study aimed to determine Chinese healthcare workers' level of engagement in behaviors for combatting vaccine-preventable diseases and assess the association between frequency of performing vaccine-focused SDL and engagement in vaccination-related behaviors.

Materials and methods

An online cross-sectional survey was conducted from January 27 to February 21, 2022, using the survey platform "wjx." Respondents were restricted to healthcare workers aged 18-65 years. A Sankey diagram and bar plots were constructed to determine patterns of engagement in a vaccination-related-behavior chain. Unconditional binary logistic regression models were fitted to determine the association between frequency of performing vaccine-focused self-directed learning and engagement in vaccination-related behaviors.

Results

Of the 2,248 survey respondents, data for 2,065 were analyzed. Participants who had received influenza or pneumococcal vaccination, routinely recommended vaccination to patients, tracked patients' vaccination status, and recommended efficiently accounted for 43.2%, 50.8%, 40.3%, and 36.4% of the total participants, respectively. When only considering those who routinely made such recommendations, the proportion of those who performed tracking and efficient recommendation was 28.8% and 26.2%, respectively. When compared to performing self-directed learning "never to less than once/six months," performing self-directed learning "more than once/week" was positively associated with being vaccinated (OR, 95% CI: 2.30, 1.74-3.03), routinely recommending vaccination (OR, 95% CI: 4.46, 3.30-6.04), and tracking the status of patients so recommended (OR, 95% CI: 6.18, 4.35-8.76).

Conclusions

Chinese healthcare workers' pattern of engagement in vaccination-related behaviors must be improved. Higher frequencies of engagement in self-directed learning are associated with more active engagement in vaccination-related behaviors, meaning raising such frequencies could be a promising intervention for fostering behavior changes in this regard and ultimately increasing vaccination coverage.

The Awareness and Attitude of Physicians to Older Adult Routine Vaccination Scheme

Purpose

Immunization is one of the main components of preventive medicine measures. Influenza, pneumococcal, tetanus, and shingles vaccines are recommended for older adults routinely. This study aimed to show the knowledge and attitudes of the physicians to older adults’ vaccination schemes.

Patients and Methods

An electronic self-reported questionnaire was sent to physicians between March and July 2021 in Turkey. Sociodemographic characteristics, professional experience, area of expertise, and practice setting of the participants were recorded. As multiple-choice questions; the routinely recommended vaccines, and vaccines suggested in their daily practice before and after the COVID-19 pandemic were enquired.

Results

A total of 435 participants were included in the study. 43.9% of the patients were primary family physicians, and 36.8% were internists. 63.4% of the participants had reported reviewing the National Vaccination Scheme. 94.5% of the medical doctors indicated that they had recommended any vaccination to their patients. 20.9% of the practitioners could select four or five of the routinely recommended vaccines. Reviewing the National Adult Vaccination Scheme and being an internist were positively related to predicting the recommended vaccines. The recommendation rates of influenza and pneumococcal conjugate (PCV13) were seen at 88% and 78%, respectively. Except for PCV13, recommendation rates of other routine vaccines were decreased after the pandemic.

Conclusion

Awareness of routine vaccination schedules should be improved among health-care professionals, and reminders for immunization should be provided periodically in each health-care setting.

PPSV-23 recommendation and vaccination coverage in China: a cross-sectional survey among healthcare workers, older adults and chronic disease patients

BACKGROUND

: 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is crucial to protecting high-risk groups. This study aimed to investigate the influencing factors of PPSV-23 recommendation among healthcare workers, and PPSV-23 coverage among Chinese older adults and chronic disease patients.

RESEARCH DESIGN AND METHODS

: In 2019, a cross-sectional questionnaire survey was conducted in ten provinces in China among older adults aged ≥65 years, chronic disease patients aged 18-64 years, and primary healthcare workers. Multiple logistic regression model was adopted to identify the influencing factors of PPSV-23 recommendation and vaccination uptake.

RESULTS

: Of the 1138 healthcare workers, 46.75% often recommended PPSV-23 to target groups, and public health workers were more likely to recommend than general practitioners. PPSV-23 vaccination rate was 3.29% among chronic disease patients aged <65 years, 6.69% among older adults without chronic disease(s), and 8.87% among chronic disease patients aged ≥65 years. Multiple logistic regression revealed that only general practitioners' recommendation was associated with increased PPSV-23 coverage (p < 0.05).

CONCLUSIONS

: The findings highlighted the suboptimal PPSV-23 coverage rate in China and the strong association between healthcare workers' recommendation and residents' vaccination uptake. Targeted and coherent PPSV-23-related training is suggested for general practitioners to encourage effective health promotion in clinical practices.

Pharmacists’ Seasonal Influenza Vaccine Recommendations

Seasonal influenza vaccination rates among European countries remain low despite the World Health Organization’s recommendations to vaccinate high-risk groups. Healthcare worker recommendations are strong predictors of increased vaccination uptake in the population. Therefore, this study aimed to analyze seasonal influenza vaccination recommendation behavior among pharmacists towards high-risk groups including patients, coworkers, and pharmacists’ family members during the COVID-19 pandemic. This cross-sectional, questionnaire-based research was conducted in Switzerland during the flu season and sent to all members of the Swiss Pharmacist Association. In December 2020, 569 community pharmacists completed the online survey. The influenza vaccination recommendation rates for high-risk patients were 93.6% for the elderly, 70.7% for pregnant women, 65.2% for immunocompromised people, and 60.3% for patients with chronic diseases. Pharmacists tend to recommend influenza immunization to patients more than to family members and colleagues. Holding a certification to administer immunization and personal influenza vaccine history were the main predictors for recommending influenza vaccination to patients, family members, and colleagues. Our results indicated that influenza vaccination recommendation rates in our whole sample of pharmacists, were higher for vaccinated and immunizing pharmacists. Ensuring high vaccinations rates and high ratio of immunizing pharmacists may be important in promoting seasonal influenza vaccination in the general population.

A review of hospital-based interventions to improve inpatient influenza vaccination uptake for high-risk adults

BACKGROUND

Despite positive steps towards transforming immunisation understanding and practice to better incorporate adults, coverage, especially those at higher risk, is not where it should be. One way to increase uptake is to take advantage of environments outside of primary care which present easy opportunities for vaccination. This study provides a narrative review of hospital-based strategies in acute care settings aimed at improving influenza vaccination rates for adult inpatients.

METHODS

A search was conducted using Scopus, Embase and PubMed databases for articles reporting on hospital-based interventions aimed at improving influenza vaccination for adults. Studies published in English were included and descriptively analysed.

RESULTS

A total of 31 articles were included. Tested interventions included 7 standing order protocols (SOP); 4 reminders; 4 assessment/administration programs; 1 patient education program; 1 organisational-based program; 7 multi-component strategies and 8 studies comparing SOPs with other strategies. One article was included in both SOPs and reminders categories. Studies were published between 1983 and 2017 and conducted in the USA, Canada, or Australia. 18 studies reported statistical significance. Individually, each type of intervention showed success. SOPs were significantly more effective than other individual interventions, but multi-component interventions (which included an SOP) were more effective than SOPs alone. Three articles reported no significant increase in uptake attributed mainly to patient refusals, even with a strategy involving patient education. Only three studies tested provider-level strategies including hospital campaigns, hospital reward programs and interdepartmental competitions, and showed success.

CONCLUSIONS

Hospital-based interventions are an effective means of improving opportunistic inpatient vaccination. Suggestions for future research include organisational or system-based interventions; qualitative review of barriers and enablers to inpatient vaccination programs; and re-examination of outpatient settings for vaccine delivery. Most studies were not randomised or controlled; therefore, we also recommend additional RCT studies to confirm existing findings on individual strategies.

Influenza vaccination among Dutch general practitioners and their attitude toward influenza vaccination in the elderly

Knowledge, attitudes and beliefs (KABs) toward influenza vaccination (IV) play a key role in HCWs’ decisions to receive vaccination and can strongly influence patients’ IV uptake. We examined the knowledge, attitudes and beliefs of GPs toward IV, exploring their opinion on IV in the elderly, mandatory HCW vaccination and the desirability of an IV trial in the elderly with hospitalization/mortality as effect measure. From November 2018 to March 2019, surveys were emailed to GPs and GP-practices (n = 1676) in three regions of the Netherlands. We assessed the self-reported IV in GPs, reasons for (not) advising IV to personnel, (not) supporting mandatory IV for personnel and (not) desiring a trial on IV in the elderly on hospitalization/mortality. Multivariable logistic regression models were used to determine predictors for GP IV. A total of 552 surveys were completed and 71.9% of the GPs reported receiving IV. Determinants for IV in GPs were male sex (aOR 1.62, 95%CI 1.06–2.49, p = .03) and age ≥60 y (aOR 5.25, 95%CI 1.51–18.32, p = .01). Seventy-nine percent of the GPs recommend IV for their practice personnel. Mandatory IV for personnel was supported by 41.2% of the GPs with GP self-reporting IV being the only determinant (aOR 10.03 (95%CI 5.69–17.70 p = .00)). An IV trial on hospitalization and/or mortality was desired by 60.5% of the GPs. We concluded that the majority of Dutch GPs receives IV and recommends IV to their personnel. These high rates along with the hesitancy of GPs toward mandatory HCW IV should be considered when policymakers decide on a mandate for IV in HCW in general.

Knowledge about vaccines and vaccination in older people: Results of a national survey by the Italian Society for Gerontology & Geriatrics

BACKGROUND

There is wide variation among physicians in the level of knowledge regarding vaccines and vaccination. We sought to compare the level of vaccine knowledge between qualified specialists and postgraduate residents.

METHODS

A questionnaire designed ad hoc by a consensus group was circulated to the Directors of 51 geriatrics internship programs in Italy. It investigated demographics, information sources, knowledge about influenza, pneumonococcal and herpes zoster vaccines and target groups. The proportion of correct responders was compared between residents and qualified specialists, and between best (top quartile) and worst (bottom quartile) performers.

RESULTS

A total of 459 questionnaires were analyzed; 245 (53%) were females; 253 (55%) were qualified specialists, 206 (45%) were residents. Mean age was 40.3 (SD: 12.8) years, almost 60% worked in acute care wards. On average, 33% of patients asked for information about vaccination. Residents answered significantly better on 7 out of 18 questions, and numerically albeit non-statistically higher correct response rates on a further 8 questions. There were significantly more men among the poor performers (p < 0.001), and significantly more residents among the best performers (p < 0.001). Overall, the rates of correct answers were low, with >50% of correct responses achieved on only 5 out of 18 questions (27.8%); for 2 questions, <20% responded correctly.

CONCLUSIONS

Postgraduate residents in training have an overall better level of knowledge of vaccines, vaccination indications and practices than qualified specialists. This study provides avenues to develop targeted interventions to ensure health care providers are up to date and providing accurate information to patients.

Knowledge of Physicians About Influenza and Pneumococcal Vaccination

OBJECTIVES

The aim of this study was to evaluate the knowledge of physicians on influenza and pneumococcal vaccine.

MATERIALS AND METHODS

A questionnaire was administered to physicians working in Kyrenia University Hospital and Near East University School of Medicine.

RESULTS

There were 38 female (56.7%) and 29 male (43.3%) participants. The mean age was 39.3±12.5 years. There were 24 general practitioners (GP) and 43 specialists participating in the study. Influenza vaccine and its risk minimization for infection were well known among 92.5% of the participants. However, 76.1% of them mentioned that they had knowledge about the pneumococcal vaccine, and this ratio about its reducing the risk of infection was 73.1%. 83.7% of specialists and 79.2% of GP thought that adult vaccines were effective (p=0.6). The rate of influenza vaccination among specialists was higher than that of GP (67.4% vs. 41.7%, p=0.04). However, the rates of pneumococcal vaccination were low and similar in both groups (p=0.3). In both specialists and GP, the most common reason for not receiving the vaccine was the belief of not being in the risk group (p=0.9). The knowledge level of pneumococcal vaccination in GP was found to be statistically lower than in specialists (p<0.05).

CONCLUSION

Although influenza vaccine and its risk minimization for infection are well known among physicians, the pneumococcal vaccine is not well known. It is suggested that training about vaccination for both specialists and GP are important for preventive medicine.

Survey of Adult Influenza Vaccination Practices and Perspectives Among US Primary Care Providers (2016-2017 Influenza Season)

BACKGROUND

Seasonal influenza vaccination is recommended for all adults; however, little is known about how primary care physicians can communicate effectively with patients about influenza vaccination.

OBJECTIVE

To assess among general internal medicine (GIM) and family physicians (FP) regarding adult influenza vaccination: (1) recommendation and administration practices, (2) barriers to discussing and perceived reasons for patient refusal, and (3) factors associated with physician self-efficacy in convincing patients to be vaccinated.

DESIGN

Email and mail survey conducted in February-March 2017 PARTICIPANTS: Nationally representative sample of GIM and FP MAIN MEASURES: Factor analysis was used to group similar items for multivariable analysis of barriers and strategies associated with high physician self-efficacy about convincing patients to be vaccinated (defined as disagreeing that they could do nothing to change resistant patients' minds).

KEY RESULTS

Response rate was 67% (620/930). Ninety-eight percent always/almost always recommended influenza vaccine to adults ≥ 65 years, 90% for adults 50-64 years, and 75% for adults 19-49 years. Standing orders (76%) and electronic alerts (64%) were the most commonly used practice-based immunization strategies. Frequently reported barriers to discussing vaccination were other health issues taking precedence (41%), time (29%), and feeling they were unlikely to change patients' minds (24%). Fifty-eight percent of physicians reported high self-efficacy about convincing patients to be vaccinated; these providers reported fewer patient belief barriers contributing to vaccine refusal (RR = 0.93 per item; 95% CI (0.89-0.98); Cronbach's α = 0.70), were more likely to report using both fact- (1.08/item; (1.03-1.14); 0.66) and personal experience-based (1.07/item; (1.003-1.15); 0.65) communication strategies, and were more likely to work in practices using patient reminders for influenza vaccine (1.32; (1.16-1.50)).

CONCLUSIONS

Physicians identified barriers to successfully communicating about adult influenza vaccination but few effective strategies to counter them. Interventions to promote self-efficacy in communication and under-utilized practice-based immunization strategies are needed.

Influenza vaccination in the elderly: Is a trial on mortality ethically acceptable?

The effectiveness of influenza vaccination in the elderly has long been a topic of debate, fueled by the absence of direct evidence from randomized trials on its effect on mortality and the methodological limitations of observational studies pointing this direction. It is argued that new placebo-controlled trials should be undertaken to resolve this uncertainty. However, such trials may be ethically questionable. To bring this discussion forward, we provide a comprehensive overview of the ethical challenges of an influenza vaccine efficacy trial designed to evaluate mortality in the elderly. An important condition in the justification of a trial is the existence of genuine uncertainty in regard to the answer to a research question. Therefore an extensive analysis of the existing levels of knowledge is needed to support the conclusion that an effect of vaccination on mortality is uncertain. Even if a so called "clinical equipoise" status applies, denying a control group vaccination would be problematic because vaccination is considered "competent care" and withholding vaccination could substantially increase patients' risk for influenza and its complications. Given the high burden of disease and already proven benefits of vaccination, such a trial is unlikely to meet the Declaration of Helsinki stating that the importance of a trial must outweigh the risk patients are exposed to. While a placebo-controlled trial in vaccine refusers may be considered, such a trial is unlikely to meet substantial methodological barriers regarding trial size and generalizability. We conclude that a new trial is unlikely to provide for a direct answer, let alone change current policy. At the same time, given the lack of consensus on the ethical acceptability of a placebo-controlled trial on the effect of influenza vaccination on mortality in the elderly, we invite researchers considering such trials to address the ethical challenges discussed in this manuscript.

Determinants of healthcare workers' willingness to recommend the seasonal influenza vaccine to diabetic patients: A cross-sectional survey in Ningbo, China

Background: Seasonal influenza vaccine uptake among diabetic patients is low in China. Recent studies showed healthcare workers'(HCWs') recommendation is an effective way to promote influenza vaccination. This study aimed to assess HCWs' willingness to recommend influenza vaccine to diabetic patients and identify the predictors of this willingness. Methods: During Dec 2016-Jan 2017, a self-administered questionnaire on perceptions, attitudes and practices related to influenza vaccination for diabetic patients was distributed to 1370 HCWs in 20 hospitals and 20 community health centers in Ningbo. Predictors of HCWs' willingness to recommend influenza vaccine were analyzed by logistic regressions. Results: Of 1340 HCWs who completed the survey, 58.13%(779/1340) participants reported willingness to recommend influenza vaccine to diabetic patients. Factors positively associated with the recommendation willingness included awareness of national influenza vaccination guideline(OR: 6.33; 95%CI: 4.66-8.60) and regional reimbursement policy(OR: 1.62; 95%CI: 1.19-2.20), training on influenza and diabetes (OR: 1.65; 95%CI: 1.21-2.23), influenza vaccination history(OR: 1.35; 95%CI: 1.01-1.79), beliefs in vaccine effects on reducing serious consequences(OR: 1.38; 95%CI: 1.01-1.91), reduction in hospitalization costs(OR: 1.43; 95%CI: 1.05-1.94) caused by influenza, and more than 10 years of practitioner experience(OR: 1.60; 95%CI: 1.04-2.46). Worries about side-effects of influenza vaccine were identified as the barriers of recommendation. Conclusion: The present study demonstrates that knowledge about national guideline and reimbursement policies, training programs, perceptions about effectiveness and safety of influenza vaccine increase HCWs' willingness to recommend the influenza vaccination to diabetic patients. These measures should be taken to ensure HCWs' role in the administration of influenza vaccination among diabetic patients.

Vaccination coverage in systemic lupus erythematosus-a cross-sectional analysis of the German long-term study (LuLa cohort)

Objectives

Vaccinations are an important measure to prevent infections in immunocompromised patients. The knowledge of vaccination coverage and reasons for non-vaccination in patients with SLE is scarce. The aim of this study was to assess coverage rates of selected vaccinations in a representative sample of SLE patients and to identify predictors for non-vaccination.

Methods

In 2013, information on selected vaccinations (coverage, application and reservations) and on demographics, clinical parameters and health beliefs was assessed by means of a self-reported questionnaire among a representative sample of SLE patients in Germany (LuLa cohort).

Results

Five hundred and seventy-nine patients participated. Vaccination status was primarily checked by their general practitioner (57.3%). Of all the patients, 24.9% did not get their vaccination status checked at all, 16.1% had generally been advised against the use of vaccinations by a physician, and 37.5% stated that they had rejected vaccinations themselves. Their main reasons were fears of developing a lupus flare (21.8%) or adverse events (13.5%). A greater belief by patients in the doctor controlling one's health and the general benefit of medication prevented the rejection of vaccines. Vaccination coverage was low for all recorded vaccinations (tetanus 65.8%, influenza 45.2%, pneumococcus 32.2% and meningococcus 6.1%). Older age was predictive of receiving influenza and pneumococcal vaccination. The same applies for CSs >7.5 mg for receiving influenza vaccination.

Conclusion

Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations. Rheumatologists need to recognize patients' reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their health-care providers.

Trial registration

German Clinical Trials Register, www.germanctr.de, DRKS00011052.

Assesssing an unmet healthcare demand: A survey of immunisation among homecare patients and their caregivers

Susceptibility of the homecare patient to vaccine preventable infections and their complications is high. Hospitalization of this patient group increases costs to the healthcare system. Therefore vaccination services are of great importance for protecting these patients from complications and hospitalization. We aimed to determine vaccination status of the patients receiving home care services from a tertiary hospital in Turkey and to reveal their vaccination needs. This cross sectional study was carried out in the Division of Home Care Services of Dışkapı Yıldırım Beyazıt Training and Research Hospital in Ankara Turkey. A questionnaire Comprised of 15 questions were administered through face to face with 336 patients and their care givers. The data obtained was analyzed with descriptive statistical methods and chi-squared test was used for comparison of proportions. A total of 86.3% of the patients and 22.6% of the caregivers were older than age 65. Approximately 45% of the patients were receiving home care due to primary neurological diagnosis such as Dementia, Parkinson's disease and Cerebrovascular Accident. In addition, 78% of the patients had at least 1 additional diagnosis other than their primary diagnosis. Although immunization indications were present among all patients included in the study and at least 22% of the care providers, only 15.2% of patients and 11.3% of care providers had been recommended to receive vaccination. Among those who had been recommended to get vaccinated, 74% of patients and 77% of care givers had been administered the recommended vaccine. This finding implied that both groups were responsive to the advice for vaccination. Moreover, since the patients receiving home care are already followed-up by a healthcare team, thus these patients can be vaccinated with very little additional logistic support.

[Implementing vaccination recommendations in discharge letters]

OBJECTIVES

There is still a lack of attention paid to the subject of vaccinations indicated for people with chronic disease, so the vaccination rates in this field are low or hardly known. Hospitals only play a minor part in the vaccination subject, although they play a big part in the treatment of chronically ill patients.

METHODS

In this study we wanted to test the practicability of the implementation of vaccination recommendations in discharge letters as a chance to give the subject more attention and involve hospital doctors in the vaccination process. In addition, we analyzed clinical und primary care physicians' attitudes towards these recommendations and vaccination in general.

RESULTS

88.5% of the general practitioners and 81.3% of the hospital doctors consider vaccination recommendations in discharge letters reasonable. 86.3% of the general practitioners said they were willing to perform the recommended vaccinations. The main responsibility in the vaccination process is clearly allocated to general practitioners, but many hospital doctors want to raise the level of attention given to the vaccination subject in their departments.

CONCLUSION

Standardized implementation of vaccination recommendations in discharge letters is a reasonable way to involve hospital doctors in the vaccination process as part of the preventive care services for chronically ill patients. At the same time, general practitioners will be regularly informed about indicated vaccinations for the individual patient.

Increasing seasonal influenza vaccination among high risk groups in China: Do community healthcare workers have a role to play?

BACKGROUND

Seasonal influenza vaccine uptake in China is low. This study aims to assess the role of community healthcare workers (HCWs) in increasing vaccination among high risk groups in China.

METHODS

We analyzed data from four knowledge, attitude and practice (KAP) studies on seasonal influenza vaccination in China targeting guardians of young children, pregnant women, adults aged ≥60years, and HCWs from 2012 to 2014.

RESULTS

Thirty-one percent of pregnant women and 78% adults aged ≥60years reported willingness to follow HCWs' recommendations for influenza vaccination. Guardians were more likely to vaccinate their children if they received HCWs' recommendations (35% vs. 17%, p<0.001). Community HCWs were more likely to recommend seasonal influenza vaccination than hospital HCWs (58% vs. 28%, p<0.001).

CONCLUSION

Study results suggest the value of incorporating community HCWs' recommendation for seasonal influenza vaccination into existing primary public health programs to increase vaccination coverage among high risk groups in China.

The intention of Dutch general practitioners to offer vaccination against pneumococcal disease, herpes zoster and pertussis to people aged 60 years and older

BACKGROUND

Increasing life expectancy results in a larger proportion of older people susceptible to vaccine preventable diseases (VPDs). In the Netherlands, influenza vaccination is routinely offered to people aged 60 years and older. Vaccination against pneumococcal disease, herpes zoster and pertussis is rarely used. These vaccines will be evaluated by the Dutch Health Council and might be routinely offered to older people in the near future. Possible expansion of the program depends partly on the willingness of general practitioners (GPs) to endorse additional vaccinations. In this study, we assessed predictors of GPs' attitude and intention to vaccinate people aged 60 years and older.

METHODS

GPs (N = 12.194) were invited to fill in an online questionnaire consisting of questions about social cognitive factors that can influence the willingness of GPs to vaccinate people aged 60 years and older, including underlying beliefs, practical considerations of adding more vaccines to the national program, demographics, and GPs' patient population characteristics. The questionnaire was filled in by 732 GPs.

RESULTS

GPs were positive both about vaccination as a preventive tool and the influenza vaccination program, but somewhat less positive about expanding the current program. Prediction analysis showed that the intention of GPs to offer additional vaccination was predicted by their attitude towards offering additional vaccination, towards vaccination as a preventive tool, towards offering vaccination during an outbreak and on GPs opinion regarding suitability to offer additional vaccination (R2 = 0.60). The attitude of GPs towards offering additional vaccination was predicted by the perceived severity of herpes zoster and pneumonia, as well as the perceived incidence of herpes zoster. Severity of diseases was ranked as important argument to recommend vaccination, followed by effectiveness and health benefits of vaccines.

CONCLUSION

Providing GPs with evidence-based information about the severity and prevalence of diseases, and effectiveness and health benefits of the vaccines, together with an active role of GPs in informing older people about vaccines, could modify the intention towards additional vaccination of people 60 years and older.

Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany

BACKGROUND

In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement.

METHODS

We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population.

RESULTS

Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8).

CONCLUSIONS

To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes.

The development of vaccination perspectives among chiropractic, naturopathic and medical students: a case study of professional enculturation

An important influence on parents' decisions about pediatric vaccination (children under 6 years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audiotaped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes. Numerous unexpected insights emerged within these themes, including students' general open-mindedness towards pediatric vaccination at the beginning of their training; the powerful influence of both formal education and informal socialization; uncritical acceptance of the vaccination views of senior or respected professionals; students' preference for multiple perspectives rather than one-sided, didactic instruction; the absence of explicit socio-cultural tensions among professions; and how divergences among professional students' perspectives result from differing emphases with respect to lifestyle, individual choice, public health and epidemiological factors-rather than disagreement concerning the biomedical evidence. This last finding implies that their different perspectives on pediatric vaccination may be complementary rather than irreconcilable. Our findings should be considered by developers of professional and interprofessional educational curricula and public health officials formulating policy on pediatric vaccination.

Attitudes of Dutch general practitioners towards vaccinating the elderly: less is more?

Background

In many European countries, vaccinations are offered to the elderly. Expanding the programme to include routine vaccination against pneumococcal disease, herpes zoster, and pertussis, for example, could reduce disease burden amongst the growing population of persons aged 50 years and older. Since most countries involve general practitioners (GPs) in the programmes, the potential success of such new vaccinations depends on the attitude of GPs towards these vaccinations. This qualitative study explores Dutch GPs’ attitudes regarding vaccination in general, and their attitudes regarding the incorporation of additional vaccines in the current Dutch influenza vaccination programme.

Methods

Interviews were held with ten Dutch GPs (five men and five women) that worked either in an academic hospital, in a practice based in a health center, or in individual practice. All interviews were recorded with a digital voice recorder and transcribed verbatim. Transcripts were analysed according to thematic analysis.

Results

GPs perceived prevention as part as their job and believed vaccination to be effective for preventing infectious diseases. However, influenza vaccination was not always perceived as effective. Doubts regarding the usefulness of additional vaccinations were identified. If additional vaccines would be offered, this should be based on scientific evidence and the severity of the infectious disease. Selection of patients for vaccination should not be based solely on age, but more on risk factors. The GP should be the central point of contact for new vaccination campaigns; however, high workload was seen as a concern. Several GPs questioned their ability to refuse to distribute the vaccinations.

Conclusions

A positive attitude towards implementing additional vaccinations is not apparent. Achieving the most health benefits seems to be the most important consideration of Dutch GPs regarding vaccinating older adults. Questions regarding the usefulness of vaccinating older adults should be taken into consideration. More research is necessary to confirm the results among a wider range of Dutch GPs.

Pneumococcal vaccination of the elderly during visits to acute care providers: who are vaccinated?

OBJECTIVE

Many elderly remain unvaccinated against invasive pneumococcal disease yet frequently visit acute care providers where they have an opportunity to receive the pneumococcal vaccine. We describe factors associated with pneumococcal vaccination in adults aged 65 years and older during visits to acute care providers.

METHOD

The study included all elderly aged 65 years of age and older enrolled in a health insurance registry in a large Canadian city in 2009. Pneumococcal vaccination status was determined using a vaccination administrative database. Unvaccinated elderly were linked to ambulatory and inpatient care databases to determine acute care visits. Logistic regression was used to determine odds ratios for vaccination during a first visit to an acute care provider in 2009.

RESULTS

Of 53,249 unvaccinated elderly, 23,574 presented to at least one acute care provider in 2009. Acute care visits were significantly associated with receipt of pneumococcal vaccine (11.0% vs. 7.8%, risk adjusted odds ratio [OR]=1.53; 95% confidence interval [CI]=1.44,1.62), particularly ambulatory care visits during influenza season (OR=4.36; 95% CI=2.86,6.66) and inpatient visits with lengths of stay >14 days (OR=7.71, 95% CI=4.41,13.47).

CONCLUSION

Acute care visits were associated with greater pneumococcal vaccine uptake for the elderly during the annual influenza season and long hospital stays.

Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement

BACKGROUND

Immunosuppressive agents used to treat inflammatory bowel disease (IBD) can increase the risk for infections, several of which are preventable through vaccination. Our study aimed to describe vaccine utilization by immunosuppression status, examine reasons for vaccine refusal, and identify characteristics associated with lack of influenza vaccination in patients with IBD.

METHODS

We administered an online survey between February 2012 and April 2012 to an internet-based cohort of patients with IBD in the Crohn's and Colitis Foundation of America Partners program.

RESULTS

During this time, 958 individuals completed the survey. The median age was 45, 72.8% were female, and 62.0% had Crohn's disease. Self-reported vaccination rates were low. Those on immunosuppression (n = 514) were more likely to be counseled to avoid live vaccines (P < 0.01). However, counseling rates were low (3.5%-19.1% for various live vaccines). Among the 776 individuals who received the influenza vaccine, maintaining health (74.1%), importance of prevention (66.1%), and provider recommendation (38%) were the most frequently cited motivations. Factors associated with lack of influenza vaccine included lower education level (P = 0.01), younger age (P = 0.02), and no chronic immunosuppression use (P < 0.01). Five hundred seventy (59.5%) individuals thought that patients were responsible for keeping track of their vaccines, whereas 428 (44.7%) placed responsibility on their gastroenterologist and 595 (62.1%) on their primary care physician.

CONCLUSIONS

Vaccine utilization remains suboptimal in patients with IBD. Educational interventions may increase vaccination rates by clarifying misconceptions. Gastroenterologists can play a more active role in health care maintenance in patients with IBD by counseling patients on which vaccines to receive or avoid.

Cross-sectional study on attitudes among general practitioners towards pneumococcal vaccination for middle-aged and elderly population in Hong Kong

OBJECTIVE

To study the attitudes among general practitioners towards pneumococcal vaccination for middle-aged (50-64) and elderly population (over 65) in Hong Kong and the factors affecting their decision to advise pneumococcal vaccination for those age groups.

DESIGN

Cross-sectional study of general practitioners in private practice in Hong Kong.

PARTICIPANTS

Members of Hong Kong Medical Association delivering general practice services in private sector.

MEASURING TOOL

Self-administered questionnaire.

MAIN OUTCOME MEASURES

Intention to recommend pneumococcal vaccination, barriers against pneumococcal vaccination.

RESULTS

53.4% of the respondents would actively recommend pneumococcal vaccination to elderly patients but only 18.8% would recommend for middle-aged patients. Consultation not related to pneumococcal vaccine was the main reason for not recommending pneumococcal vaccine (43.6%). Rarity of pneumonia in their daily practice was another reason with 68.4% of respondents attending five or less patients with pneumonia each year. In multivariate analysis, factors such as respondents would get vaccination when reaching age 50 (ORm 10.1), and attending 6 pneumonia cases or more per year (ORm 2.28) were found to be associated with increasing likelihood for recommending vaccination to the middle-aged. While concerns of marketing a product (ORm 0.41), consultation not related to vaccination (ORm 0.45) and limited time (ORm 0.38) were factors that reduced the likelihood.

CONCLUSION

Public policy is needed to increase the awareness of impact of pneumococcal pneumonia and the availability of preventive measures.

A review of the evidence to support influenza vaccine introduction in countries and areas of WHO's Western Pacific Region

Background

Immunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region.

Methodology/Principal Findings

Studies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women.

Conclusions/Significance

The evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies should be considered to maximize resource utilization for cross-cutting issues such as vaccine presentation and other inventions.

General practitioners' experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: a qualitative study

Introduction

Diseases caused by Streptococcus pneumoniae generate substantial morbidity and mortality. Despite official recommendations to vaccinate everyone over the age of 64, the estimated vaccination rate for this target population is around 2%. In Switzerland, pneumococcal vaccinations are for the most part provided by general practitioners (GPs); in addition, a small number of patients get vaccinated during a hospital stay. We wanted to investigate GPs’ attitudes and opinions about the pneumococcal vaccination in primary care and why it is so rarely provided.

Methods

For this qualitative study, we conducted semistructured interviews with 20 GPs. Transcriptions of all interviews were analyzed following the technique of qualitative content analysis, supported by the ATLAS.ti^© software.

Results

Most GPs reported that they know pneumococcal vaccination is recommended for several risk groups and elderly patients. As to reasons for the low vaccination rate, GPs mentioned the pneumococcal vaccination had little priority in daily practice, especially in comparison with the importance of other vaccinations, namely influenza. This low level of priority was supported by the fact that the GPs rarely ever experienced a case of a severe pneumococcal disease in their daily work. Furthermore, perceived insufficient evidence resulting from existing epidemiologic data and clinical trials enhanced the little attention given to the pneumococcal vaccination.

Conclusion

We found the generally low level of priority given within a consultation, the missing awareness of this subject in daily practice, and the perception of epidemiologic and scientific data as insufficient, as the reasons for the low rate in pneumococcal vaccinations. Efforts to increase the epidemiologic data on the pneumococcal vaccination should be taken. To increase the vaccination rate, it would be necessary to raise the awareness and priority of the pneumococcal vaccination; a feasible way could be the combination of the seasonal flu vaccination campaign with a campaign for pneumococcal vaccination.

Annual influenza vaccination: coverage and attitudes of primary care staff in Australia

Please cite this paper as: Ward et al. (2011) Annual influenza vaccination: coverage and attitudes of primary care staff in Australia. Influenza and Other Respiratory Viruses 5(2), 135–141.

Background  Annual influenza vaccination is recommended for all Australian health care workers (HCWs) including those working in primary health care. There is limited published data on coverage, workplace provision, attitudes and personal barriers to influenza vaccination amongst primary health care staff. The aim of this study was to contribute to the limited literature base in this important area by investigating these issues in the primary health care setting in New South Wales (NSW), Australia.

Methods  A postal survey was sent to general practitioners (GPs) and practice nurses (PNs) from inner city, semi‐urban and rural areas of NSW, Australia. There were 139 responses in total (response rate 36%) from 79 GPs (response rate 30%) and 60 PNs (response rate 46%).

Results  Reported influenza vaccination coverage in both 2007 and 2008 was greater than 70%, with GPs reporting higher coverage than PNs in both years. The main barriers identified were lack of awareness of vaccination recommendations for general practice staff and concern about adverse effects from the vaccine.

Conclusions  Rates of influenza vaccination coverage reported in this study were higher than in previous studies of hospital and institutional HCWs, though it is possible that the study design may have contributed to these higher results. Nevertheless, these findings highlight that more needs to be done to understand barriers to vaccination in this group, to inform the development of appropriate strategies to increase vaccination coverage in primary health care staff, with a special focus on PNs.

Vaccination in older adults: development of an educational tool, Vaxisenior, in France

The benefits of vaccination in older adults are well documented yet there is poor uptake of such preventive measures, and one of the main reasons in France is a lack of recommendation and support from healthcare professionals. To address this issue a multidisciplinary group of experts has developed an educational tool, Vaxisenior, to assist in the training of physicians/healthcare workers who can act as advocates for immunization programs. The tool comprises of eight sections (general introduction; immunosenescence; diphtheria-tetanus-poliomyelitis; influenza; pneumococcus; pertussis; herpes zoster; and vaccines for travelers). In addition, it includes national immunization schedules and recommendations, practical information regarding opportunities to expand vaccine coverage that is convenient to the patient and a questions and answers section covering topics relating to particular usage and responsibilities. Implementation of vaccination policies for older adults is a major issue and will require extensive promotional campaigns, as well as active support from healthcare and public health professionals to improve overall vaccine coverage.

Burden of community-acquired pneumonia in North American adults

To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were >60,000 deaths due to pneumonia in persons aged>or=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was >or=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at >$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.

Improving the vaccination coverage of geriatric populations

Vaccination is an important component of disease prevention in the elderly; however, immunization coverage in this population is low. There is a clear need to improve vaccine coverage among this age group. To this end, various strategies can be employed. Raising awareness and improving the education of physicians and health care workers in the field of vaccination in geriatric populations play an important role. Active promotion of vaccination uptake should be implemented by health authorities and targeted to older adults. Other means, including the use of educational tools and guidelines to improve practice, should be more widely employed.

Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions

Limited information exists regarding optimal methods for the recruitment and retention of older people in clinical trials. The aim of this review is to identify common barriers to the recruitment of older people in clinical trials and to propose solutions to overcome these barriers. A review of literature was performed to identify common difficulties in recruiting older people. This in combination with our experience during recruitment for a randomized control trial, have highlighted numerous barriers. Population-specific recruitment strategies, simple informed-consent processes, and effective communication between the researcher and subject are effective strategies to overcome these barriers.

Disparities in influenza vaccination coverage rates by target group in five European countries: trends over seven consecutive seasons

BACKGROUND

The primary objective of this study was to measure influenza vaccination coverage rates in the general population, including children, and in high-risk groups of five European countries during the season 2007/2008. An additional aim was to analyze coverage trends over seven consecutive seasons and to gain an understanding of the primary drivers and barriers to immunization.

METHODS

Community-based telephone and mail surveys have been conducted in the UK, Germany, Italy, France, and Spain, yearly, since 2001/2002. Approximately 2,000 individuals per country and season were interviewed who were considered to be representative of the adult population aged 14 years and older. Data on the vaccination status of children were obtained by proxy interviews. The questionnaire used was essentially the same for all seven seasons. Five target groups were identified for the study: (1) persons aged > or = 65 years; (2) elderly suffering from a chronic illness; (3) patients suffering from a chronic illness; (4) persons working in the health care sector; (5) children.

RESULTS

In the season 2007/2008, vaccination coverage rates in the general population remained stable in Germany. Compared to the coverage rates of the previous season, increases of 3.7%, 2.0%, and 1.8% were observed for the UK, Spain, and France, respectively, while a decrease of -1.5% was observed for Italy. Across all five countries, vaccination rates in the predefined target groups decreased to some extent (elderly) or increased slightly (chronically ill and health care workers). Vaccination rates among children varied strongly between countries and ranged from 6.1% in UK to 19.3% in Germany. The most powerful motivation for getting vaccinated in all countries was advice from a family doctor (58.6%) and the perception of influenza as a serious illness (51.9%). The major reasons why individuals did not become vaccinated were (1) the feeling of not being likely to catch influenza (39.5%) and (2) never having considered the option of being vaccinated (35.8%).

CONCLUSIONS

The change in general influenza vaccination coverage in the 2007/2008 season compared to the previous season was small, but decreases were seen in some target groups. The underlying motivations for and against vaccination did not substantially change. An effort to activate those driving forces that would encourage vaccination as well as dealing with barriers that tend to prevent it may help enhance coverage rates in Europe in the future.

Educational vaccine tools: the French initiative

Prevention is an important but neglected issue in geriatric medicine. Vaccination plays a major role in prevention of infectious diseases, but its implementation in clinical practice is far from perfect. To improve practice, a group of French experts composed of geriatricians and infectious disease specialists prepared a set of educational material about vaccination for older subjects. The tool has been designed to be used by medical teachers to help them teach this topic to other physicians, nursing staff and students. The group first defined teaching objectives and reviewed the scientific literature on the efficacy and use of various vaccines in the elderly. Results were recorded in 217 slides. These slides were grouped to allow their use for short presentations: the immune system in the elderly and general information about vaccination; universal vaccines, influenza vaccines, pneumococcal vaccines, Herpes zoster vaccine, pertussis vaccine, vaccines for old travellers. Written comments were added to most slides to help presenters teach the topics. The content and design of the slides were analyzed and discussed by the whole group. The set was collected in a CD with ready-to-use files for oral presentations. This educational tool was presented and given to French teachers in geriatrics. It has been used for educational sessions in geriatric hospital wards, for continuous medical education for general practitioners and for courses for physicians learning geriatrics. It has also been proposed to physicians in charge of medical coordination of nursing homes and is available on a web site.

Increasing influenza vaccination coverage in recommended population groups in Europe

The clinical and economic burden of seasonal influenza is frequently underestimated. The cornerstone of controlling and preventing influenza is vaccination. National and international guidelines aim to implement immunization programs and targeted vaccination-coverage rates, which should help to enhance the vaccine uptake, especially in the at-risk population. This review purposes to highlight the vaccination guidelines and the actual vaccination situation in four target groups (the elderly, people with underlying chronic conditions, healthcare workers and children) from a European point of view.

A qualitative study to assess the perceived benefits and barriers to the pneumococcal vaccine in hospitalised older people

Pneumococcal vaccine is now recommended for all people aged 65 years and over in Australia, yet many in this age group remain unvaccinated, especially those from Non-English Speaking Backgrounds (NESB).

AIM

Our aim was to assess some of the perceived beliefs, benefits and barriers to pneumococcal immunisation in older people.

DESIGN AND SETTING

We conducted qualitative open-ended interviews among elderly hospital inpatients aged receiving care in the geriatric, cardiology, and orthopaedic departments of a large, 800-bed tertiary referral hospital.

METHODS

24 participants who had not received pneumococcal immunisation, and who were aged 60 years and over, were mentally competent and well enough to be interviewed were selected for our study.

RESULTS

Three topics were addressed: patient attitudes towards vaccination, knowledge of vaccines and their purpose, and accessibility of patient education materials about vaccines and their purpose. Patients who accepted pneumococcal immunisation (acceptors) generally were unaware of the vaccine or did not know it was recommended for them. Patients who refused the pneumococcal vaccine (refusers) either would not consider it without the recommendation of their general practitioner or they maintained the belief that the vaccination would cause illness or symptoms. Knowledge about the availability and purpose of the pneumococcal vaccine was poor amongst our group.

CONCLUSION

Poor knowledge of the availability and purpose of pneumococcal immunisation was prevalent in our subjects. Appropriate education campaigns and trusting and positive relationships with the general practitioners are likely to improve immunisation uptake.