Although many deaths can be prevented by simple, inexpensive flu shots,
vaccination rates remain modest, according to Richard Kent Zimmerman, M.D.,
M.P.H., of the University of Pittsburgh and colleagues. Too few adults
appreciate the importance of this preventable disease and too many harbor
doubts about the safety and effectiveness of vaccines, Zimmerman says.
The study appears in the December issue of the American
Journal of Preventive Medicine.
Influenza immunization rates for people age 65 years or older fell to
63 percent in 2000-2001, well below the national goal of 90 percent and
down from 68 per cent a year earlier. Rates among minority groups were
even lower: 49 percent for blacks and 52 percent for Hispanics.
However, the researchers found a vaccination-friendly
culture at veterans’ hospitals
exceeded the national goal, with equally high rates among both blacks
and whites.
Zimmerman and colleagues questioned 60 physicians and a sampling of 925
of their patients to discover factors affecting influenza vaccination among
older adults.
The study was done before the current outbreak of a new flu strain that
started earlier than usual and has produced a shortage of vaccines. The
shortage is due, in part, to the fact that manufacturers cut production
in response to lower-than-expected demand last year, according to the Centers
for Disease Control and Prevention.
Zimmerman found, unsurprisingly, that economic issues
played a role in the low rates. One-fifth of doctors he surveyed were “very concerned” about
Medicare reimbursement, and half were likely to refer a patient on Medicaid
to public health departments for the shots.
“Patients in these practices had lower vaccination rates than did
patients whose physicians were unconcerned about economic issues,” Zimmerman
says.
The strongest predictor of vaccination status seemed to
be a patient’s
personal outlook on preventive measures. Higher rates were found among
those who also intended to be vaccinated the following flu season, who
believed in the usefulness of vaccines and who had been screened for
colon cancer.
Physicians’ attitudes toward promoting good health
were also a key to vaccination rates among their patients. Patients whose
doctors agreed
with national recommendations to vaccinate persons with asthma or who
also recommended tetanus shots were also more likely to get the flu vaccine,
as were those whose doctors had never smoked.
Physicians who offered express vaccination services, flu shot clinics,
patient education about vaccines or systems to remind the doctors to give
patients flu vaccinations also had higher rates.
The high rates at the VA were a result of a campaign that
includes patient reminders, standing orders for physicians and a general “culture
that promotes prevention by sharing responsibility among team members
and reducing competing demands.”
Funding for this project was provided by the Agency for Healthcare Research
and Quality.
