Patient, doctor attitudes can affect rate of flu shots

December 16, 2003

Success in immunizing the elderly against flu largely depends on attitudes of both patients and physicians, according to a study that found decreasing vaccination rates before this year's outbreak occurred.

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.

By Aaron Levin, Science Writer
Health Behavior, News Service
-end-
FOR MORE INFORMATION:
Health Behavior News Service: 202-387-2829 or http://www.hbns.org.
Interviews: Contact Richard Kent Zimmerman, M.D., M.P.H., 412-383-2354 or zimmer@pitt.edu.
American Journal of Preventive Medicine: Contact the editorial office at 858-457-7292.

This story is also available online at http://www.hbns.org/news/flushot12-15-03.cfm.

Center for Advancing Health

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