Improving Physician Coverage of Pneumococcal Vaccine: A Randomized Trial of a Telephone Intervention Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice. Determinants of adult influenza and pneumonia immunization rates. Increasing influenza immunization among high-risk patients: education or financial incentive? Impact of Medicare reimbursement on influenza vaccination rates in the elderly. Successful implementation of a combined pneumococcal and influenza vaccination program in a Canadian emergency department. Increasing influenza and pneumococcal immunization rates: a randomized controlled study of a senior center-based intervention. Improving compliance with immunization in the older adult: results of a randomized cohort study. Achieving the national health objective for influenza immunization: success of an institution-wide vaccination program. Standing orders for influenza vaccination increased vaccination rates in inpatient settings compared with community rates. Effectiveness of a co-ordinated nation-wide programme to improve influenza immunisation rates in The Netherlands. Mass mailings have little effect on utilization of influenza vaccine among Medicare beneficiaries. Enhancing physician adoption of practice guidelines. Dissemination of influenza vaccination guideline using a small-group consensus process. Influenza Vaccination Coverage Rates in 5 European Countries: a Population-Based Cross-Sectional Analysis of the Seasons 02/03, 03/04 and 04/05 Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization.
Improved pneumococcal vaccine ( PPV ) immunization for seniors is a national goal of the Medicare program . This study examined whether adding a simple telephone follow-up to an existing mailed physician performance feedback under the Medicare program would increase the impact on billed pneumococcal immunizations . Medicare fee-for-service cl aims data were used to select New York primary care physicians with high volume ( n = 732 ) or African-American serving ( n = 329 ) practice s. All practice s received mailed feedback on their 1999 Medicare practice specific PPV coverage rates , along with educational material s and offers of assistance . Practice s were also r and omized to receive telephone calls directing attention to the mailing and further promoting improvements in PPV coverage or no active follow-up . Physicians r and omized to telephone follow-up showed significantly higher rates of practice specific PPV coverage in 2000 than those receiving the routine mailing only , and 27 % vs. 17 % ( p = 0.01 ) of high volume physicians and 34 % vs. 22 % ( p = .052 ) of African American serving physicians achieved at least a 5 % increase in their cumulative PPV cl aims coverage . This study concludes that telephone follow-up is an effective and straightforward method to enhance the impact of practice specific feedback to promote improvements in Medicare PPV immunization . However , improved methods may be needed to induce a large percentage of physicians to change BACKGROUND Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60 % and 70 % . Almost all influenza immunisation in the UK is done within general practice . Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies . AIM To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practice s. DESIGN OF STUDY R and omised controlled trial . SETTING Three research general practice s within the East London and Essex network of research ers ( ELENoR ) . METHOD Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice . The intervention , during October 2000 , was a telephone call from the practice receptionist to intervention group households , offering an appointment for influenza immunisation at a nurse-run . clinic Main outcome measures were the numbers of individuals in each group receiving immunisation , and practice costs of a telephone-appointing programme . RESULTS intention to treat analysis showed an immunisation rate in the control group of 44 % , compared with 50 % in the intervention group ( odds ratio = 1.29 , 95 % confidence interval = 1.03 to 1.63 ) . Of the patients making a telephone appointment  , 88 % recieved immunisation , while 22 % of those not wanting an appointment went on to be immunised . In the controlgroup , income generated was 11.35 pounds per immunisation , for each additional immunisation in the intervention group the income was 5.20 pounds . The ' number needed to telephone ' was 17 . CONCLUSION Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6 % using a simple intervention by receptionists . Immunisation rates in this low-risk group fell well short of the 60 % government target . Improving immunisation rates will require a sustained public health campaign . Retaining the item-of-service payments to practice s should support costs of practice -based interventions OBJECTIVES To determine national adult  immunization rates  for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases . DESIGN Retrospective , cross-sectional , r and om national sample data from the Centers for Disease Control and Prevention 's 1999 Behavioral Risk Factor Surveillance System survey . Data extraction and analysis were conducted using SPSS and STATA , with adjustments made for weighted data . PARTICIPANTS Individuals aged 65 years and older and individuals aged 50 to 64 years ( for influenza only ) . RESULTS Immunization rates in the 65 and older age group were 66.7 % for influenza and 53.8 % for pneumonia ; immunization rate for influenza in the 50 to 64 age group was 35.6 % . Predisposing factors such as race ( white ) and education ( high school and above ) positively influenced immunization status . Enabling factors such as income , health insurance , and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study population s. Health care coverage ( odds ratio [ OR ] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group ; OR = 1.80 for influenza in the 50 to 64 years age group ) and physician visit in the last year ( OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group ; OR = 1.86 for influenza in the 50 to 64 years age group ) were strong positive predictors of vaccination status . Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates . CONCLUSION Underst and ing the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospect i ve recipients of immunization services PURPOSE To determine whether an educational brochure or a lottery-type incentive increases influenza immunization rates . PATIENTS AND METHODS In a prospect i ve , single-blind factorial design r and omized trial at an urban community health center , all high-risk patients ( n = 797 ) seen in the preceding 18 months were r and omly assigned to one of four groups : a control group ; a group mailed a large print , illustrated educational brochure emphasizing factors important to patients in making a decision about influenza immunization ; a group mailed a lottery-type incentive announcing that all patients receiving influenza immunization  would be eligible for grocery gift certificates ; and a group mailed both educational brochure and incentive . Immunization was free , available without an appointment , and recorded by a computerized tracking system . RESULTS The group mailed the brochure was more likely to be immunized than control ( odds ratio [ OR ] = 2.29 , 95 % confidence interval [ CI ] 1.45 to 3.61 ) , as was the group mailed the incentive ( OR = 1.68 , 95 % CI 1.05 to 2.68 ) , but there was no difference between the group mailed both interventions and the control group . The effectiveness of the brochure was more striking for individuals who had not accepted immunization in the prior year ( OR = 4.21 , 95 % CI 2.48 to 7.14 ) , suggesting a true educational effect rather than simply a reminder . CONCLUSION In this community health center setting , an illustrated educational brochure increased influenza immunization among high-risk patients , a lottery-type incentive was much less effective , and both together was not effective BACKGROUND Influenza is responsible for significant morbidity , mortality , and medical costs , but immunization rates in the elderly remain low . METHODS As part of a demonstration project in rural Pennsylvania , 1,989 community-dwelling Medicare beneficiaries , 65 - 79 years old , completed a health risk appraisal including questions about flu shots . Participants were r and omized to two experimental ( hospital or physician ) or control groups . Experimental groups were offered free flu shots for the 1990 - 91 flu season . Follow-up interviews to determine vaccination rates were completed about 1 year later . RESULTS Baseline immunization rates were almost identical for the hospital-based ( 41.2 % ) , physician-based ( 41.3 % ) , and control group not offered free immunizations ( 40.6 % ) . Follow-up rates for the groups offered immunizations rose significantly to 63.6 and 69.1 % for hospital and physician groups , respectively , while the control group also increased significantly to 54.1 % . Individuals who were more educated , were older , and had greater chronic diseases history ( myocardial infa rct ion , hypertension , and pulmonary disease ) were more likely to be immunized . Male and married elderly were more likely to be immunized as a result of the demonstration . CONCLUSIONS Increasing community education and providing immunizations free through Medicare will increase immunization rates among elderly . The elderly are more likely to receive flu shots provided through physicians ' offices than through hospital-based clinics OBJECTIVES To determine the proportion of patients vaccinated with pneumococcal ( PVAX ) and influenza ( IVAX ) vaccines under an emergency department ( ED ) vaccination program , that would not otherwise have been vaccinated by other primary care re sources . METHODS This prospect i ve cohort study was performed in a tertiary care academic centre . A question naire was administered to all consenting ED patients who met screening eligibility criteria to receive either IVAX or PVAX . Eligible unvaccinated patients who did not plan on receiving vaccination elsewhere were offered one or both of the vaccines and , if agreeable , were immunized in the ED . RESULTS During the 4-week study period , 754 patients ( 36 % of all presenting ED patients ) were eligible for vaccination with one or both vaccines . Of these 525 ( 70 % ) consented to participate in the study and completed a question naire . Of the 525 participants , 289 ( 55 % of IVAX eligible patients ; 95 % confidence interval [ CI ] , 51%-59 % ) were unvaccinated against influenza that year and did not plan on being vaccinated elsewhere and 277 ( 60 % of PVAX eligible patients ; 95 % CI , 56%-64 % ) were unvaccinated against pneumococcus and did not plan on being vaccinated elsewhere . IVAX was administered to 187 patients ( 65 % penetration ; 95 % CI , 59%-70 % ) , and PVAX was administered to 165 patients ( 60 % penetration ; 95 % CI , 54%-65 % ) . Overall vaccine penetration was 46 % ( 95 % CI , 42%-50 % ) in the study participants and 32 % ( 95 % CI , 29%-35 % ) for the entire ED screened and eligible group . Reasons for vaccination refusal included concerns about benefit , side effects , and the desire to discuss vaccination with their primary care physician . CONCLUSIONS An ED-based program can result in the vaccination of a significant proportion of patients eligible for IVAX and /or PVAX who would otherwise likely go unprotected BACKGROUND Immunizations decrease morbidity from influenza and pneumococcal infections . Immunization levels remain below desired levels despite clinic-based and public education efforts . This paper describes a r and omized , controlled trial of a senior center-based program , which used peer-to-peer outreach to increase pneumococcal and influenza immunization rates among an urban senior population . METHODS Seniors were r and omized to intervention or control groups . The intervention group received educational brochures mailed with reply cards to report immunization status , telephone calls from senior volunteers to unimmunized participants , and computerized immunization tracking .  Immunization rates were obtained before and after the intervention by self-report . RESULTS Among participants without prior pneumococcal immunization , the pneumococcal immunization rate among the intervention group ( 52.0 % ; 95 % CI = 46.6%-57.4 % ) was significantly higher than that of the control group ( 30.9 % ; 95 % CI = 26.6%-35.2 % ) ( rate ratio = 1.68 ; 95 % CI = 1.40 - 2.03 ) . Among those without influenza immunization in the prior year , significantly more ( 50.0 % ; 95 % CI = 40.0%-60.0 % ) were immunized against influenza in the intervention group than in the control group ( 23.0 % ; 95 % CI = 15.2%-33.3 % ) ( rate ratio = 2.17 ; 95 % CI = 1.42 - 3.31 ) . Among those with influenza immunization in the prior year , the rate ratio was 1.04 ( 95 % CI = 1.01 - 1.07 ) . CONCLUSIONS The intervention increased both influenza and pneumococcal immunization rates to high levels , suggesting that further progress in increasing adult immunization coverage is possible OBJECTIVE To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients . DESIGN R and omized controlled trial using three parallel group practice s at a public urban teaching hospital . SETTING Public teaching hospital . SUBJECTS All patients 65 years of age and older ( n = 1202 ) seen by resident physicians ( n = 66 ) attending three ambulatory medical practice s from October 1 , 1989 to March 31 , 1990 . INTERVENTIONS All three provider groups received intensive education in immunization st and ards . The control group received no further intervention . Staff in the second group offered education to patients at their visits . In the third group , the prevention team , a flowsheet was used , patient education offered , and staff had their tasks redefined to facilitate compliance ; for vaccinations , eg , nurses could vaccinate independent of MD initiative . MEASUREMENTS AND MAIN RESULTS Medical records were review ed for the 1202 patients seen , including 756 patients seen during both the 1988 - 89 and 1989 - 90 influenza seasons , to determine documented offering and receipt of vaccinations . During the intervention period ( 1989 - 90 ) ,  influenza vaccinations  were offered significantly more frequently to prevention team patients ( 68.3 % ) than to patients in either the patient education ( 50.4 % ) or control ( 47.6 % ) groups ( P = 0.006 ) , even after adjusting for the patients ' prior vaccination status , age , gender , race , and high-risk co-morbidity and for physicians ' level of training . Likewise , pneumococcal vaccinations  were offered more frequently to previously unvaccinated prevention team patients ( 28.3 % ) than to patient education ( 6.5 % ) or control ( 5.4 % ) group patients ( P = 0.001 ) , even after adjusting for the factors using multivariate analysis . Compliance rates did not differ between patient education and control subjects for either vaccine . Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines , with 89.0 % and 52.8 % of physicians believing that they complied with influenza and pneumococcal vaccination guidelines , respectively . CONCLUSIONS The results of this trial provide strong support for organizational changes that involve non-physician personnel to enhance vaccination rates among older adults PURPOSE To enhance influenza vaccination rates for high-risk out patients at the Department of Veterans Affairs Medical Center ( VAMC ) in Minneapolis , Minnesota , an institution-wide immunization program was implemented during 1987 . PATIENTS AND METHODS The program consisted of : ( 1 ) a hospital policy allowing nurses to vaccinate without a signed physician 's order ; ( 2 ) stamped reminders on all clinic progress notes ; ( 3 ) a 2-week walk-in flu shot clinic ; ( 4 ) influenza vaccination " stations " in the busiest clinic areas ; and ( 5 ) a mailing to all out patients . Risk characteristics and vaccination rates for patients were estimated from a vali date d self-administered postcard question naire mailed to 500 r and omly selected out patients . For comparison , 500 patients were surveyed from each of three other Midwestern VAMCs without similar programs . RESULTS Overall , 70.6 % of Minneapolis patients were high-risk and 58.3 % of them were vaccinated . In contrast , 69.9 % of patients at the comparison medical centers were high-risk , but only 29.9 % of them were vaccinated . CONCLUSION The Minneapolis VAMC influenza vaccination program was highly successful and may serve as a useful model for achieving the national health objective for influenza immunization BACKGROUND Hospitalization of older adults during the period of influenza vaccination in the fall of each year presents a barrier to immunization against influenza . This study evaluates a program using st and ing orders for influenza vaccination to increase vaccination rates among hospitalized older adults and to determine the effect of vaccination on readmission rates for influenza-like illness . METHODS An influenza vaccination program using a st and ing order policy was implemented to vaccinate all consenting persons 65 years and older prior to hospital discharge . This was a prospect i ve , single center , cohort study in a tertiary care university teaching hospital during an 8-week vaccination period in the fall of 1994 and follow-up during the subsequent influenza season . The vaccination status of each patient was recorded as no vaccination , vaccination received in hospital , or vaccination in the community prior to or after the hospitalization . Hospital vaccination rates were compared with the rate of vaccination of older adults in the community . During the subsequent influenza season , the number of subjects reporting symptoms of influenza-like illness ( ILI ) or who were readmitted to hospital with influenza-related illness was compared in an analysis of vaccinated versus unvaccinated subjects . RESULTS Seven hundred and sixty-one patients were interviewed , and 332 of these individuals had been vaccinated in the community prior to their hospital admission . Of the remaining 429 unvaccinated patients who were eligible for vaccination in the study , 171 were vaccinated in our immunization program , eight were vaccinated in the community after discharge , and 244 were not vaccinated . We were able to increase the absolute vaccination rate by 22 % , when compared with community rates , with our immunization program . The number of subjects with ILI symptoms or readmission to hospital was too small to compare the vaccinated to the unvaccinated group in the study . CONCLUSIONS An inpatient influenza immunization program using a st and ing order policy was able to target a particularly high-risk subset of persons 65 years and over who might otherwise have not received influenza vaccination OBJECTIVE To assess t he effectiveness of a nation-widemultifaceted intervention programme involving general practitioners ( GPs ) on influenza immunisation practice . DESIGN Pragmatic before-after trial using pre- and post-measurement question naires . SETTING AND SUBJECTS R and om sample of Dutch general practice s. INTERVENTION During a 2.5-year period ( 1995 - 1997 ) a variety of methods was implemented to enhance  physician adoption of the immunisation guideline , including employment of facilitators , information-based methods , small-group consensus meetings , individual instructions and introduction of supportive computer software . MAIN OUTCOME MEASURES Influenza immunisation practice and influenza vaccine uptake . RESULTS In 988 practice s all influenza vaccination characteristics markedly improved from 1995 to 1997 . The most significant changes were found in computerised marking of high-risk patients ( from 54 % to 82 % of practice s ) , computerised selection ( 41 % to 77 % ) and sending personal reminders ( 40 % to 77 % ) . Vaccine uptake increased from 9 % to 16 % of the practice population ( 78 % increase , p < 0.001 ) . Uptake was most prominent in urban and single-h and ed practice s and in those with more patients insured through the National Health Service , low GP workload and low baseline uptake . CONCLUSION Our data suggest that a co-ordinated approach involving primary care physicians can succeed in enlarging the public health impact of a population -based preventive measure BACKGROUND We review ed published and unpublished studies of mass mailings design ed to increase utilization of  influenza vaccine  among Medicare beneficiaries . METHODS Search of computerized indexes for published studies and the Medicare Peer Review Organization Health Care Quality Improvement Project data base for unpublished studies . Study selection criteria were : use of a controlled trial design and use of mass mailings direct  to Medicare beneficiaries to increase receipt of influenza vaccinations .  Study selection and data extraction were performed in duplicate by physician review ers with consensus resolution . RESULTS Six controlled trials of mass mailings were identified . One study , published in the Morbidity and Mortality Weekly Report ( MMWR ) , reported a modest but statistically significant improvement in influenza vaccination rates among patients who received a letter relative to those who did not . This study was cited as justification for mail interventions performed in five subsequent studies , none of which reported clinical ly meaningful results . None of these five studies was published . CONCLUSIONS Mass mailings have at best had clinical ly trivial effects on increasing influenza vaccination among Medicare beneficiaries . Publication bias has contributed to continued use of a relatively ineffective intervention BACKGROUND A dissemination intervention to facilitate adoption of a preventive practice guideline ( influenza vaccination for older adults ) in group practice s was developed and evaluated . The intervention , small-group consensus process , started with a physician expert presenting the guideline and followed with the group participating in a structured discussion of ways to implement the guideline that culminated in a public commitment ( ie , " buy in " ) to adopt the guideline . METHODS Thirteen group practice s and their primary care physicians ( mean size , 5 ) were assigned r and omly to intervention or control arms . In each group practice , physicians in the intervention arm met for 1 hour . Control physicians participated in an unrelated discussion ( non-steroidal drug use ) . Guideline adoption was determined by changes in physicians ' vaccination rates that were obtained through prechart and postchart review s of 51 physicians . Pre question naires and post question naires measured influenza knowledge and prevention attitudes . RESULTS Using analysis of covariance , the small-group consensus process was found to increase physician vaccination rates by 34 % compared with the control arm ( F ( 1,48 ) = 19.49 ) . All intervention arm physicians increased vaccination rates from before to after compared with 54 % of control arm physicians . Attitudes and knowledge did not change and were unrelated to increased vaccination rates . CONCLUSIONS A case is made for the small-group consensus process as an effective utilization-focused dissemination method . Interventions based on group dynamics and sensitive to local practice context s can be useful in facilitating adoption of guidelines by physicians in group practice Introduction : Influenza continues to be a considerable health problem in Europe .  Vaccination is the only preventive measure , reducing mortality and morbidity of influenza in all age groups Objectives : The objective of this survey was to assess and compare the level of influenza vaccination coverage during three consecutive influenza seasons ( 02/03 , 03/04 , 04/05 ) in the five European countries United Kingdom , France , Italy , Germany and Spain , underst and the driving forces and barriers to vaccination now and 3 years ago and determine vaccination intentions for the following winter . Methods : We conducted a r and om-sampling , telephone-based household survey among non-institutionalized individuals representative of the population aged 14 and over . The surveys used the same question naire for all three seasons . The data were subsequently pooled . Four target groups were determined for analysis : ( 1 ) persons aged 65 and over ; ( 2 ) people working in the medical field ; ( 3 ) persons suffering from chronic illness and ( 4 ) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness . Results : The overall sample consisted of 28,021 people . The  influenza vaccination coverage rate increased from 21.0 % in season 02/03 to 23.6 % in season 03/04 and then to 23.7 % in season 04/05 . The differences between the seasons are statistically significant ( p = 0.01 ) . The highest rate over all countries and seasons had Germany in season 04/05 with 26.5 % , Spain had in season 02/03 with 19.3 % the lowest rate totally . The coverage rate in the target group composed of person 's aged 65 and over or working in the medical field or suffering from a chronic illness was 49.7 % in season 02–04 and 50.0 % in season 04/05 . The driving forces and barriers to vaccination did not change over the years . The most frequent reasons for being vaccinated given by vaccines were : influenza , considered to be a serious illness which people wanted to avoid , having received advise from the family doctor or nurse to be vaccinated and not wanting to infect family and friends . Reasons for not being vaccinated mentioned by people who have never been vaccinated were : not expecting to catch influenza , not having considered vaccination before and not having received a recommendation from the family doctor to be vaccinated . Options encouraging influenza vaccination are : recommendation by the family doctor or nurse , more available information on the vaccine regarding efficacy and tolerance and more information available about the disease . The adjusted odds ratio of receiving  influenza vaccine  varied between 2.5 in Germany and 6.3 in the United Kingdom in any risk group . Conclusion : The vaccination coverage rate increased from the first season ( 21.0 % ) to the third season ( 23.7 % ) by 2.6 % . The family doctor is the most important source of encouragement for people to be vaccinated against influenza . It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine , as well as the disease . We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself , so that they can actively inform their patients on these topics OBJECTIVE To examine the effects of using positive or negative frames to describe influenza vaccine benefits and side effects on patients ' expectations , decisions , decisional conflict , and reported side effects . METHODS 292 previously unimmunized patients with chronic respiratory or cardiac disease were r and omly assigned to receive benefit/risk information that was framed : ( 1 ) positively as the percentage who remain free of influenza and have no vaccine side effects , or ( 2 ) negatively as the percentage who acquire influenza and have vaccine side effects . Question naires elicited expectations , decisions , and decisional conflict . Vaccines were telephoned 3 days later for a self-report of local and systemic side effects and work absenteeism . RESULTS Both groups had similar immunization rates and decisional conflict scores . The positive frame group had lower and more realistic expectations of vaccine side effects , fewer systemic side effects , and less work absenteeism ( p < 0.05 ) . CONCLUSION In contrast to previous studies of health care workers , framing did not influence patients ' decisions , possibly due to the patients ' awareness of their higher risk of influenza complications and greater desire to follow recommendations . The common practice of using negative frames when describing probabilities of side effects may need to be reexamined , considering its deleterious influence on self-reported side effects and work absenteeism
BACKGROUND Although the evidence to support influenza vaccination is poor , it is promoted by many health authorities .
There is uncertainty about the effectiveness of interventions to increase  influenza vaccination rates in those 60 years or older .
OBJECTIVES To assess effects of interventions to increase  influenza vaccination rates in those 60 or older .