Point-of-care info campaigns drive up influenza, pneumococcal vaccination rates in seniors

Informational materials, such as flyers and posters, positioned at general practitioner clinics are likely to improve vaccination rates for influenza and pneumonia among elderly adults, according to a recent Singapore study.

“Our point-of-care study intervention appeared to contribute to modest but significantly increased vaccination rates among elderly primary care patients,” said researchers. “Concurrent administration of both vaccinations should be recommended to reduce missed opportunities.”

Twenty-two private general practitioner clinics participated in the pragmatic, cluster-randomized crossover trial. During the first 4 months, half of the clinics were assigned randomly to 3 months of the informational intervention followed by a 1-month washout, while the other half underwent the control period. Clinics then switched roles during the next 4-month crossover period.

A total of 602 patients were vaccinated, almost half of whom (47.5 percent) received both vaccines. Uptake rates for both influenza (5.9 percent vs 4.8 percent; p=0.047) and pneumococcal (5.7 percent vs 3.7 percent; p=0.001) vaccines were significantly higher during the intervention vs control periods. [Am J Public Health 2019;17:e1-e8]

Multivariable logistic regression analysis found that clinic visits during the intervention period were more likely to include an influenza (adjusted odds ratio [OR], 1.43, 95 percent CI, 0.9–2.07; p=0.06) and pneumococcal (adjusted OR, 1.78, 1.28–2.48; p<0.01) vaccination, as compared to control period visits. Analyses were controlled for potential intervention and study phase effects.

“The effect size of our intervention was greater for pneumococcal vaccination compared with influenza vaccination, possibly because low awareness was a more important barrier toward pneumococcal vaccination, and this was easily addressed by our intervention,” the researchers explained.

“In contrast, while patients were more likely to know about influenza vaccination, they might not have viewed it as a necessity because of low perceived susceptibility to infection or perceived severity of health complications,” they added.

In terms of secondary outcomes, the researchers found that elderly adults who were on follow-up for hyperlipidaemia, diabetes mellitus, hypertension or any combination were significantly more likely to get vaccinated for either infectious disease. Seeking management for asthma or chronic obstructive pulmonary disease was also positively correlated with pneumococcal vaccination rates.

Moreover, the volume of visits emerged as an important factor for vaccination rates. Clinics that saw 201–300 patients over a single study phase were more likely to dispense vaccines for influenza and pneumonia relative to those which only had 0–100 or 101–200 visits.

“Point-of-care informational interventions delivered in private [general practitioner] clinics likely contributed to modest increases in influenza and pneumococcal vaccination uptake,” said the researchers.

Aside from strengthening the engagement of elderly patients who are already more likely to receive vaccines, “[h]ealth promotion efforts should also target the oldest elderly subgroup and emphasize the importance of annual influenza vaccination,” they added.