Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France; UMR7268 ADES, Aix-Marseille Univ., Marseille, France.
UMR INSERM 1027, University of Toulouse III, Toulouse, France; Service de Pharmacologie Clinique, CHU de Toulouse, Toulouse, France.
Vaccine. 2014 Feb 7;32(7):846-51. doi: 10.1016/j.vaccine.2013.12.023. Epub 2013 Dec 23.
Older adults living in nursing homes (NH) are at high risk of developing influenza and pneumococcal infections. The objectives of this study were to describe vaccination coverage for influenza and pneumococcal among French NH residents and to investigate which NH structure- and organisation-related aspects could impact on vaccination in this population.
This study is based on cross-sectional data from 175 French NHs (N=6275 residents), collected in May-July 2011. Residents' vaccination status (yes vs. no) against pneumococcal infection and seasonal influenza was recorded by the NH staff (on the basis of the resident's medical chart). Residents' health-related variables (e.g., co-morbidities) and information on NH structure and internal organisation were recorded by the NH staff. Mixed-effects logistic regressions were performed on influenza and pneumococcal vaccination separately.
Influenza vaccination coverage was high (n=5071, i.e., 80.8% of residents) and relatively well-distributed across NHs, whereas pneumococcal vaccination was low (n=1758, i.e., 28%) and highly variable across facilities. Mixed-effects logistic regressions confirmed that structural and organisational aspects related to the NH functioning impacted vaccination coverage. More precisely, living in a private for profit NH, living in NHs located in low-urban areas, and coordinating physician training increased the odds of receiving pneumococcal vaccine, whereas living in NHs located at high-urban areas decreased this odds. Moreover, the time spent by the coordinating physician in the NH increased the odds of receiving influenza vaccine. Prescriptions re-examination since resident's admission at the NH and the presence of an individualised health care project increased the odds of receiving both influenza and pneumococcal vaccines.
Our findings suggest that a more standardised approach is needed to improve vaccination coverage against pneumococcal infection in French NH residents.
居住在养老院（NH）的老年人患流感和肺炎球菌感染的风险很高。本研究的目的是描述法国 NH 居民流感和肺炎球菌疫苗接种覆盖率，并调查 NH 的结构和组织相关方面如何影响该人群的疫苗接种。
本研究基于 2011 年 5 月至 7 月期间在 175 家法国 NH 中收集的横断面数据（N=6275 名居民）。NH 工作人员根据居民的医疗记录（基于居民的医疗记录）记录了居民对肺炎球菌感染和季节性流感的疫苗接种状况（是与否）。NH 工作人员记录了居民的健康相关变量（例如合并症）以及 NH 结构和内部组织的信息。分别对流感和肺炎球菌疫苗接种进行混合效应逻辑回归。
流感疫苗接种覆盖率高（n=5071，即 80.8%的居民），在 NH 之间分布相对均匀，而肺炎球菌疫苗接种率低（n=1758，即 28%），在各机构之间差异很大。混合效应逻辑回归证实，与 NH 功能相关的结构和组织方面影响了疫苗接种覆盖率。更具体地说，居住在私立营利性 NH、居住在低城市地区的 NH 以及协调医生培训增加了接种肺炎球菌疫苗的几率，而居住在高城市地区的 NH 则降低了这种几率。此外，协调医生在 NH 中花费的时间增加了接种流感疫苗的几率。自居民入住 NH 以来的处方复查以及个人医疗保健计划的存在增加了接种流感和肺炎球菌疫苗的几率。
我们的研究结果表明，需要采取更标准化的方法来提高法国 NH 居民对肺炎球菌感染的疫苗接种覆盖率。
