Department of Infectious Diseases, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy.
Regional Directorate for Health and Social Policy, Lazio Region, Via R. Raimondi Garibaldi 7, 00145 Rome, Italy.
Vaccine. 2019 Aug 23;37(36):5314-5322. doi: 10.1016/j.vaccine.2019.07.054. Epub 2019 Jul 19.
Elderly people are a priority target group for influenza vaccination and their decision to be vaccinated might partly depend on advice received from general practitioners (GP). This study aims to investigate the association between influenza vaccine uptake in the elderly residents in the Lazio region of Italy and the demographic and professional characteristics of their GPs, taking simultaneously into account the elderly's individual characteristics.
We used data retrieved from different administrative sources to retrospectively analyse the cohort of 1,255,657 elderly residents aged ≥65 years who were alive and registered in the regional healthcare service at the beginning of the 2016-2017 influenza vaccination campaign (1 Oct. 2016-31 Jan. 2017). We assessed influenza vaccine uptake at the end of the vaccination campaign and evaluated its association with both individual and GP-related characteristics through a multilevel Poisson regression models accounting for clustering at physician level.
Overall, vaccination coverage at the end of vaccination campaign was 50.6%. Elderly residents who were male, older, vaccinated in the previous seasons, living in smaller provinces, and spending more money for specialist medical care showed a significantly increased probability to be vaccinated. Vaccine uptake was also significantly higher in the elderly residents assisted by GPs who got master's degree more recently, assisted a relatively high proportion of elderly patients, received influenza vaccination, had a computer assistant, and were associated with other physicians.
Our results indicate that influenza vaccination coverage in the elderly residents of the Lazio region is still unsatisfactorily low. We identified several determinants of influenza vaccine uptake, related to both individual and GP characteristics. Understanding how GP characteristics affected influenza vaccine uptake in the elderly population might provide insight on GPs' attitudes and concerns regarding influenza vaccination, allowing the implementation of targeted evidence-based interventions to sensitise GPs and increase vaccination coverage.
老年人是流感疫苗接种的重点目标人群，他们是否接种疫苗的部分决定因素可能取决于全科医生（GP）提供的建议。本研究旨在调查意大利拉齐奥地区老年人接种流感疫苗的情况与老年 GP 的人口统计学和职业特征之间的关系，同时考虑到老年人的个体特征。
我们使用从不同行政来源获取的数据，通过多水平泊松回归模型（考虑医生层面的聚类），回顾性分析了在 2016-2017 年流感疫苗接种活动开始时（2016 年 10 月 1 日至 2017 年 1 月 31 日）年龄≥65 岁且仍在世并在区域医疗保健系统中注册的 1255657 名老年居民队列。我们在疫苗接种活动结束时评估了流感疫苗接种率，并评估了其与个体和 GP 相关特征的关系。
总体而言，疫苗接种覆盖率在疫苗接种活动结束时为 50.6%。在男性、年龄较大、在之前的季节接种过疫苗、居住在较小的省份以及为专科医疗保健支付更多费用的老年人中，疫苗接种的可能性显著增加。在最近获得硕士学位、为相对较高比例的老年患者提供服务、接种流感疫苗、使用计算机辅助和与其他医生有联系的 GP 协助的老年居民中，疫苗接种率也显著更高。
我们的结果表明，拉齐奥地区老年居民的流感疫苗接种覆盖率仍然不理想。我们确定了几个与个体和 GP 特征相关的流感疫苗接种率决定因素。了解 GP 特征如何影响老年人群的流感疫苗接种率，可能有助于了解 GP 对流感疫苗接种的态度和关注点，从而实施有针对性的基于证据的干预措施，提高 GP 的意识并增加疫苗接种率。
