School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia.
School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia.
Prev Med. 2022 Feb;155:106946. doi: 10.1016/j.ypmed.2021.106946. Epub 2021 Dec 30.
Vaccine uptake in adult immunisation programs is often suboptimal. We aimed to assess the impact of the structured older persons health assessment (health assessment) on herpes zoster (zoster) vaccine uptake in Australia. We used national general practice electronic medical records (MedicineInsight) of encounters with patients aged 75-79 years because these patients were age-eligible for both free zoster vaccines and health assessments in the two years following the addition of zoster vaccine to the national immunisation program (Nov 2016-Dec 2018). Due to repeated encounters, we used generalized estimating equations with each patient treated as a clustering variable to analyse the comparison of rates of zoster vaccine administration during encounters where a health assessment was provided versus encounters where the health assessment was not provided. In analyses there were 31,876 patients with a total of 266,204 eligible general practice encounters. Of the 5018 encounters where a health assessment was provided, 592 zoster vaccinations also occurred on the same day (118.0/1000 encounters); for the 261,186 encounters where no health assessment was provided, 9226 zoster vaccinations occurred (35.3/1000 encounters). Zoster vaccine was more likely to be administered during a general practice encounter with a health assessment compared to encounters without one (adjusted odds ratio 2.99; 95% CI: 2.76-3.23). In conclusion, the structured older persons health assessment, which acts as both an incentive and a reminder for healthcare providers to recommend vaccinations in adults improves uptake of zoster vaccine in eligible adults. Such interventions may have a role in improving vaccine uptake among older adults.
成人免疫计划中的疫苗接种率往往不理想。我们旨在评估结构化老年人健康评估（健康评估）对澳大利亚带状疱疹（带状疱疹）疫苗接种率的影响。我们使用了全国普通实践电子病历（MedicineInsight）中 75-79 岁患者的就诊记录，因为这些患者在带状疱疹疫苗被纳入国家免疫计划（2016 年 11 月至 2018 年 12 月）后的两年内符合免费带状疱疹疫苗和健康评估的年龄要求。由于重复就诊，我们使用广义估计方程，每个患者作为聚类变量进行分析，比较提供健康评估和未提供健康评估的就诊记录中带状疱疹疫苗接种率。在分析中，有 31876 名患者，共有 266204 次符合条件的普通实践就诊记录。在提供健康评估的 5018 次就诊中，有 592 次同时接种了带状疱疹疫苗（118.0/1000 次就诊）；在未提供健康评估的 261186 次就诊中，有 9226 次接种了带状疱疹疫苗（35.3/1000 次就诊）。与没有健康评估的就诊相比，在提供健康评估的普通实践就诊中更有可能接种带状疱疹疫苗（调整后的优势比 2.99；95%置信区间：2.76-3.23）。总之，结构化老年人健康评估既可以作为激励措施，也可以作为医疗保健提供者推荐成年人接种疫苗的提醒，从而提高符合条件的成年人接种带状疱疹疫苗的意愿。这种干预措施可能在提高老年人的疫苗接种率方面发挥作用。
