Elsevier

Vaccine

Volume 19, Issue 32, 14 September 2001, Pages 4760-4767
Vaccine

Importance of patients’ perceptions and general practitioners’ recommendations in understanding missed opportunities for immunisations in Swiss adults

https://doi.org/10.1016/S0264-410X(01)00223-7Get rights and content

Abstract

Over the last decades, tremendous efforts have been made to strengthen childhood immunisation programs. However, the burden of influenza and pneumococcal infections remains disturbingly high in adults and elderly. We conducted a cross-sectional self-administered mail survey to identify characteristics associated with low use of recommended vaccines in adult patients attending routine primary care appointments in Switzerland. Tetanus vaccination was reported by 84% of respondents aged 16–34, and by only 42% of respondents aged 65 or more. For influenza and pneumococcal vaccination, of high-risk patients (age ≥65 or history of diabetes, kidney, heart, or chronic pulmonary disease), only 41% were on schedule for influenza and 6% for pneumococcal vaccination. Compared with patients from the German- and Italian-speaking areas of the country, patients from the French-speaking region were more likely to report past immunisation against influenza and pneumococcal disease or a recent physician's recommendation for immunisation against influenza, but equally likely to have ever refused influenza vaccination. For all three diseases, area of residence, physician's recommendation for immunisation, and patient's perceived usefulness of vaccination were independently and significantly associated with vaccination status. Although patient's opinion is an important determinant of vaccination coverage in adults, lack of physician's encouragement accounted for most missed vaccination opportunities in this study. The higher vaccination coverage among patients from the French-speaking area suggests that the promotion campaigns carried out in this region effectively improved influenza vaccine use. Interventions designed to increase vaccination coverage in adults must help providers incorporate immunisation in routine health care.

Introduction

Over the past decades, tremendous efforts have been made world-wide to strengthen childhood immunisation programs. Immunisation coverage has increased in most regions and cases of vaccine-preventable diseases have fallen by 90–100% in children of industrialised nations. Polio eradication may be on the horizon.

In contrast to these successes, the burden of influenza and pneumococcal infections remains disturbingly high in older adults of most countries, and cases of tetanus are still regularly reported. A common characteristic of all three diseases is that their residual incidence in older age groups results directly from adults’ underimmunisation [1], [2], [3], [4].

Several factors have been proposed to account for the poor implementation of recommended schedules for immunisations in adults [5]: (1) The limited perception by health care providers and the general public that adult vaccine-preventable diseases are important health problems; (2) doubts in the doctors’ and patients’ minds about the efficacy and safety of the vaccines used for adults; (3) the complexity of vaccine schedules in adults (different vaccines have different target groups); (4) the larger size of some adult target populations as compared with those of childhood vaccination; (5) the lack of statutory requirements for adults immunisations; and (6) the rarity of both public and private programs for vaccinating adults.

We surveyed Swiss adult patients attending general practices to determine how patients’ attitudes toward vaccination and physicians’ past recommendation for immunisation were related to their immunisation status against tetanus, influenza, and pneumococcal infection. As prevention programs related to immunisation vary greatly across Swiss regions, we also compared patients’ attitudes toward vaccination, physicians’ recommendation for immunisation, and immunisation status across the three linguistic areas of the country.

Section snippets

Setting

Recent surveys have shown that only 37% of Swiss adults over 65 are immunised against influenza [6], [7], [8]. Although no reliable data are available for immunisation coverage against tetanus and pneumococcal disease among adults, local public health experts agree that rates are low. Reflecting the lack of a national strategy for adult immunisation, there are no coordinated effort to ensure high immunisation coverage against tetanus in adults and no official guidelines for pneumococcal

Results

Of the 178 physicians selected, 123 (69%) participated in the survey and 100 contributed 15 or more questionnaires. In total, 2129 patient questionnaires were received, for an overall response rate of 60%. Eighty-seven patients (4%) refused to participate, and 69 reported reasons for not completing the questionnaire (not fluent in the language used for the questionnaire 28%, sight impairment 20%, feeling too sick 10%, did not want to complete the survey 42%).

For the remaining 2042 participants,

Discussion

The lack of clear national objectives and guidelines regarding the prevention of vaccine-preventable diseases in the adult population were reflected in our findings. Tetanus, influenza, and pneumococcal vaccination coverage remains low in adults attending primary care practices in Switzerland. In high-risk patients, rate of pneumococcal and influenza immunisations were close to zero and below 50%, respectively. Only two-third of patients were on schedule for tetanus vaccination. Lack of a

Acknowledgements

We would like to thank the Swiss Academy for Medical Science and the Federal Office for Public Health (contract no. 316.98.6766), who funded this research, as well as all the physicians and the patients who participated in this survey.

References (21)

  • W.W Williams et al.

    Immunization policies and vaccine coverage among adults. The risk for missed opportunities

    Ann. Intern. Med.

    (1988)
  • D.S Fedson et al.

    Influenza vaccination in 22 developed countries: an update to 1995

    Vaccine

    (1997)
  • D.S Fedson

    Pneumococcal vaccination in the United States and 20 other developed countries, 1981–1996

    Clin. Infect. Dis.

    (1998)
  • F Ambrosch et al.

    Influenza vaccination in 29 countries. An update to 1997

    Pharmacoeconomics

    (1999)
  • D.S Fedson

    Adult immunization. Summary of the National Vaccine Advisory Committee Report

    J. Am. Med. Assoc.

    (1994)
  • Swiss Federal Office for Statistics, Enquête suisse sur la santé 1997. Neuchâtel: Swiss Federal Office for Statistics;...
  • L Gauthey et al.

    Influenza vaccination coverage in the geriatric population of the State of Geneva, Switzerland

    Eur. J. Public Health

    (1999)
  • C.E Ammon

    A survey of institutional influenza vaccination in Switzerland

    Soz. Praventivmed.

    (2000)
  • Swiss Federal Office of Public Health, Recommandations pour la prévention de la grippe. Bern: OFSP/BAG; 1996. p. suppl....
  • G.D Koch et al.

    Strategies in the multivariate analysis of data from complex surveys

    Int. Stat. Rev.

    (1975)
There are more references available in the full text version of this article.

Cited by (0)

View full text