Abstract
BACKGROUND: The uptake of influenza vaccination among older people is suboptimal. Contact with a doctor or nurse is associated with older people deciding to accept influenza vaccination. AIM: To compare different forms of approach in improving uptake of influenza vaccination among patients aged 75 years and over in primary care. DESIGN OF STUDY: Randomised controlled trial. SETTING: One large rural general practice serving the town and surrounding area of Melton Mowbray, Leicestershire. METHOD: All 2,052 patients aged 75 years and over, registered with the practice and not living in nursing/residential homes or sheltered accommodation, were included in the study. One-third of patients were randomised to receive an offer of influenza vaccination as part of an over-75 health check administered by a practice nurse in the patient's home, and two-thirds of patients were randomised to receive a personal letter of invitation to attend an influenza vaccination clinic held at the surgery. The main outcome measure was uptake of influenza vaccination. RESULTS: Six hundred and eighty patients were randomised to the health check arm of the trial and 1,372 were randomised to receive a personal letter. Of those randomised to the health check arm, 468 received the health check from the nurse. Overall, the difference in influenza vaccination uptake was 6.4% (95% confidence interval [CI] = 2.2% to 10.4%) with 67.9% (n = 932) of those who were sent a personal letter actually receiving the vaccine, compared with 74.3% (n = 505) of those offered a combined health check and influenza vaccination (P = 0.003). CONCLUSION: Combining home-based over- 75 health checks with influenza vaccination can improve uptake among older patients. However this intervention is likely to be costly and its effect on influenza vaccination rates is modest. The difference in uptake is greater among those who do not routinely comeforwardfor vaccination and a more viable option may be to target these patients.
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Selected References
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- Armstrong K., Berlin M., Schwartz J. S., Propert K., Ubel P. A. Educational content and the effectiveness of influenza vaccination reminders. J Gen Intern Med. 1999 Nov;14(11):695–698. doi: 10.1046/j.1525-1497.1999.11098.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brown K., Boot D., Groom L., Williams E. Problems found in the over-75s by the annual health check. Br J Gen Pract. 1997 Jan;47(414):31–35. [PMC free article] [PubMed] [Google Scholar]
- Chew C. A., Wilkin D., Glendinning C. Annual assessments of patients aged 75 years and over: views and experiences of elderly people. Br J Gen Pract. 1994 Dec;44(389):567–570. [PMC free article] [PubMed] [Google Scholar]
- Cornford C. S., Morgan M. Elderly people's beliefs about influenza vaccination. Br J Gen Pract. 1999 Apr;49(441):281–284. [PMC free article] [PubMed] [Google Scholar]
- Duclos P., Hatcher J. Epidemiology of influenza vaccination in Canada. Can J Public Health. 1993 Sep-Oct;84(5):311–315. [PubMed] [Google Scholar]
- Govaert T. M., Thijs C. T., Masurel N., Sprenger M. J., Dinant G. J., Knottnerus J. A. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA. 1994 Dec 7;272(21):1661–1665. [PubMed] [Google Scholar]
- Gross P. A., Hermogenes A. W., Sacks H. S., Lau J., Levandowski R. A. The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med. 1995 Oct 1;123(7):518–527. doi: 10.7326/0003-4819-123-7-199510010-00008. [DOI] [PubMed] [Google Scholar]
- Honkanen P. O., Keistinen T., Kivela S. L. Factors associated with influenza vaccination coverage among the elderly: role of health care personnel. Public Health. 1996 May;110(3):163–168. doi: 10.1016/s0033-3506(96)80070-9. [DOI] [PubMed] [Google Scholar]
- Igoe G., Bedford D., Howell F., Collins S. How to improve the uptake of influenza vaccination in older persons at risk. Ir J Med Sci. 1999 Apr-Jun;168(2):107–108. doi: 10.1007/BF02946476. [DOI] [PubMed] [Google Scholar]
- Jagger C., Clarke M., O'Shea C., Gannon M. Annual visits to patients over the age of 75--who is missed? Fam Pract. 1996 Feb;13(1):22–27. doi: 10.1093/fampra/13.1.22. [DOI] [PubMed] [Google Scholar]
- McDowell I., Newell C., Rosser W. Comparison of three methods of recalling patients for influenza vaccination. CMAJ. 1986 Nov 1;135(9):991–997. [PMC free article] [PubMed] [Google Scholar]
- Moran W. P., Nelson K., Wofford J. L., Velez R., Case L. D. Increasing influenza immunization among high-risk patients: education or financial incentive? Am J Med. 1996 Dec;101(6):612–620. doi: 10.1016/S0002-9343(96)00327-0. [DOI] [PubMed] [Google Scholar]
- Morgan R., King D., Turnbull C. J. Influenza vaccination: do the aged reap the benefit? Postgrad Med J. 1995 Jan;71(831):22–23. doi: 10.1136/pgmj.71.831.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Puech M., Ward J., Lajoie V. Postcard reminders from GPs for influenza vaccine: are they more effective than an ad hoc approach? Aust N Z J Public Health. 1998 Apr;22(2):254–256. doi: 10.1111/j.1467-842x.1998.tb01183.x. [DOI] [PubMed] [Google Scholar]
- Whiting P., Joseph C. A., Zambon M., Nunn M., Fleming D., Watson J. M. Influenza activity in England and Wales: October 1998 to June 1999. Commun Dis Public Health. 1999 Dec;2(4):273–279. [PubMed] [Google Scholar]
- van Essen G. A., Kuyvenhoven M. M., de Melker R. A. Why do healthy elderly people fail to comply with influenza vaccination? Age Ageing. 1997 Jul;26(4):275–279. doi: 10.1093/ageing/26.4.275. [DOI] [PubMed] [Google Scholar]
- van Haastregt J. C., Diederiks J. P., van Rossum E., de Witte L. P., Crebolder H. F. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ. 2000 Mar 18;320(7237):754–758. doi: 10.1136/bmj.320.7237.754. [DOI] [PMC free article] [PubMed] [Google Scholar]