Factors Influencing Team-Based Vaccination Collaboration in Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Survey of Primary Care Teams in Beijing, China

Abstract

Purpose

This study aims to investigate the factors influencing the impact of healthcare team collaboration on vaccination status among patients with Chronic Obstructive Pulmonary Disease (COPD) in primary care settings in Beijing, China.

Patients and Methods

A multicenter cross-sectional survey was conducted among members of family doctor teams in Beijing from October to December 2025. A structured questionnaire assessed team collaboration behaviors, influencing factors, guideline awareness, and vaccination practices. Descriptive statistics and chi-square tests were performed.

Results

A total of 209 valid responses were included (response rate: 92.07%). Although 57.9% of participants supported shared responsibility for vaccination, only 24.9% reported frequent team discussions, and 9.1% reported none in the past three months. Unstable vaccine supply (M=2.83) and limited performance incentives (M=3.76) were key barriers. While 66.5% of respondents were familiar with relevant guidelines, only 44.5% consistently provided strong vaccination recommendations in clinical scenarios. Patient hesitancy was primarily attributed to concerns about side effects (69.4%). Most respondents (67.0%) estimated vaccination coverage among COPD patients to be below 30%.

Conclusion

A substantial gap exists between guideline awareness and implementation of vaccination in primary care COPD management. Limited team communication, inadequate system support, and patient hesitancy jointly constrain vaccination uptake. Strengthening structured team collaboration, improving incentive mechanisms, and enhancing scenario-based guideline training may help improve vaccination coverage in this population.

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous chronic airway disease characterized by persistent airflow limitation and progressive respiratory symptoms.¹ Its clinical progression and pathological mechanisms exhibit significant individual differences.² According to global epidemiological data in 2025, the total number of COPD patients has exceeded 400 million, ranking third among the leading causes of death and constituting a major public health burden worldwide.³ In China, the prevalence of COPD among people aged 40 and above is approximately 13.7%, with an estimated number of patients reaching about 100 million. The number of disease-related deaths ranks first globally.^4,5 It is predicted that between 2020 and 2050, COPD will cause a cumulative economic loss of approximately $4.3 trillion worldwide, with China bearing the highest economic burden of the disease among all countries.⁶

With a deepening understanding of disease heterogeneity, the diagnostic and therapeutic paradigms for COPD are progressively evolving toward precision medicine.⁷ Current research emphasizes the quantitative relationship between exacerbations and lung function decline: each acute exacerbation event is associated with a 2.96 mL increase in the annual rate of decline in forced expiratory volume in 1 second (FEV1) (95% CI: 1.81–4.12). Furthermore, if a patient experiences at least one severe exacerbation, the annual FEV1 decline rate increases by an additional 14.6 mL (95% CI: 8.56–20.6), while the risk of all-cause mortality nearly doubles (Hazard Ratio [HR] = 1.97).^8,9 Consequently, the effective prevention of exacerbations has become a critical aspect of delaying COPD progression and improving patient prognosis. As a vital non-pharmacological intervention to prevent exacerbations induced by respiratory infections, vaccination is explicitly recommended by numerous authoritative guidelines worldwide.¹ Evidence indicates that pneumococcal and influenza vaccinations can significantly reduce exacerbation frequency, hospitalization rates, and mortality among COPD patients. Nevertheless, clinical data reveal that vaccination rates in this population remain suboptimal, highlighting a substantial gap between guideline recommendations and real-world implementation.¹⁰

Under China’s healthcare service system, family doctor teams based in community health service centers play a pivotal role in the long-term health management of COPD patients, encompassing various aspects such as disease management, health education, and preventive vaccination. These teams typically consist of multidisciplinary roles including general practitioners, nurses, public health personnel, and administrative staff. Their collaborative efficiency directly impacts patients’ awareness, willingness, and ultimate coverage level of vaccination.² However, grassroots teams still face multiple challenges in promoting vaccination, including patients’ concerns about vaccine safety, regional disparities in the accessibility of medical resources, instability in vaccine supply, and systematic and practical obstacles such as poor internal collaboration mechanisms within the team.¹¹

Therefore, this study aimed to explore the factors influencing team-based vaccination collaboration among primary care family doctor teams in Beijing, China, and to identify key barriers contributing to the gap between guideline awareness and implementation.

Participants and Methods

Study Design

This study adopted a multi-center cross-sectional survey design and conducted a questionnaire survey among members of primary care family doctor teams in Beijing from October 1st to December 31st, 2025. The research protocol was designed in accordance with the Statement on the Reporting of Observational Studies (STROBE).

Participants

The study population consisted of members of family doctor teams working in community health service centers in Beijing, China, including general practitioners, nurses, preventive care physicians, and other relevant professionals (eg, pharmacists, rehabilitation therapists, and administrative staff).

A convenience sampling strategy was used, whereby eligible participants were recruited through their respective institutions.

Inclusion criteria were as follows: (1) currently working in a community health service center in Beijing; (2) directly involved in the management of patients with chronic respiratory diseases; and (3) willing to participate and provide informed consent.

Exclusion criteria included: (1) incomplete questionnaires; (2) abnormal response time (<60 seconds or >1800 seconds, defined a priori to reduce random or inattentive responses); and (3) logically inconsistent answers.

A total of 227 questionnaires were collected, of which 209 were valid, resulting in a response rate of 92.07%.

Methods

Based on the relevant literature review and research objectives, we designed a structured questionnaire. The content was refined through expert consultations with primary care and public health professionals to ensure its relevance and clarity. The questionnaire consists of ten sections: Demographic characteristics,Teamwork behaviors,Factors influencing vaccination,Collaboration tools and processes,Patient-related barriers,Policy incentives,Intersectoral collaboration,Awareness of guidelines,Patient education,Follow-up practices. As this is an exploratory cross-sectional study, formal reliability and validity testing was not conducted, which constitutes a limitation of this research.

Data Collection

Create an electronic questionnaire through the “wechat” platform, and generate a unique QR code and link. The person in charge of each community health service center will uniformly forward the information to the family doctor team’s work group. The first page of the questionnaire includes research instructions and informed consent content. Participants must check the box to agree before entering the formal questionnaire.

Statistical Analysis

Data analysis was conducted using SPSS version 25.0. Descriptive statistics were used to summarize participant characteristics and survey responses. Continuous variables were presented as mean ± standard deviation or median as appropriate, while categorical variables were expressed as frequencies and percentages. The chi-square test or Fisher’s exact test was used to assess differences between categorical variables. A two-sided P value <0.05 was considered statistically significant.

Ethical

This study was approved by the Ethics Committee of Beijing Puren Hospital (No.prll-2025-29). All participants provided informed consent through an electronic platform. Given that Beijing Donghuashi Community Health Service Center does not have its own dedicated Ethics Committee, we sought ethical approval for our study through the Ethics Committee of Puren Hospital, which possesses the necessary ethical review qualifications. To confirm this, we have attached a sealed authorization letter from Beijing Donghuashi Community Health Service Center, officially authorizing Beijing Puren Hospital to conduct the ethical review.

Results

Part I: Data Screening and Basic Information Characteristics

Data Screening Process

Data were collected via an online questionnaire platform, resulting in a total of 227 raw responses. To ensure the quality of the analysis, the data were cleaned according to the following criteria: invalid records were removed, and extreme response times were addressed by excluding questionnaires with a response time that was too short (<30 seconds). As a result, 18 questionnaires were removed. After cleaning, 209 valid responses were obtained, yielding an effective response rate of 92.07%. All subsequent analyses are based on these 209 valid data points.

Basic Demographic and Occupational Characteristics of Respondents

The research survey participants were all from primary care medical institutions in Beijing. All respondents were members of family doctor teams, with their job roles being general practitioners (19.1%), general nurses (27.8%), preventive care physicians (13.9%), and other members of the family doctor team (such as pharmacists, rehabilitation therapists, etc). (39.2%). The family doctor team constitutes the core team for primary care vaccination collaboration. In terms of work experience, over 60% (62.7%) of the respondents have more than 10 years of work experience. These results indicate that the study population was composed of experienced primary care professionals, supporting the reliability of the responses. See Table 1 for details.

Table 1.

Distribution of Basic Characteristics of Survey Respondents (N=209)

Characteristic	Category	Number (n)	Percentage (%)
Work Role	General practitioner	40	19.1
	General Nurse	58	27.8
	Preventive care physician	29	13.9
	Other (pharmacists, rehabilitation therapists, managers, and other team members)	82	39.2
Years of Work Experience	< 5 years	19	9.1
	5–10 years	59	28.2
	> 10 years	131	62.7

Part II: Description of the Current Status of Primary Care Team Collaboration

Team Collaboration Behavior

Regarding team communication, 9.1% of respondents reported no discussion related to vaccination in the past three months, while only 24.9% reported frequent discussions (≥6 times). This suggests that routine communication on vaccination within teams remains insufficient despite its recognized importance. In terms of responsibility perception, 57.9% of respondents supported shared responsibility for vaccination, while 31.1% believed it should primarily be led by preventive care physicians. Significant differences in responsibility perception were observed across professional roles (χ² = 91.409, P < 0.01), indicating inconsistency in role definition within teams. When managing patient refusal of vaccination, 45.5% of respondents chose to explain independently, whereas only 3.8% referred patients to colleagues. This finding highlights a tendency toward individual-based practice rather than collaborative decision-making. See Table 2 for details.

Table 2.

Distribution of Vaccine Vaccination Collaboration Behaviors Among Primary Care Team Members (N=209)

Item	Option	Number (n)	Percentage (%)
Frequency of discussing vaccination with team members in the past 3 months	0 times	19	9.1
	1-2 times	92	44.0
	3-5 times	46	22.0
	≥6 times	52	24.9
Perception of primary responsible party for vaccination	General Practitioner	9	4.3
	General Nurse	6	2.9
	Preventive Health Physician	65	31.1
	Shared responsibility	121	57.9
	No clear division of responsibilities	8	3.8
Response to patient refusal of vaccination	Self-explanation	95	45.5
	Refer to colleagues	8	3.8
	Document but do not intervene	68	32.5
	Other	8	3.8

Perception of Factors Influencing Team Collaboration (5‑Point Likert Scale)

Respondents gave high ratings to the clarity of collaboration processes (M=4.35) and the speed of referral feedback between team members (M=4.24). In contrast, insufficient vaccine supply (M=2.83) and limited performance incentives (M=3.76) were identified as the primary factors hindering vaccination efforts. Table 3 details the scores for four key statements regarding team collaboration. Responses were measured on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), where higher scores indicate a higher level of agreement.

Table 3.

Perception Scores of Factors Influencing Team Collaboration (Mean ± SD)

Item	Mean (M)	Standard Deviation (SD)
I am clear about the collaborative process for vaccination in my institution	4.35	1.11
Other team members respond promptly to my vaccination suggestions	4.24	1.11
Insufficient vaccine stock often disrupts collaboration	2.83	1.61
Performance assessment motivates my participation in vaccination collaboration	3.76	1.42

Use of Collaboration Tools and Training Status

Digital tools can assist teams in working efficiently. The results indicate that shared Electronic Health Record (EHR) systems have the highest penetration rate (83.3%), providing a foundation for information exchange and teamwork. The use of automated vaccination reminder programs stands at 66.5%, while standardized handover forms show a lower utilization rate (39.2%).

Notably, 12% of family doctor team members do not use any dedicated collaboration tools, relying primarily on traditional communication methods. Regarding capacity building, over half (68.4%) of the respondents reported having received specific training on teamwork related to vaccination, suggesting that there is still room for improvement in targeted collaboration skills training. The underutilization of tools combined with incomplete training coverage may collectively limit the efficiency of collaboration among team members. See Table 4 for further details.

Table 4.

Utilization of Collaboration Tools and Specialized Training (N=209, Multiple Selection)

Item	Number of Users	Utilization Rate (%)
Electronic Health Record Sharing System	174	83.3
Vaccination Automatic Reminder System	139	66.5
Standardized Cross-Role Handover Form	82	39.2
No Specialized Tools Used	25	12.0
Received Specialized Training on Team Collaboration in Vaccination	143	68.4

Part III: Knowledge and Practice of Vaccination for Chronic Respiratory Diseases

Awareness of Clinical Guidelines and Strength of Vaccine Recommendations

Familiarity with Clinical Guidelines

Regarding guideline awareness, the familiarity levels with the “Technical Guidelines for Immunization of Adults in China” (53.6%) and the “GOLD Guidelines” (66.5%) indicate that the dissemination of domestic guidelines still requires improvement. Notably, 19.6% of respondents were not familiar with any relevant guidelines, highlighting a critical need to strengthen the popularization of clinical guidelines within primary care teams. Further details are provided in Table 5.

Table 5.

Familiarity with Vaccination Guidelines for Chronic Respiratory Diseases Among Primary Healthcare Teams (Multiple Choice, N=209)

Guideline Type	Number of Respondents (n)	Percentage (%)
Chinese Adult Immunization Guidelines	112	53.6
GOLD Guidelines	139	66.5
Unfamiliar with any related guidelines	41	19.6

Strength of Vaccine Recommendations for COPD Patients

Among vaccine recommendations, influenza, pneumococcal, and pertussis vaccines received the highest recommendation intensity (mean scores ≈ 4.2), consistent with the consensus in both domestic and international guidelines regarding their recommendation for COPD patients. More than half of the respondents selected “strongly recommend” (5 points) for these vaccines. The recommendation intensity for the COVID-19 vaccine was the lowest (M=3.89), reflecting that after the reclassification of COVID-19 to a Category B infectious disease in China, primary healthcare providers may have become more conservative or uncertain about recommending its vaccination for COPD patients. The recommendation intensity for the herpes zoster vaccine was slightly lower than that for pneumococcal vaccines, which may be attributed to the following factors: insufficient promotion of its recommendation for COPD patients in China; unclear understanding among primary healthcare providers regarding its specific benefits for COPD patients; and issues related to vaccine accessibility and cost affecting willingness to recommend. Details are presented in Table 6.

Table 6.

Strength of Vaccine Recommendations for Patients with Chronic Obstructive Pulmonary Disease (COPD) (Scale: 1–5, N=209)

Vaccine Type	Mean Score	SD
Pneumococcal Vaccine	4.22	1.01
Influenza Vaccine	4.21	1.07
COVID-19 Vaccine	3.89	1.23
Pertussis Vaccine	4.22	1.02
Herpes Zoster Vaccine	4.18	1.03

Notes: Scoring Note: 1 = Not recommended → 5 = Strongly recommended. Higher mean scores indicate stronger recommendation intensity.

Patient Communication and Education Strategies

Approaches to Explaining the Necessity of Vaccination

In terms of patient communication, nearly 80% (78.9%) of respondents prioritized emphasizing the risk of disease exacerbation as the main strategy to explain the necessity of vaccination. Additionally, 76.1% of respondents would compare the prognosis between vaccinated and unvaccinated individuals, while 69.9% would provide data on vaccine efficacy. However, 19.1% of respondents only briefly informed patients with a simple “vaccination is recommended”, lacking in-depth and personalized communication. Details are shown in Table 7.

Table 7.

Main Methods for Explaining the Necessity of Vaccination to Patients (Multiple Choice, N=209

Explanation Method	Number of Respondents (n)	Percentage (%)
Emphasizing the risk of disease exacerbation	165	78.9
Comparing prognosis between vaccinated and unvaccinated	159	76.1
Providing data on vaccine efficacy	146	69.9
Simply informing “vaccination is recommended”	40	19.1

Use of Decision Support Tools for Patients

In terms of decision support tools, traditional educational materials such as brochures and posters remained the most commonly used (87.56%), while multimedia tools such as short videos or animations were used relatively less frequently (62.20%). The use of patient success case sharing stood at 59.33%. However, 11.48% of respondents did not use any decision support tools, which may negatively impact the quality of patient decision-making and vaccination rates. Details are shown in Table 8.

Table 8.

Use of Decision Support Tools for Patient Vaccination Decisions (Multiple Choice, N=209)

Support Tool	Number of Respondents (n)	Percentage (%)
Brochures/Posters	183	87.6
Patient Success Case Sharing	130	62.2
Short Videos/Animations	124	59.3
No Support Tools Used	24	11.5

Clinical Decision-Making in Special Scenarios

Vaccination Recommendations for Stable COPD Patients

Only 44.50% of respondents (93 individuals) provided the guideline-consistent recommendation of “strongly recommending” vaccination. Approximately half (50.72%, 106 individuals) chose “recommend depending on the situation”, while 4.78% (10 individuals) selected “not recommend”. This reflects persistent concerns among family doctor teams regarding the safety of vaccination for COPD patients in clinical practice.

Management of Previous Vaccine Adverse Reactions

When faced with patients who had experienced previous vaccine adverse reactions, over half (63.64%) of respondents chose “defer vaccination and refer to a specialist”, demonstrating a strong emphasis on patient safety and awareness of referral protocols. However, 25.84% directly chose “not recommend revaccination”, an approach that may stem from insufficient understanding of the risks associated with severe adverse reactions. Details are shown in Table 9.

Table 9.

Management Approaches for Patients with Previous Vaccine Adverse Reactions (Single Choice, N=209)

Management Approach	Number of Respondents (n)	Percentage (%)
Defer vaccination and refer to a specialist (respiratory/allergy)	133	63.6
Proceed as planned with enhanced monitoring	12	5.7
Switch vaccine type	10	4.8
Do not recommend revaccination	54	25.8

Analysis of Clinical Scenario Decision-Making

This study assessed the vaccination decision-making capability of primary healthcare providers in real clinical settings through a hypothetical scenario. The clinical scenario was set as follows: a 65-year-old male diagnosed with GOLD stage 2 COPD (FEV₁ 60% predicted), with no recent history of acute exacerbations but presenting with daily cough and sputum. He was currently using a LAMA/LABA combination inhaler for symptom control, with an mMRC dyspnea score of 2. The patient actively inquired about whether he should receive pneumococcal and influenza vaccines.

In this scenario, 69.86% of respondents made decisions consistent with current guideline recommendations, indicating that stable COPD patients should receive both pneumococcal and influenza vaccines immediately, even in the presence of chronic respiratory symptoms, without delay. However, approximately 30% of respondents did not choose guideline-concordant recommendations: 11.48% believed vaccination should be “deferred until symptoms are controlled”, 8.61% chose to “administer only the influenza vaccine and defer the pneumococcal vaccine”, and 10.05% believed “only the pneumococcal vaccine should be recommended”. This suggests that although most healthcare providers have some awareness of relevant guidelines, certain decision-making deviations persist in specific clinical contexts, particularly reflecting insufficient clarity in distinguishing between “stable symptoms” and “acute exacerbations”. Details are presented in Table 10.

Table 10.

Distribution of Clinical Scenario Decision Choices (N=209)

Clinical Decision	Option Number (n)	Percentage (%)
Administer pneumococcal vaccine (PCV13/PPSV23) and influenza vaccine immediately without delay	146	69.9
Defer vaccination due to respiratory symptoms and reassess after symptom control	24	11.5
Administer influenza vaccine only; postpone pneumococcal vaccine until symptoms fully resolve	18	8.6
Recommend only pneumococcal vaccine, as influenza vaccine has limited efficacy in stable patients	21	10.0

Correlation Analysis Between Training Experience and Clinical Decision-Making

To further explore factors influencing vaccination decision-making, this study conducted an association analysis between “whether specialized training in team-based vaccination collaboration was received” and vaccination decisions in different clinical scenarios. The results indicate that training experience had a significant impact on certain decisions: Vaccination Decision for Stable COPD Patients: A significant correlation was found between training experience and vaccination recommendations for stable COPD patients (FEV₁ ≥ 50%) (χ² = 5.187, P = 0.013), suggesting that specialized training helps improve guideline adherence among healthcare providers for vaccinating such patients. Management of Previous Vaccine Adverse Reactions: No significant association was found between training experience and the management approach for patients with previous vaccine adverse reactions (χ² = 4.957, P = 0.175), indicating that training had no direct significant impact on such complex safety-related decisions. Specific Clinical Scenario Decision: Similarly, no significant difference was found between training experience and decision-making for the aforementioned clinical scenario involving the 65-year-old COPD patient.

Part IV: Barriers, Policies, and Systemic Factors Influencing Vaccination

Patient-Level Barriers and Estimated Vaccination Rates

Main Reasons for Patient Refusal of Vaccination

The patient-level factors affecting vaccination showed that as many as 69.38% of patients refused vaccination primarily due to “concerns about side effects”. This was followed by the belief that “the vaccine is ineffective” (22.49%). Additionally, 5.26% of respondents cited “distance to vaccination sites” as a reason, suggesting that accessibility may remain a barrier for some patients. The cost of vaccination accounted for only 2.87%, indicating that even with medical insurance coverage in Beijing, cost-related barriers are minimal, reflecting good accessibility of primary healthcare services. Details are presented in Table 11.

Table 11.

Primary Reasons for Patient Refusal of Vaccination as Perceived by Primary Healthcare Providers (Single Choice, N=209)

Reason for Refusal	Number (n)	Percentage (%)
Concerns about side effects	145	69.4
Belief that the vaccine is ineffective	47	22.5
Cost-related issues	6	2.8
Distance to vaccination sites	11	5.7

Estimated Vaccination Rates for COPD Patients

Regarding estimated vaccination rates, healthcare providers reported low vaccination rates among the COPD patients they encountered. Over two-thirds (66.99%) of family doctor team members estimated that the vaccination rate among their COPD patients was below 30%. In contrast, 5.74% of respondents estimated the vaccination rate to be above 70%. This disparity may reflect significant differences in the effectiveness of vaccination promotion efforts across institutions and teams, as well as variations in the characteristics of the patient populations they serve. Details are shown in the Table 12 below.

Table 12.

Estimated Vaccination Rate Range for COPD Patients as Reported by Primary Healthcare Providers

Estimated Vaccination Rate Range	Number (n)	Percentage (%)
<10%	92	44.0
10–30%	48	22.9
30–50%	40	19.1
50–70%	17	8.1
70–90%	10	4.8
90–100%	2	0.9

Institutional Policies and Incentives

Performance Linkage

In terms of policy incentives, only half (54.55%) of the team members confirmed that vaccination targets were linked to their personal performance, indicating potential issues of transparency or inadequate communication regarding institutional policies. Details are presented in Table 13.

Table 13.

Linkage Between Institutional Vaccination Targets and Personal Performance (N=209)

Performance Linkage Status	Number (n)	Percentage (%)
Uncertain	25	11.9
Yes	114	54.6
No	70	33.5

Preferences for Team Collaboration Incentives

Regarding incentive preferences, financial rewards were the most favored (72.25%), which may be related to the high workload and relatively lower income levels among primary healthcare providers. Career advancement credits ranked second (12.44%), reflecting the widespread difficulty in professional title promotion faced by primary healthcare providers. Details are shown in Table 14.

Table 14.

Preferred Incentive Measures to Enhance Team Collaboration (Single Choice, N=209)

Incentive Measure	Number (n)	Percentage (%)
Financial rewards	95	72.3
Reduction of non-vaccination tasks	53	12.4
Career advancement credits	36	9.6
Public recognition	27	5.7

Cross-Departmental Collaboration and Information Support

Communication with Senior Leadership

In terms of cross-departmental collaboration, only about one-third (37.32%) of respondents reported having communicated with center leadership regarding vaccination issues. This suggests that most healthcare providers do not proactively seek support from senior leaders when encountering difficulties. Details are presented in Table 15.

Table 15.

Whether Respondents Have Communicated with Center Leadership Regarding Vaccination Issues (N=209)

Communication Status	Number (n)	Percentage (%)
Yes	78	37.3
No	131	62.7

Frequency of Vaccine Supply Information Updates

Regarding information support factors, the frequency of vaccine supply information updates was predominantly irregular (70.33%), while real-time updates were available in only 17.70% of cases. The untimely and irregular updates may lead to insufficient planning in vaccination efforts. Details are shown in Table 16.

Table 16.

Frequency of Vaccine Supply Information Updates in Units (N=209)

Update Frequency	Number (n)	Percentage (%)
Irregular	147	70.3
Monthly	21	10.1
Quarterly	4	1.9
Real-time	37	17.7

Discussion

This multicenter cross-sectional study explored factors influencing team-based vaccination collaboration for patients with chronic obstructive pulmonary disease (COPD) in primary care settings in Beijing, China. The findings reveal a persistent gap between guideline awareness and real-world implementation and suggest that intra-team collaboration may be an important but underexplored factor affecting vaccination practices in primary care. Although most participants supported shared responsibility for vaccination, routine communication within teams remained insufficient. In addition, unstable vaccine supply, limited performance incentives, patient hesitancy, and incomplete integration of collaborative tools were identified as key barriers to effective implementation.

Knowledge–Practice Gap in Team-Based Vaccination

Although a majority of participants reported familiarity with relevant guidelines, only a limited proportion consistently provided strong vaccination recommendations in clinical scenarios. This discrepancy between knowledge and practice has been widely reported in previous studies on vaccination and chronic disease management, suggesting that knowledge alone is insufficient to drive behavioral change.^1,10

Compared with prior research focusing primarily on patient hesitancy or individual physician behavior, our study extends existing evidence by highlighting the role of intra-team collaboration dynamics in vaccination implementation. In this study, inconsistent role perception and limited communication frequency suggest that unclear task allocation and weak coordination mechanisms may contribute to suboptimal translation of guideline knowledge into clinical practice. These findings indicate that improving guideline adherence requires not only individual knowledge enhancement but also more structured team-based workflows.

System-Level Constraints: Supply and Incentive Mechanisms

This study identified unstable vaccine supply and insufficient performance incentives as important barriers to effective collaboration. These findings are consistent with previous research showing that logistical constraints and inadequate incentive structures may hinder preventive service delivery in primary care settings.^6,10

Our results further suggest that such system-level constraints may disrupt team-based workflows even when internal collaboration processes are perceived as relatively clear. For example, vaccine shortages or delayed supply information may reduce the feasibility of implementing vaccination plans, while unclear or insufficient performance incentives may weaken team members’ motivation to participate in vaccination promotion. These findings highlight the importance of aligning organizational support with team-based care models. Therefore, improving vaccination uptake requires not only strengthening individual competencies but also optimizing institutional support, resource allocation, and policy incentive mechanisms.

Patient Hesitancy as a Persistent Barrier

Concerns about vaccine side effects were identified as the primary reason for patient refusal, which is consistent with previous evidence on vaccine hesitancy, particularly among individuals with chronic diseases.¹⁰ In vaccination decision-making, patients with chronic conditions may pay more attention to perceived risks than to potential preventive benefits, especially when they are uncertain about vaccine safety or disease stability.

Notably, accessibility-related barriers such as cost and distance were relatively minor in this study. This may reflect the relatively well-developed primary care infrastructure in urban China, particularly in Beijing. Therefore, future interventions should shift from focusing solely on improving access to strengthening risk communication and patient education. Primary care teams should be equipped with more practical communication strategies to explain the relationship between respiratory infections, acute exacerbations, and COPD prognosis, thereby helping patients make more informed vaccination decisions.

Underutilization of Collaborative Tools

Although digital tools such as electronic health record systems were widely available, their effective integration into team-based workflows appeared limited. The relatively high use of electronic health record systems suggests that primary care institutions have established a basic digital infrastructure. However, the lower use of standardized handover forms and specialized collaboration tools indicates that digital resources may not yet be fully embedded into routine collaborative practice.

This “high availability but low integration” pattern suggests that digital infrastructure alone does not necessarily improve care coordination. Our findings highlight the need for more integrated, user-centered tools that support communication, task allocation, decision-making, and follow-up within primary care teams. Future work should focus on improving interoperability, workflow compatibility, and usability rather than merely increasing the number of digital tools.

Implications for Practice and International Relevance

This study provides several practical implications for improving vaccination uptake among patients with COPD in primary care settings. First, structured team communication should be strengthened, and role responsibilities should be clarified to improve coordination efficiency. Second, performance-based incentive mechanisms should be made more transparent and better aligned with vaccination-related tasks. Third, scenario-based guideline training may help bridge the gap between guideline awareness and clinical decision-making, particularly in situations involving stable COPD symptoms, previous adverse reactions, or patient concerns about vaccine safety.

Importantly, although this study was conducted in Beijing, its findings may have broader relevance to other healthcare systems, particularly those relying on multidisciplinary primary care teams for chronic disease management. The challenges identified in this study, including the knowledge–practice gap, patient hesitancy, system-level constraints, and insufficient workflow integration of digital tools, are not unique to China and have been reported across different healthcare contexts.^6,10 Therefore, the findings may provide useful evidence for improving team-based preventive care in other regions and countries with similar primary care structures.

Study Limitations

This study has several limitations. First, the cross-sectional design limits causal inference. Second, vaccination rates were based on healthcare providers’ self-reported estimates rather than objective vaccination records, which may introduce recall bias or reporting bias. Third, the use of a convenience sampling strategy may limit the generalizability of the findings. Fourth, although the questionnaire was developed based on literature review and expert consultation, formal reliability and validity testing was not conducted, which may affect measurement precision.

Finally, the analysis was primarily descriptive, and no multivariate analysis was performed to control for potential confounding factors. Therefore, the findings should be interpreted with caution. Future studies should adopt more rigorous sampling strategies, validate measurement tools, and use multivariate or longitudinal designs to further examine the relationship between team collaboration and vaccination outcomes.

Conclusion

In summary, improving vaccination rates among COPD patients is a systematic endeavor that requires moving beyond the technical skills of individual healthcare providers and integrating efforts across multiple dimensions, including team collaboration, organizational management, and systemic support. Only by establishing an efficient and collaborative primary care implementation system can guideline recommendations be translated into widespread practice, ultimately reducing the disease burden of COPD and improving long-term patient outcomes.

Disclosure

The authors report no conflicts of interest in this work.