Abstract
Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients.
Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients’ needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment.
Results: The overall rate of immunization reached about 80% by 2002. Factors such as age, respiratory problems, diabetes and congestive heart failure were associated with greater uptake, but overall rates of influenza immunization were lower than expected. Low education, smoking and poor medication adherence were negatively associated with influenza immunization. In addition, there was considerable variation in uptake among CCACs after adjusting for other significant individual-level independent variables.
Interpretation: Comprehensive assessments like the RAI-HC can be used to help identify and respond to health promotion and disease prevention issues in this population, and to compare rates across Canada.
MeSH terms: Influenza, home care services, risk factors
Résumé
Contexte: Cette étude porte sur les facteurs associés à l’administration du vaccin antigrippal à la clientèle des soins à domicile en Ontario.
Méthode: Dans le cadre d’une visite programmée, nous avons évalué des personnes recevant des soins à domicile. Ces évaluations s’inscrivaient dans une étude pilote de la méthode d’évaluation RAI-HC (Resident Assessment Instrument - Home Care) dans 12 centres d’accès aux soins communautaires (CASC) de l’Ontario. La méthode RAI-HC est un outil d’évaluation multidimensionnel qui permet de définir les besoins des clients et leur niveau de capacité fonctionnelle. Par analyse de régression logistique multiple, nous avons cerné les facteurs associés à l’immunisation contre la grippe au cours des deux années antérieures à l’évaluation.
Résultats: Le taux global d’immunisation atteignait environ 80 % en 2002. L’âge, les troubles respiratoires, le diabète et l’insuffisance cardiaque congestive étaient associés à une demande accrue pour le vaccin antigrippal, mais dans l’ensemble, les taux d’immunisation contre la grippe étaient plus faibles que prévu. La sous-scolarisation, le tabagisme et le non-respect des directives concernant les médicaments étaient négativement associés à l’immunisation contre la grippe. De plus, nous avons noté d’importants écarts dans la demande pour le vaccin d’un CASC à l’autre, après rajustement des données pour tenir compte d’autres variables indépendantes significatives à l’échelle individuelle.
Interprétation: Des outils d’évaluation globaux comme la méthode RAI-HC peuvent être utiles pour cerner et résoudre les problèmes liés à la promotion de la santé et à la prévention des maladies dans la population recevant des soins à domicile, et pour comparer les taux à l’échelle du Canada.
Footnotes
Sources of Funding: This research received financial support from the Health Transition Fund - Health Canada (ON245), the Canadian Institutes for Health Research (CIHR), and interRAI. Health Canada and CIHR played no role in the design, execution, analysis and interpretation of data or writing of the study.
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