[Flu vaccination in primary care: analysis of the process and proposals for increasing coverage]. / Vacunación antigripal en atención primaria: análisis del proceso y propuestas para aumentar las tasas de cobertura.

INTRODUCTION: Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. OBJECTIVES: To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. PROGRAMME: To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. DISCUSSION: After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced.

Vacunación antigripal en atención primaria: análisis del proceso y propuestas para aumentar las tasas de cobertura / Flu vaccination in primary care: analysis of the procedures and proposals for extending coverage

Introducción. La vacunación antigripal (VAG) en ancianos de riesgo se asocia con una reducción del 50-60% de las hospitalizaciones y hasta el 80% de los fallecimientos derivados de las complicaciones de la enfermedad. Se han descrito igualmente claros beneficios para otros grupos de riesgo, como los pacientes con enfermedades crónicas cardiovasculares o respiratorias. La vacuna tiene una buena relación coste-beneficio, tanto en ancianos como en otros grupos de riesgo. Pese a ello, se observan bajas tasas de vacunación, incluso entre el propio personal sanitario. Objetivos. Actualizar los conocimientos sobre la VAG mediante una revisión de la bibliografía y describir una serie de intervenciones que han sido ensayadas con éxito para aumentar las tasas de esta vacunación. Programa. Para conocer el proceso se analizan los factores del entorno, de los pacientes y de los profesionales sanitarios que condicionan la vacunación, las características de la organización asistencial que disponemos para la campaña vacunal, y la necesaria organización clínica sobre los grupos de riesgo. Discusión. Tras este análisis es posible la discusión de algunas estrategias comunicadas que han conseguido incrementar la vacunación, y proponer otras que serían posibles en el ámbito de nuestra atención primaria. Nuestra conclusión es que, dada la evidencia clínica disponible y la alta aplicabilidad en la práctica de algunas intervenciones implementadoras es, además de aconsejable, éticamente exigible abordar la mejora del proceso de vacunación antigripal y el aumento de las coberturas vacunales en pacientes de riesgo, pudiendo introducir mejoras dentro de las posibilidades de cada puesto asistencial de atención primaria

Introduction. Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. Objectives. To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. Programme. To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. Discussion. After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced

[Can we improve influenza vaccination rates in older people with chronic diseases?]. / Podemos mejorar las tasas de vacunación antigripal en los ancianos con enfermedades crónicas?

OBJECTIVE: To determine the proportion of older patients (>or= 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the 2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. DESIGN: Observational, descriptive, retrospective study. SETTING: The urban health center serving Area 19 in the Community of Valencia (eastern Spain). PARTICIPANTS: Of the 29757 inhabitants served by this center (10.4% >or= 65 years), we included 3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853 older patients with chronic diseases who were not vaccinated. MAIN MEASURES: Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. RESULTS: The vaccination rates were 52.12% (95% CI, 50.4-53.9) for older patients, 26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17% came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for nonvaccination was recorded for only 10.4%. CONCLUSIONS: Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good.

¿Podemos mejorar las tasas de vacunación antigripal en los ancianos con enfermedades crónicas? / Can we improve influenza vaccination rates in older people with chronic disease?

Objetivo. Determinar la proporción de pacientes ancianos (≥ 65 años) adscritos al centro de salud estudiado, con alguna enfermedad crónica y que no fueron vacunados en la campaña antigripal 2001-2002, y conocer el porqué. Diseño. Observacional, descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano del Área 19 de la Comunidad Valenciana. Participantes. De los 29.757 habitantes adscritos (10,4% ancianos), se incluyó a3.868 pacientes registrados en los programas de crónicos y a 2.980 en el de vacunación antigripal (VAG), y se encontró a 853pacientes crónicos ancianos no vacunados. Mediciones principales. Tasa de VAG en crónicos, ancianos y crónicos ancianos. Auditoría de historias clínicas para conocerlas causas de la falta de vacunación en estos últimos. Resultados. La tasa de VAG en los pacientes ancianos fue del 52,12% (intervalo de confianza [IC] del 95%, 50,4-53,9), en los pacientes crónicos fue del 26,96% (IC del95%, 25,6-28,4) y en los pacientes ancianos crónicos del 54,43% (IC del 95%, 51,4-57,5).De los 853 ancianos crónicos no vacunados, el 48,17% acudió al menos una vez al centro de salud durante la campaña de vacunación. El 27,34% hacía más de 1 año que no acudía al centro de salud y sólo en el 10,4%se había documentado la causa de la falta de vacunación. Conclusiones. La cobertura de VAG en ancianos y crónicos es baja. Es posible intervenir en grupos accesibles de pacientes para incrementar la tasa de vacunación

Objective. To determine the proportion of older patients (≥ 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. Design. Observational, descriptive, retrospective study. Setting. The urban health center serving Area19 in the Community of Valencia (eastern Spain).Participants. Of the 29 757 inhabitants served by this center (10.4% ≥ 65 years), we included3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853older patients with chronic diseases who were not vaccinated. Main measures. Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. Results. The vaccination rates were 52.12%(95% CI, 50.4-53.9) for older patients,26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17%came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for non-vaccination was recorded for only 10.4%.Conclusions. Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good