[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.

[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.

[Influence of physician and physician list characteristics on influenza vaccination rates in older people in a health care area in the community of Valencia, Spain]. / Influencia de las características de los médicos y del cupo en la vacunación antigripal de ancianos en un área de salud de la comunidad Valenciana.

OBJECTIVE: To identify the characteristics of physicians and the patients on their list related with rates of influenza vaccination in older people, and to quantify influenza vaccination coverage in this population group. DESIGN: Observational, cross-sectional, multicenter population-based study with primary data. PARTICIPANTS: All health centers in the health care area that used computerized registries of influenza vaccinations. Vaccination records were analyzed for 73 physicians who had been at their present post for at least 2 years prior to the study, and for 19 457 older people who were vaccinated during the 2001-2002 vaccination campaign. SETTING: Primary health care area number 19. MAIN MEASURES: Physician's age and sex, whether the physician was certified as a specialist in family and community medicine, teaching accreditation, permanent or temporary post, length of time in present post, years of professional practice, type of health center administration, total number of patients in the physician's list, population and percentage of the population >65 years old in the physician's list, influenza vaccination rate referred to the total number of patients on the physician's list. The criterion evaluated was the influenza vaccination rate in older people. Descriptive analysis, bivariate analysis and multivariate analysis were used. A P value < .05 was considered statistically significant, and 95% confidence intervals were calculated. RESULTS: The overall influenza vaccination rate in older people (>65 years) was 50.9%, with considerable variability between physicians (from 18% to 77%). Vaccination rates were lowest in physicians who had been in their current post for longer (P=.001), with larger patient lists (P=.03), with more older people in their list (P=.000), and with larger proportions of older people in their list (P=.001). Lower rates of vaccination in older people were also associated with lower proportions of all patients on the list being vaccinated (P=.000). No significant associations were found for any of the other variables. After multivariate analysis only the percentage of older people on the physician's list remained significantly associated with vaccination rate. CONCLUSIONS: Influenza vaccination rates for older people were low and similar to rates reported earlier for this region of Spain. The percentage of older people in the list was the only explanatory variable in the model, and was inversely proportional to vaccination coverage.