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Generalist and Subspecialist Physicians' Knowledge, Attitudes, and Practices Regarding Influenza and Pneumococcal Vaccinations for Elderly and Other High-Risk Patients
A Nationwide Survey
Kristin L. Nichol, MD, MPH, MBA;
Richard Zimmerman, MD, MPH
Arch Intern Med. 2001;161:2702-2708.
Background Influenza and pneumococcal vaccination rates remain too low. This survey
assessed generalist and subspecialist physicians' knowledge, attitudes, and
practices regarding influenza and pneumococcal vaccinations for high-risk
patients.
Methods A self-administered questionnaire was mailed to 6000 physicians randomly
selected from a national database.
Results After 3 mailings, 1874 physicians (32%) of the 5858 eligible responded.
Although most physicians thought that it was very important for their high-risk
patients be current on influenza and pneumococcal vaccinations, only 86% and
75% of generalists and subspecialists, respectively, very strongly recommended
influenza vaccinations to their elderly patients and only 81% and 64%, respectively,
very strongly recommended pneumococcal vaccinations to their elderly patients
(P<.001 for both). After multivariate logistic
regression, factors significantly associated with strongly recommending vaccinations
to elderly patients in the influenza and pneumococcal vaccination models included
female sex of provider, the provider having received an influenza vaccination,
the provider's beliefs about vaccine effectiveness and cost-effectiveness,
a patient's risk for illness, and ease of targeting patients. In addition,
generalists were more likely than subspecialists to strongly recommend pneumococcal
vaccinations to their patients. Patient reminders, special clinics, and standing
orders were each used by fewer than 30% of respondents, although generalists
were more likely than subspecialists to use such strategies.
Conclusions Nontrivial proportions of generalist and subspecialist physicians fail
to strongly recommend influenza and pneumococcal vaccinations to their elderly
and high-risk patients. Other effective strategies for promoting vaccine delivery
are also used relatively infrequently. These findings suggest areas for improvement
if vaccination rates are to reach national goals.
From the Medicine Service and the Center for Chronic Disease Outcomes
Research, Veterans Affairs Medical Center and the University of Minnesota,
Minneapolis (Dr Nichol); and the Department of Family Medicine and Clinical
Epidemiology, School of Medicine, and the Department of Health Services Administration,
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
(Dr Zimmerman).
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