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Influenza and pneumonia are the fifth leading cause of death among elderly people in the United States. Vaccines against these illnesses can prevent thousands of deaths each year, yet in the first quarter of 2002, only 66 percent of all seniors (43 percent of Hispanics and 50 percent of blacks) were vaccinated against influenza. Only 55 percent of all seniors (26 percent of Hispanics and 32 percent of blacks) were immunized against pneumococcus. These estimates are based on patient self-report.
Two studies supported by the Agency for Healthcare Research and Quality (HS09874) and led by Richard Kent Zimmerman, M.D., of the University of Pittsburgh School of Medicine, recently examined the accuracy of patient self-report of vaccination status and barriers and facilitators to vaccination. Both studies are discussed here.
Zimmerman, R.K., Raymund, M., Janosky, J.E., and others (2003). "Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata." Vaccine 21, pp. 1486-1491.
Large national surveys showing moderate adult vaccination rates are based on patient self-report. To examine how accurately elderly patients report receipt of annual flu and one-time-only pneumonia vaccines, these researchers compared self-report on questionnaires with medical records for 820 people aged 66 or older from inner city health centers, Veterans Affairs (VA) outpatient clinics, and rural and suburban practices. Medical record reviewers marked whether the person had received an influenza vaccine from September 1999 through March 2000 or the pneumococcal polysaccharide vaccine (PPV) any time between January 1, 1995 and December 31, 2000.
The researchers found that sensitivity—the ability to accurately recall having received vaccine—when compared with the records of the primary care physician was high for both influenza vaccine and pneumococcal vaccine, but specificity—the ability to accurately recall not having received vaccine—was lower. Based on the relatively high negative predictive value of self-report (74 percent) in this study and the excellent safety record of adult vaccines, the researchers conclude that physicians can confidently recommend vaccination to adult patients who report not having received influenza and pneumococcal vaccines.
Zimmerman, R.K., Santibanez, T.A., Fine, M.J., and others (2003). "Barriers and facilitators of pneumococcal vaccination among the elderly." Vaccine 21, pp. 1510-1517.
The Healthy People 2010 immunization goal, set at 90 percent for pneumococcal polysaccharide vaccine (PPV), remains elusive, with barely more than half of elderly people reporting receipt of PPV in 2000. To understand barriers to vaccination in diverse settings, these investigators surveyed patients 66 years of age and older at inner-city health centers, VA outpatient clinics, and rural and suburban practices. Among the 1,007 respondents, self-reported PPV rates were 85 percent for VA, 62 percent for rural, 66 percent for suburban, and 57 percent for inner city, with substantial variability among practices.
Half of the elderly people surveyed did not know they needed vaccination against pneumonia. Compared with those who had not been vaccinated, most of the vaccinated individuals thought that their doctor believed they should be vaccinated (95 vs. 23 percent) and believed that the vaccine "keeps a person from getting pneumonia" (75 vs. 54 percent). Predictors of vaccination included: belief that the doctor recommends the vaccine, feeling that vaccination is wise, recommendation by someone in the physician's office, and receipt of influenza vaccine. These variables accounted for over half (52 percent) of the variance in ever receiving PPV.
The most commonly reported reasons for not being vaccinated were: their doctor did not recommend a pneumonia shot (59 percent), they did not know they needed the shot (50 percent), and they did not think they were likely to get pneumonia (47 percent). The researchers conclude that physicians should give clear recommendations to patients that they need to be vaccinated against pneumonia. They also recommend that patient education programs emphasize vaccine indications and efficacy in a culturally competent manner.
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