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Health Care Decisionmaking

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Making pneumonia and influenza vaccinations more convenient may increase immunizations among elderly and at-risk people

Most of the 50,000 to 80,000 pneumonia and influenza deaths in the United States each year are among elderly men and women. Younger people with chronic heart or lung disease or diabetes also are at higher risk of dying from these diseases. Unfortunately, only 58 percent of elderly people and 38 percent of at-risk younger adults are vaccinated against influenza each year. Making vaccinations more convenient might help increase immunization rates among these groups, concludes a study that was supported in part by the Agency for Healthcare Research and Quality (HS10021).

John D. Grabenstein, Ph.D., of the U.S. Army Medical Command, and his colleagues surveyed over 2,000 people, who were either elderly or at risk for complications from pneumonia or influenza (based on medication prescriptions) and who received medications from any of 24 pharmacies in Washington and Oregon.

Convenience and provider experience influenced choice of site for vaccination. However, convenience was the stronger factor for those not vaccinated in the previous year, for nonelderly people taking medications for chronic problems, and for the increasing numbers of people seeking vaccinations at pharmacies. For example, between 1997 and 1998, the proportion of people vaccinated at traditional sites held steady at 55 percent, while the proportion vaccinated at nontraditional sites like pharmacies rose from 14 to 17 percent.

People vaccinated at traditional sites in 1998 were more likely to identify physicians' offices and public health clinics as vaccine providers compared with those vaccinated at nontraditional sites (95 vs. 64 percent). Conversely, people vaccinated at nontraditional sites in 1998 were more likely to name pharmacies as vaccine providers (55 vs. 37 percent). More experience and trust in vaccine providers were major factors for people vaccinated at traditional sites, while those vaccinated at nontraditional sites were more likely to highlight issues of convenience.

See "Attitudinal factors among adult prescription recipients associated with choice of where to be vaccinated," by Dr. Grabenstein, Harry A. Guess, M.D., Ph.D., Abraham G. Hartzema, Pharm.D., Ph.D., and others, in the Journal of Clinical Epidemiology 55, pp. 279-284, 2002.

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