title: Failure to immunize the elderly: a systems problem or a statement of personal values?
abstract: BACKGROUND
  Despite the proven efficacy of the influenza vaccine in reducing the risk for pneumonia, hospitalization, and death and the potential savings in costs, most elderly persons do not receive annual immunizations. The study tested the influence of health care delivery system characteristics and individual personal values on the influenza immunization status.
  
  
  METHODS
  The study involved a secondary data analysis based on the results of a mailed survey of 3,362 seniors 65 years of age and older enrolled in HealthPartners, a mixed-model health maintenance organization in Minnesota. The three care delivery systems in which respondents were enrolled varied in the intensity and consistency with which they addressed immunization.
  
  
  RESULTS
  The immunization rate for this population (77.1%) was higher than the state rate (64%). After controlling for many variables historically known to influence the likelihood of immunization, both care delivery system characteristics and personal values remained significantly associated with immunization status. Elderly individuals getting care in delivery systems with well-developed immunization programs were more likely to be immunized. Those who avoided going to the physician and who practiced risky behaviors such as smoking were less likely to be immunized, regardless of the care delivery system they were enrolled in.
  
  
  CONCLUSIONS
  Managed care can provide a number of system improvements to assist in meeting national health care objectives such as influenza immunization for the elderly. It has reduced some common barriers to immunization, such as cost and access. Yet to achieve the full benefits of a successful influenza immunization program, the role of individual values, as well as implementing systems solutions, needs to be addressed.
authors.affiliation: Health Research Center, Institute for Research and Education, HealthSystem Minnesota, Minneapolis 55416, USA. fowlej@hsmnet.com
authors.forename: J B
authors.initials: JB
authors.lastname: Fowles
authors.forename: T J
authors.initials: TJ
authors.lastname: Beebe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016001:Confidence Intervals; D004493:Education; D004651:Employment; D005260:Female; D006279:Health Maintenance Organizations; D006304:Health Status; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007182:Income; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control*; D008019:Life Style; D008297:Male; D008910:Minnesota; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D007252:Influenza Vaccines