title: Introducing a pneumococcal vaccine to an existing influenza immunization program: vaccination rates and predictors of noncompliance.
abstract: OBJECTIVE
  Influenza vaccination has been recommended for all elderly people in The Netherlands since 1996, with greater than 80% compliance. It is unknown, however, if the addition of another vaccine to this immunization program will affect compliance.
  
  
  METHODS
  General practitioners offered a pneumococcal vaccine together with the yearly influenza vaccination to 3365 patients aged 65 years and older. A questionnaire was then mailed to a stratified sample (n = 972) of these patients. Factors associated with noncompliance with vaccination were assessed using polytomous logistic regression.
  
  
  RESULTS
  A total of 2529 patients (75%) received the pneumococcal vaccine and 2812 (84%) received the influenza vaccine. Predictors of noncompliance with the pneumococcal vaccine were perceived lack of recommendation by the general practitioner (odds ratio [OR] = 4.6; 95% confidence interval [CI], 2.6 to 8.3) and fear of local side effects (OR = 2.8; 95% CI, 1.6 to 4.6). Predictors of noncompliance with both vaccinations also included unwillingness to comply with the doctor's advice (OR = 6.1; 95% CI, 2.4 to 15.4), the belief that vaccinations weaken one's natural defenses (OR = 2.7; 95% CI, 1.4 to 5.3) or that influenza is not dangerous (OR = 2.9; 95% CI, 1.5 to 5.4), and the fear of becoming sick from pneumococcal vaccination (OR = 2.9; 95% CI, 1.1 to 7.9). People who felt healthy, found it difficult to visit the doctor's office, had private medical insurance, or were younger than 75 years of age also had a greater risk of not being vaccinated.
  
  
  CONCLUSIONS
  Introducing a pneumococcal vaccine to an existing influenza immunization program resulted in high pneumococcal and influenza vaccination rates. A wider diversity of patient characteristics and attitudes was present when neither vaccination was received.
authors.affiliation: Julius Center for General Practice and Patient Oriented Research, University Medical Center, Location Stratenum, 3508 AB Utrecht, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Opstelten
authors.forename: E
authors.initials: E
authors.lastname: Hak
authors.forename: T J
authors.initials: TJ
authors.lastname: Verheij
authors.forename: G A
authors.initials: GA
authors.lastname: van Essen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005239:Fear / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines