title: What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and Veterans Affairs practices.
abstract: BACKGROUND
  Despite strong evidence of the effectiveness of influenza vaccination, immunization rates have reached a plateau that is below the 2010 national goals. Our objective was to identify facilitators of, and barriers to, vaccination in diverse groups of older patients.
  
  
  METHODS
  A survey was conducted in 2000 by computer-assisted telephone interviewing of patients from inner-city health centers, Veterans Affairs (VA) outpatient clinics, rural practices, and suburban practices. The inclusion criteria were age > or =66 years and an office visit after September 30, 1998.
  
  
  RESULTS
  Overall, 1007 (73%) interviews were completed among 1383 patients. Influenza vaccination rates were 91% at VA clinics, 79% at rural practices, 79% at suburban practices, and 67% at inner-city health centers. There was substantial variability in vaccination rates among practices, except at the VA. Nearly all persons who were vaccinated reported that their physicians recommended influenza vaccinations, compared with 63% of unvaccinated patients (P <0.001). Thirty-eight percent of unvaccinated patients were concerned that they would get influenza from the vaccine, compared with only 6% of vaccinated persons (P <0.001). Sixty-three percent of those vaccinated, in contrast with 22% of unvaccinated persons, thought that an unvaccinated person would probably contract influenza (P <0.001).
  
  
  CONCLUSIONS
  Older patients need intentional messages from physicians that recommend vaccination. Furthermore, more patient education is needed to counter myths about adverse reactions.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA. zimmer@pitt.edu
authors.forename: Richard Kent
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Tammy A
authors.initials: TA
authors.lastname: Santibanez
authors.forename: Janine E
authors.initials: JE
authors.lastname: Janosky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wilson
authors.forename: Inis Jane
authors.initials: IJ
authors.lastname: Bardella
authors.forename: Anne R
authors.initials: AR
authors.lastname: Medsger
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
mesh_terms: D000368:Aged; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006787:Hospitals, Veterans; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007252:Influenza Vaccines; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services; D019036:Suburban Health Services; D019037:Urban Health Services
chemical_list: D007252:Influenza Vaccines