title: Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany.
abstract: In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement.
  
  
  
  We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population.
  
  
  
  Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8).
  
  
  
  To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes.
authors.affiliation: Department for Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, Braunschweig, 38124, Germany.|Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
authors.forename: Carolina Judith
authors.initials: CJ
authors.lastname: Klett-Tammen
authors.affiliation: Department for Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, Braunschweig, 38124, Germany.|Chair for Infectious Disease Epidemiology, Hannover Medical School, Hannover, Germany.
authors.forename: Gérard
authors.initials: G
authors.lastname: Krause
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: von Lengerke
authors.affiliation: Department for Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, Braunschweig, 38124, Germany. Stefanie.Castell@helmholtz-hzi.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Castell
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D005260:Female; D058005:General Practitioners; D005858:Germany; D006801:Humans; D007252:Influenza Vaccines; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants; D022242:Pneumococcal Vaccines; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: Aged; Attitudes; Elderly; General practitioners; Health knowledge; Physician assistants; Practice; Vaccination