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RESEARCH AND PRACTICE: Richard K. Zimmerman, Mary Patricia Nowalk, Mahlon Raymund, Melissa Tabbarah, David G. Hall, J. Todd Wahrenberger, Stephen A. Wilson, and Edmund M. Ricci Tailored Interventions to Increase Influenza Vaccination in Neighborhood Health Centers Serving the Disadvantaged Am J Public Health 2003; 93: 1699-1705 [Abstract] [Full text] [PDF]

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General Practitioners, incentives and influenza vaccine coverage

Giorgio Simon, Giulio Borgnolo   (11 November 2003)

General Practitioners, incentives and influenza vaccine coverage 11 November 2003
Giorgio Simon, plannig and administration Agenzia Regionale della Sanità - Regione Friuli - Veneiza Giulia Italy, Giulio Borgnolo Send letter to journal: Re: General Practitioners, incentives and influenza vaccine coverage giorgio.simon{at}ass6.sanita.fvg.it Giorgio Simon, et al.	Zimmerman, Nowalk et all. analyze strategies to improve influenza vaccination coverage (1) We analyzed socio-demographic factors associated with influenza vaccination coverage among people aged >65 in Friuli-Venezia Giulia (FVG) Region, Northeast Italy before and after GPs incentives. In Italy, although recommended, influenza immunization rates remain low, being vaccinated less than 40% of 65 years of age and older citizens (2). Since 1995, for 65 years of age and older residents, influenza vaccine is dispensed free of charges by the Local health authorities (LHAs). To increase vaccination coverage in elderly people, the Regional health authority introduced during 1997-1998 influenza season a financial incentive for the 6 LHAs and for the 1168 general practitioners (GPs). The target of 70% for influenza vaccine uptake was established to receive full incentive for every vaccinated resident over 65. If the coverage exceeded 50% but did not reach 70%, a proportionally decreased incentive was given. FVG Region keeps records of its 1.2 million inhabitants in various computerized databases on the utilization of health care resources which include data on birth, hospital discharge diagnoses, outpatient prescriptions, pathology, death and immunization with a unique personal identifier which allows link among them. Regional data base has been used for epidemiological studies (3) Information for the 1996-1997 and 1997- 1998 influenza seasons from the Regional databases were linked and compared. The target population was 245,108 elderly in 1996-97 and 235,774 in 1997- 98. The Regional influenza vaccination rate rose from 22.1% in 1996-97 to 51.0% in 1997-1998. Five out of six LHAs met the minimum established 50% target. Fifty three percent of Regional GPs had 50% or more elderly vaccinated in their list in 1997-98 influenza season. In all Regional LHAs, vaccination rates were higher among subjects who were male and older than 74 years of age. Elderly people with conditions that put them at special risk of complications due to influenza such as BPCO, diabetes, and cardiovascular diseases were vaccinated more often by 19%, 27% and 14%, respectively. On the contrary, cirrhotic patients, who are strongly associated with excessive alcohol drinking in our Region, were less vaccinated by 15% (Table). The proportion of GPs who succeeded in vaccinating at least 50% of their elderly patients was the factor with stronger contribution to reaching the LHA minimum effective target (r=0.89,p<0.02). After adjustment for the other factors, analyses by type of household indicate that GPs provided vaccination less frequently to patients living alone. Our study underlines the value of financial incentives in improving overall influenza coverage for elderly people and shows that GPs spontaneously targeted the oldest subjects and those with diabetes, chronic pulmonary and cardiovascular diseases. However, access to this preventive service was lower among vulnerable elderly people such as widows and subjects with alcohol-related conditions. We plan to evaluate whether lower access to preventive services associated with socio - demographic factors determines a subsequent higher use of other health services. 1) R K.Zimmerman, M P Nowalk, , M R, M Tabbarah, D G Hall, J T Wahrenberger, SA Wilson, E M. Ricci, Tailored Interventions to Increase Influenza Vaccination in Neighborhood Health Centers Serving the Disadvantaged ., Am J Public Health 2003; 93:1699-1705 2) D'Argenio P, Manfredi Selvaggi TM, Ponzio G, Romano A, Pennino G, Greco D. La copertura vaccinale contro l'influenza tra gli anziani e alcuni fattori che la condizionano. Ig.Moderna 1995;103:209-222 3) M Sturkenboom, F Romano, G Simon, ML Correa-Leite, A Nicolosi, M Villa, G Borgnolo, G Bianchi-Porro, S Mannino. The iatrogenic costs of NSAID therapy: a population study. Arthr Rheum 2002;47:132-40 Table: Variables associated with vaccination coverage in elderly people (>65 years) in Friuli-Venezia Giulia -(North-East Italy). Vaccinated Non vaccinated Odds ratio N % N % (CI* 95%) Total population 119837 50.9 115277 49.1 Gender† Females 73634 49.9 73958 50.1 1 Males 46203 52.8 41319 47.2 1.16 (1.14-1.18) Age (years) † 65 - 74 56926 47.6 62705 52.4 1 75 - 84 44190 54.1 37530 45.9 1.35 (1.33-1.35) >84 18721 55.5 15042 44.5 1.46 (1.43-1.50) Comorbidity‡ COPD+ 3056 63.5 1754 36.5 1.19 (1.12-1.27) Diabetes+ 3302 63.8 1859 36.2 1.27 (1.20-1.35) Cardiovascular diseases+ 11991 60.8 7736 37.2 1.14 (1.10-1.19) Liver cirrhosis+ 814 54.6 676 45.4 0.85 (0.76-0.94) * Confidence interval. † Adjusted for LHA vaccination coverage. ‡ Adjusted for age, sex and LHA vaccination coverage.