Eldelry/Long-term Care

Doctors can use proactive office systems and patient education to persuade more elderly patients to get flu shots

Influenza vaccination rates among elderly adults, at 63 percent in 2000-2001, were well below national goals of 90 percent. By using certain proactive office systems—such as express vaccine clinics, immunization prompting systems, and patient education—doctors can influence more elderly patients to get flu shots. That's the conclusion of a study supported by the Agency for Healthcare Research and Quality (HS09874) and led by Richard K. Zimmerman, M.D., M.P.H., of the University of Pittsburgh School of Medicine.

Dr. Zimmerman and his colleagues used questionnaire responses and interviews with 60 randomly selected clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices and a random sample of 925 of their patients aged 65 years or older to assess physician, patient, and practice factors related to vaccination among older people. Patients at practices with express vaccination clinics had higher vaccination rates than those at clinics without such immunization programs (87 vs. 76 percent). Influenza vaccination status was also related to several patient factors, including plans to receive a flu shot next year; belief that those who are not vaccinated will contract influenza; and history of being screened for colon cancers.

Influenza vaccination status was also related to several physician factors, including awareness of the recommendation to vaccinate asthma patients, agreement with these recommendations, and practice type and setting. VA clinics had the highest vaccination rate at 91 percent. These clinics used patient reminders, standing orders (that authorize nurses and pharmacists to administer vaccinations according to an institution- or physician-approved protocol without an individual order for each patient), free-standing vaccination clinics, and assessment of vaccination rates with feedback and incentives to clinicians.

See "Physician and practice factors related to influenza vaccination among the elderly," by Dr. Zimmerman, Mary Patricia Nowalk, Ph.D., R.D., Inis J. Bardella, M.D., and others, in the American Journal of Preventive Medicine 26(1), pp. 1-10, 2004.

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