Original article
Attitudinal factors among adult prescription recipients associated with choice of where to be vaccinated

https://doi.org/10.1016/S0895-4356(01)00452-8Get rights and content

Abstract

The objective of this article was to evaluate adult prescription recipients' choices among vaccine providers. The study setting was a cluster sample from 24 community pharmacies based on prescription records that suggested need for pneumococcal and influenza vaccines. Vaccination status, choice of vaccine provider, and opinions regarding vaccine providers were retrospectively surveyed by mail in spring 1999. Overall, 52% of survey recipients responded; 89% of respondents reported returning to the same type of vaccine provider in consecutive years. Two key factors affected choice of provider: convenience and provider experience. Convenience was a stronger factor for people younger than 65 taking chronic medications and those not vaccinated in the previous year. Most adult recipients of influenza vaccine returned to sites where they were vaccinated the previous year. Convenience was a major factor in vaccination decisions of adult prescription recipients.

Introduction

Between 50,000 and 80,000 Americans die due to pneumococcal disease or influenza each year 1, 2, 3. Although most of these deaths involve people over 65 years of age, younger people with chronic heart or lung disease or diabetes are also at elevated risk.

On average, 58% of people over 65 years of age are vaccinated against influenza each year, but only 20 to 38% of younger adults at risk [4]. Immunization programs have been substantially less successful against pneumococcal disease. Only 36% of the elderly and 9 to 15% of younger people at elevated risk have been immunized against Streptococcus pneumoniae, the leading infectious cause of death in the United States.

Vaccination goals against influenza (but not pneumococcal disease) for the elderly were met in 2000. But neither goal was met for younger adults with chronic diseases 5, 6. For 2010, the national goals for vaccination of people 65 years and older increase from 60 to 90%.

Whereas many previous studies assessed individuals' decisions whether or not to be immunized 7, 8, 9, 10, 11, 12, 13, no study has yet assessed adult choices among several vaccine providers. Such an analysis is needed as more nontraditional sites provide influenza immunization services.

A traditional site of vaccination is typically defined as a physician's office, hospital, or public health clinic [14]. Nontraditional sites include pharmacies, as well as places that do not typically provide medical care (e.g., work places, senior centers, grocery stores, shopping malls, schools, fire departments, county fairs, homes). Many ad hoc sites across the country offered influenza vaccine each autumn in the 1990s. One survey reported that 19% of grocery stores offered influenza immunization at least 1 day in 1997 [15].

Pharmacists can play a role in promoting immunization, because they can identify people residing in the community who are at elevated risk of influenza and pneumococcal disease, advise them of their risk, and significantly increase vaccine-acceptance rates 16, 17, 18, 19, 20, 21, 22, 23, 24. For this reason, we examined data on demographic, clinical, and opinion characteristics of people who receive prescriptions at community pharmacies, to assess individual choices whether and where to receive pneumococcal and influenza vaccines. We explored the hypothesis that demographic differences and perceptions of access, convenience, and trust would explain choices between traditional and nontraditional vaccine providers.

Section snippets

Methods

We conducted a retrospective cohort study among people receiving prescription medications from any of 24 Fred Meyer pharmacies contributing to a central data repository. The study included all 11 pharmacies in the Puget Sound area of Washington State and all 13 pharmacies in urban areas of Oregon. Participating pharmacists in Washington administered influenza and pneumococcal vaccine daily between October and December 1998 to people with health or age indications corresponding to the guidelines

Results

Among 80,462 prescription records accessible, 13,987 eligible patients were identified. The number of eligible patients from each pharmacy varied. To yield pharmacy subsamples of comparable size, subjects were selected at random, stratified by pharmacy, with a probability proportionate to the number of eligible subjects from each pharmacy. These methods yielded 4,403 subjects. The Washington cohort included 1,110 subjects 65 years or older and 1,101 subjects less than 65 years old taking

Discussion

Respondents tended to return to the same category of vaccine provider where they had been vaccinated in the previous year. Consistently, most respondents were vaccinated by the same broad category of vaccine provider (i.e., traditional or nontraditional) in consecutive years (Table 3). Selection of a traditional or nontraditional provider clearly differed based on perceptions of convenience, proximity and experience, upholding our initial hypothesis. We identified no previous studies that had

Acknowledgements

This work was supported by grant support from the U.S. Army Medical Department (DAKF40-98-C-0112), the Agency for Health Care Policy & Research (R03 HS10021-01), and the American Pharmaceutical Association Foundation. The authors acknowledge the critical review of Kristen A. Weigle, MD, MSH.

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    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the U.S. Department of the Army or the Department of Defense.

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