Original articleAttitudinal factors among adult prescription recipients associated with choice of where to be vaccinated☆
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.
References (29)
- et al.
The flu shot studyusing multiattribute utility theory to design a vaccination intervention
Org Behav Hum Decis Proc
(1986) - et al.
Implementation of a community pharmacy-based influenza vaccination program
J Am Pharm Assoc
(1997) - et al.
People vaccinated by pharmacistsdescriptive epidemiology
J Am Pharm Assoc
(2001) - et al.
Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients
Am J Prev Med
(1999) Adult immunizationsummary of the National Vaccine Advisory Committee report
JAMA
(1994)Prevention of pneumococcal disease
MMWR
(1997)Prevention and control of influenza
MMWR
(2000)Influenza, pneumococcal, and tetanus toxoid vaccination of adults—United States, 1993–1997
MMWR
(2000)Immunization and infectious disease. Healthy people 2000National health promotion & disease prevention objectives
(1991)Immunization and infectious disease. Healthy people 2010National health promotion & disease prevention objectives
(2000)
Why people fail to seek poliomyelitis vaccination
Public Health Rep
Factors affecting the use of vaccinesconsiderations for immunization program planners
Public Health Rep
Do postcard reminders improve influenza vaccination compliance? A prospective trial of different postcard “cues
Med Care
Developing and testing a decision model for predicting influenza vaccine compliance
Health Serv Res
Cited by (42)
Characteristics of U.S. older adult medicare beneficiaries receiving the influenza vaccination at retail pharmacies
2023, Exploratory Research in Clinical and Social PharmacyPatient characteristics associated with the use of pharmacist-administered vaccination services and predictors of service utilization
2021, Journal of the American Pharmacists AssociationCitation Excerpt :All states also authorized pharmacists to administer human papillomavirus and hepatitis B except for New Hampshire and New York.11 Data on the impact of pharmacist training to administer vaccines are available; however, research on understanding the characteristics of patients who use this service is scarce.13-15 This study aimed to identify the characteristics of the users of pharmacist-administered vaccination and recognize predictors of utilizing these services.
Pharmacy patron perspectives of community pharmacist administered influenza vaccinations
2019, Research in Social and Administrative PharmacyClinical Pharmacy Considerations in Special Populations: Geriatrics
2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy: Volumes 1-3Clinical pharmacy considerations in special populations: Geriatrics
2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy
- ☆
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.