Influenza Vaccination of Primary Healthcare Physicians May Be Associated With Vaccination in Their Patients: A Vaccination Coverage Study

Pere Godoy; Jesús Castilla; José María Mayoral; Vicente Martín; Jenaro Astray; Núria Torner; Diana Toledo; Núria Soldevila; Fernando González-Candelas; Susana García; José Diaz-Borrego; Sonia Tamames; Angela Domínguez; the Working Group for the Survey on Influenza Vaccination in Primary Health Care Professionals

Disclosures

BMC Fam Pract. 2015;16(44)

Abstract

Background To assess the contribution of physician-related factors, especially their influenza vaccine status, in the vaccination coverage of their patients.

Methods A study of vaccination coverage was carried out in Spain in 2011–12. The dependent variable (vaccination coverage in patients aged ≥65 years) was obtained from regional records. Information was gathered on the vaccination of physicians through an anonymous web survey. We compared the vaccination coverage of patients with the vaccination of their physicians using the Student t test. Associations were determined using a multilevel regression model.

Results The coverage in patients aged ≥ 65 years was 56.3% and was higher (57.3%) in patients whose physician had been vaccinated than in those whose physician had not (55.2%) (p = 0.008). In the multilevel regression model, vaccination of the physician was associated (p = 0.049) with vaccination of their patients after controlling for the effects of age (p = 0.046), region (p = 0.089), and opinions on the effectiveness of the vaccine (p = 0.013).

Conclusions Vaccination of physicians together with their opinions on the effectiveness of the vaccine may be a predictor of vaccination coverage in their patients. Further studies are required to confirm this.

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Table 1. Characteristics of primary care physicians who responded to the survey, Spain, 2012
Variables	%	n/N
Sex:
Female	58.4	476/815
Male	41.6	339/815
Age (years)
25 – 34	3.3	27/815
35 – 44	25.6	209/815
45 – 54	44.7	364/815
55 – 64	26.4	215/815
Participates in the influenza sentinel system
Yes	11.4	93/815
No	88.6	722/815
Training activities on influenza
Yes	38.7	315/815
No	61.3	500/815
I believe that influenza may be a severe illness
Yes	67.2	548/815
No	32.8	267/815
I worry about infecting my patients
Yes	59.4	484/815
No	40.6	331/815
I believe the influenza vaccine is effective
Yes	87,4	712/815
No	12.6	103/815
I worry about becoming ill due to influenza
Yes	49.8	406/815
No	50.2	409/815

Table 2. Prevalence of influenza vaccination in primary care physicians according to study variables, Spain, 2012
Characteristics of primary care physicians	Prevalence of vaccination %	n/N	p^a
Total	55.3	451/815
Sex:
Female	53.6	255/476	0.129
Male	57.8	196/339
Age (years)
25 – 34	37.0	10/27	0.098
35 – 44	51.7	108/209
45 – 54	58.5	213/364
55 – 64	55.8	120/215
Participates in the influenza sentinel system
Yes	54.8	51/93	0.918
No	55.4	400/722
Training activities on influenza
Yes	56.8	179/315	0.498
No	54.4	272/500
I believe that influenza may be a severe illness
Yes	56.9	312/548	0.189
No	52.1	139/267
I worry about infecting my patients
Yes	69.6	337/484	<0.001
No	34.4	114/331
I believe the influenza vaccine is effective
Yes	60.1	428/712	<0.001
No	22.3	23/103
I worry about becoming ill due to influenza
Yes	77.1	313/406	<0.001
No	33.7	138/409

^ap value.

Table 3. Influenza vaccination coverage in patients aged ≥ 65 years according to the characteristics of their primary care physician, Spain, 2012
Characteristics of primary care physicians	Mean vaccination coverage in patients aged ≥ 64 years	95% Confidence intervals	P^a
Total	56.3	55.6 – 57.1
Influenza vaccination
Yes	57.3	56.2 - 58.3	0.008
No	55.2	54.1 - 56.2
Sex:
Female	56.6	55.7 - 57.5	0.448
Male	56.0	54.7 - 57.2
Age (years)
25 – 34	57.3	53.6 - 61.0	0.330
35 – 44	56.7	55.1 - 58.2
45 – 54	56.8	55.7 - 57.8
55 – 64	55.2	53.6 - 56.8
Participates in the influenza sentinel system			0.585
Yes	55.8	53.9 - 57.6
No	56.4	55.6 - 57.2
Training activities on influenza			0.199
Yes	57.0	55.9 - 58.0
No	56.0	54.9 - 57.0
I believe that influenza may be a severe illness
Yes	56.5	55.9 - 57.4	0.639
No	56.1	54.7 - 57.5
I worry about infecting my patients
Yes	56.0	55.1 – 57.0	0.321
No	56.8	55.5 – 58.0
I believe the influenza vaccine is effective
Yes	56.8	56.0 – 57.5	0.005
No	53.5	51.2 – 55.9
I worry about becoming ill due to influenza
Yes	54.8	54.0 – 55.7	0.912
No	54.7	53.9 – 55.5

^ap value.

Table 4. Factors in primary care physicians associated with influenza vaccination of their patients aged ≥ 65 years in the multilevel regression model, Spain, 2012
Characteristics of primary care physicians	Regression coefficient β	Regression coefficient β 95% CI^a		t^b	p^c
Fixed effects
Constant	53.526	49.828	57.225	30.215	0.000
Influenza vaccination (1.Yes; 0.No)	1.650	.005	3.295	1.969	.049
Age (1. 55+; 0. <55 years)	1.675	.031	3.319	2.000	.046
I believe the influenza vaccine is effective (1.Yes; 0.No)	2.866	.596	5.136	2.478	.013
I worry about infecting my patients (1.Yes; 0.No)	−1.579	−3.292	.134	−1.809	.071
I worry about becoming ill due to influenza (1.Yes; 0.No)	-.401	−2.142	1.341	-.451	.652
Random effects
Spanish regions^d, Estimated variance	11.829 ± 6.952 (p = 0.089)