Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2021

Open Access 01-12-2021 | Influenza Vaccination | Research article

Regional differences in general practitioners’ behaviours regarding influenza vaccination: a cross-sectional study

Authors: Jonathan Arlt, Kristina Flaegel, Katja Goetz, Jost Steinhaeuser

Published in: BMC Health Services Research | Issue 1/2021

Login to get access

Abstract

Background

The World Health Organization recommends vaccination rates of 75% against seasonal influenza for patients over 65 years old. In the 2013/2014 season, the German vaccination rates ranged between 14 and 65%. This study aimed to compare the attitudes, personal characteristics and vaccination behaviours of general practitioners (GPs) in regions with high and low vaccination rates in Germany.

Methods

In May 2016, a questionnaire was sent to 1594 GPs practising in 16 districts with the highest and the lowest vaccination rates in Western and Eastern Germany as described by the Central Research Institute of Ambulatory Health Care in Germany for the 2013/2014 season. Descriptive statistics and multiple regression analyses were computed to identify potential factors associated with high vaccination rates.

Results

A total response rate of 32% (515/1594 participants) was observed in the study. GPs reported their attitudes towards vaccination in general and vaccination against influenza as mostly ‘very positive’ (80%, n = 352 and 65%, n = 288, respectively). GPs practising in regions with low vaccination rates reported their attitudes towards vaccinations in general (p = 0.004) and towards influenza vaccination (p = 0.001) more negatively than their colleagues from regions with high vaccination rates. Multiple logistic regression identified an increasing influence of year-dependent changing efficiency on GPs’ influenza rates as the strongest factor for predicting GPs from highly vaccinating regions (OR = 4.31 [1.12–16.60]), followed by the patient’s vaccination refusal despite GP advice due to already receiving a vaccination from another physician (OR = 3.20 [1.89–5.43]) and vaccination information gathering through medical colleagues (OR = 2.26 [1.19–4.29]).

Conclusions

The results of this study suggest a correlation between GPs’ attitudes and regional vaccination rates. Beneath GPs’ individual attitudes, the regional attitude patterns of patients, colleagues and medical assistants surrounding those GPs seem decisive and should be integrated into future campaigns to increase vaccination rates at a regional level.
Appendix
Available only for authorised users
Literature
1.
2.
3.
4.
5.
Standing Committee on Vaccination. Recommendations of the Standing Committee on Vaccination at the Robert-Koch-Institute. Epid Bull. 2017;34:333–76.
6.
7.
8.
9.
10.
11.
12.
Rehmet S, Ammon A, Pfaff G, Bocter N, Petersen LR. Cross-sectional study on influenza vaccination, Germany, 1999-2000. Emerg Infect Dis. 2002;8:1442–7.PubMedPubMedCentralCrossRef
13.
Poethko-Müller C, Schmitz R. Vaccination coverage in German adults. Results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsbl. 2013;56:845–57.CrossRef
14.
Wortberg S, Walter D, Knesebeck M, Reiter S. Physicians as key communicators of the influenza vaccination for the elderly, patients with chronic conditions, and health care workers. Results of a nationwide survey in the context of the national influenza vaccination campaign. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009;52:945–52.PubMedCrossRef
15.
Nessler K, Krztoń-Królewiecka A, Chmielowiec T, Jarczewska D, Windak A. Determinants of influenza vaccination coverage rates among primary care patients in Krakow, Poland and the surrounding region. Vaccine. 2014;32:7122–7.PubMedCrossRef
16.
Gurmankin AD, Baron J, Hershey JC, Ubel PA. The role of physicians’ recommendations in medical treatment decisions. Med Decis Mak. 2002;22:262–71.CrossRef
17.
Böhmer MM, Walter D, Krause G, Müters S, Gösswald A, Wichmann O. Determinants of tetanus and seasonal influenza vaccine uptake in adults living in Germany. Hum Vaccine. 2011;7:1317–25.CrossRef
18.
Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005–2016. PLoS One. 2017;12:e0170550.PubMedPubMedCentralCrossRef
19.
Ganczak M, Gil K, Korzeń M, Bażydło M. Coverage and influencing determinants of influenza vaccination in elderly patients in a country with a poor vaccination implementation. Int J Environ Res Public Health. 2017;14:E665.PubMedCrossRef
20.
Mohammed H, Clarke M, Koehler A, Watson M, Marshall H. Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia. PLoS One. 2018;13:e0197867.PubMedPubMedCentralCrossRef
21.
Walker TY, Elam-Evans LD, Yankey D, Markowitz LE, Williams CL, Fredua B, Singleton JA, Stokley S. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(33):718–23.PubMedPubMedCentralCrossRef
22.
Collange F, Zaytseva A, Pulcini C, Bocquier A, Verger P. Unexplained variations in general practitioners’ perceptions and practices regarding vaccination in France. Eur J Pub Health. 2019;29:2–8.CrossRef
23.
Toffolutti V, McKee M, Melegaro A, Ricciardi W, Stuckler D. Austerity, measles and mandatory vaccination: cross-regional analysis of vaccination in Italy 2000-14. Eur J Pub Health. 2019;29:123–7.CrossRef
24.
25.
Costantino C, Mazzucco W, Azzolini E, Baldini C, Bergomi M, Biafiore AD, et al. Influenza vaccination coverage among medical residents: an Italian multicenter survey. Hum Vaccines Immunother. 2014;10:1204–10.CrossRef
26.
Amodio E, Tramuto F, Maringhini G, Asciutto R, Firenze A, Vitale F, et al. Are medical residents a “core group” for future improvement of influenza vaccination coverage in health-care workers? A study among medical residents at the University Hospital of Palermo (Sicily). Vaccine. 2011;29:8113–7.PubMedCrossRef
27.
Machowicz R, Wyszomirski T, Ciechanska J, Mahboobi N, Wnekowicz E, Obrowski M, et al. Knowledge, attitudes, and influenza vaccination of medical students in Warsaw, Strasbourg, and Teheran. Eur J Med Res. 2010;15(Suppl 2):235–40.PubMedPubMedCentralCrossRef
28.
Petersen S, Roggendorf H, Wicker S. Vaccine preventable diseases: knowledge, attitudes and vaccination status of medical students. Gesundheitswesen. 2017;79:394–8.PubMedCrossRef
29.
Massin S, Ventelou B, Nebout A, Verger P, Pulcini C. Cross-sectional survey: risk-averse French general practitioners are more favorable toward influenza vaccination. Vaccine. 2015;33:610–4.PubMedCrossRef
30.
Wicker S, Rabenau HF, Doerr HW, Allwinn R. Influenza vaccination compliance among health care workers in a German university hospital. Infection. 2009;37:197–202.PubMedCrossRef
31.
Socan M, Erculj V, Lajovic J. Knowledge and attitudes on pandemic and seasonal influenza vaccination among Slovenian physicians and dentists. Eur J Pub Health. 2013;23:92–7.CrossRef
32.
Antón-Ladislao A, García-Gutiérrez S, Soldevila N, González-Candelas F, Godoy P, Castilla J, et al. Visualizing knowledge and attitude factors related to influenza vaccination of physicians. Vaccine. 2015;33:885–91.PubMedCrossRef
33.
Opstelten W, van Essen GA, Ballieux MJP, Goudswaard AN. Influenza immunization of Dutch general practitioners: vaccination rate and attitudes towards vaccination. Vaccine. 2008;26:5918–21.PubMedCrossRef
34.
Ehrenstein BP, Hanses F, Blaas S, Mandraka F, Audebert F, Salzberger B. Perceived risks of adverse effects and influenza vaccination: a survey of hospital employees. Eur J Pub Health. 2010;20:495–9.CrossRef
35.
Betsch C, Wicker S. Personal attitudes and misconceptions, not official recommendations guide occupational physicians’ vaccination decisions. Vaccine. 2014;32:4478–84.PubMedCrossRef
36.
37.
38.
39.
40.
Field A. Discovering statistics using SPSS. London: SAGE Publications; 2009.
41.
42.
Seale C, Anderson E, Kinnersley P. Treatment advice in primary care: a comparative study of nurse practitioners and general practitioners. J Adv Nurs. 2006;54:534–41.PubMedCrossRef
43.
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47:826–34.PubMedCrossRef
44.
Nittritz C, Schaffer S, Kühlein T, Roos M. Consultation skills training as an element of general practice training in Germany - a qualitative survey. Z Evid Fortbild Qual Gesundhwes. 2016;117:57–64.PubMedCrossRef
45.
Kießling C, Dieterich A, Fabry G, Hölzer H, Langewitz W, Mühlinghaus I, et al. Basler Consensus statement “Kommunikative und soziale Kompetenzen im Medizinstudium”: Ein Positionspapier des GMA-Ausschusses Kommunikative und soziale Kompetenzen. GMS Z Med Ausbild. 2008;25:1–7.
46.
Fischer MR, Bauer D, Mohn K. Finally finished! National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education (NKLM) and Dental Education (NKLZ) ready for trial. GMS Z Med Ausbild. 2015;32:Doc35.PubMedPubMedCentral
47.
48.
49.
Standing Committee on Vaccination. Empfehlungen der Ständigen Impfkommission (STIKO) am Robert-Koch-Institut. Epid Bull. 2018;34:335–82.
50.
Jacobson Vann JC, Jacobson RM, Coyne-Beasley T, Asafu-Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev. 2018;1:CD003941.PubMed
51.
Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev. 2018;5:CD005188.PubMed
52.
Schulte K, Schierke H, Tamayo M, Hager L, Engehausen R, Raspe M, et al. Strategies for improving influenza vaccination rates in patients with chronic renal disease – results from two randomized controlled trials and a prospective interventional study. Dtsch Arztebl Int. 2019;116:413–9.PubMedPubMedCentral
53.
Corace KM, Srigley AJ, Hargadon DP, Yu D, MacDonald TK, Fabrigar LR, et al. Using behavior change frameworks to improve healthcare worker influenza vaccination rates: a systematic review. Vaccine. 2016;34:3235–42.PubMedCrossRef
54.
Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med. 2010;7:e1000352.PubMedPubMedCentralCrossRef
55.
Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open. 2017;7:e016408.PubMedPubMedCentralCrossRef
56.
Lieb K, Brandtönies S. A survey of German physicians in private practice about contacts with pharmaceutical sales representatives. Dtsch Arztebl Int. 2010;107:392–8.PubMedPubMedCentral
57.
Friedl A, Aegerter C, Saner E, Meier D, Beer JH. An intensive 5-year-long influenza vaccination campaign is effective among doctors but not nurses. Infection. 2012;40:57–62.PubMedCrossRef
58.
Osterholm MT, Kelley NS, Sommer A, Belongia EA. E fficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:36–44.PubMedCrossRef
59.
Sano K, Ainai A, Suzuki T, Hasegawa H. The road to a more effective influenza vaccine: up to date studies and future prospects. Vaccine. 2017;35:5388–95.PubMedCrossRef
60.
Bleidorn J, Voigt I, Wrede J, Dierks ML, Junius-Walker U. Keeping the wire hot with calls? Recruiting family practices for a health care research project. Z Allg Med. 2012;88:61–8.
61.
62.
Halbesleben JRB, Whitman MV. Evaluating survey quality in health services research: a decision framework for assessing nonresponse Bias. Health Serv Res. 2013;48:913–30.PubMedCrossRef
Metadata
Title
Regional differences in general practitioners’ behaviours regarding influenza vaccination: a cross-sectional study
Authors
Jonathan Arlt
Kristina Flaegel
Katja Goetz
Jost Steinhaeuser
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-021-06177-x

Other articles of this Issue 1/2021

BMC Health Services Research 1/2021 Go to the issue

Research

Impacts of chronic disease prevention programs implemented by private health insurers: a systematic review

Research article

Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort

Research

The relationship between urban and rural health insurance and the self-rated health of migrant workers in Southwest China

Research

Validation of the German version of the work and social adjustment scale in a sample of depressed patients

Research

Exploring community tuberculosis program in the pastoralist setting of Ethiopia: a qualitative study of community health workers’ perspectives in Borena Zone, Oromia Region

Research

Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review