[Influence of physician and physician list characteristics on influenza vaccination rates in older people in a health care area in the community of Valencia, Spain]

Abstract

Objective: To identify the characteristics of physicians and the patients on their list related with rates of influenza vaccination in older people, and to quantify influenza vaccination coverage in this population group.

Design: Observational, cross-sectional, multicenter population-based study with primary data.

Participants: All health centers in the health care area that used computerized registries of influenza vaccinations. Vaccination records were analyzed for 73 physicians who had been at their present post for at least 2 years prior to the study, and for 19 457 older people who were vaccinated during the 2001-2002 vaccination campaign.

Setting: Primary health care area number 19.

Main measures: Physician's age and sex, whether the physician was certified as a specialist in family and community medicine, teaching accreditation, permanent or temporary post, length of time in present post, years of professional practice, type of health center administration, total number of patients in the physician's list, population and percentage of the population >65 years old in the physician's list, influenza vaccination rate referred to the total number of patients on the physician's list. The criterion evaluated was the influenza vaccination rate in older people. Descriptive analysis, bivariate analysis and multivariate analysis were used. A P value < .05 was considered statistically significant, and 95% confidence intervals were calculated.

Results: The overall influenza vaccination rate in older people (>65 years) was 50.9%, with considerable variability between physicians (from 18% to 77%). Vaccination rates were lowest in physicians who had been in their current post for longer (P=.001), with larger patient lists (P=.03), with more older people in their list (P=.000), and with larger proportions of older people in their list (P=.001). Lower rates of vaccination in older people were also associated with lower proportions of all patients on the list being vaccinated (P=.000). No significant associations were found for any of the other variables. After multivariate analysis only the percentage of older people on the physician's list remained significantly associated with vaccination rate.

Conclusions: Influenza vaccination rates for older people were low and similar to rates reported earlier for this region of Spain. The percentage of older people in the list was the only explanatory variable in the model, and was inversely proportional to vaccination coverage.