Patient’s behaviors and missed opportunities for vaccination against seasonal epidemic influenza and evaluation of their impact on patient’s influenza vaccine uptake

Enrique Casalino,Enrique Casalino,Enrique Casalino,Enrique Casalino,Aiham Ghazali,Aiham Ghazali,Aiham Ghazali,Aiham Ghazali,Donia Bouzid,Donia Bouzid,Donia Bouzid,Donia Bouzid,Laurent Pereira,Laurent Pereira,Philippe Kenway,Philippe Kenway,Stephanie Antoniol,Christophe Choquet,Christophe Choquet,Justin R Ortiz

doi:10.1371/journal.pone.0193029

Abstract

ObjectivesInfluenza vaccination (IV) coverage remains low in France. Objectives were to assess patient knowledge and behaviors and missed opportunities for vaccination (MO) and their impact on vaccine uptake.MethodsThis is a prospective-observational study, including emergency department patients at risk for severe influenza. Patients were interviewed about their knowledge and behaviors. We evaluated the health-care voucher scheme (HCVS) and MO.Results868 patients were included. Vaccine uptake was 33.2%, 42% of patients knew about the possible severity of influenza, 23% thought that they were not at risk for severe influenza, 39% knew that they have an indication for the vaccine, and 4.3% to 11.5% expressed reservations concerning IV side effects and effectiveness. HCVS was used by 44.3% of patients, but only 14.8% had been vaccinated. MO were reported by 484 patients (69.4%) declaring 1104 consultations and 148 IV propositions (86.6%). Predictors of vaccine uptake (p<0.0001) were: knowledge of serious and fatal influenza forms [OR 0.36 (CI95% 0.25–0.5)]; confidence in influenza vaccine effectiveness [0.38 (0.2–0.7)]; opposition to vaccines [0.22 (0.1–0.48)]; visit to general practitioner [4.53 (2.9–7.1)]; general practitioner proposed IV [2.1 (1.2–3.4)].ConclusionOur results indicate that high rate of missed opportunities, some patient behaviors and general practitioner visits may explain low influenza vaccine uptake, and that HCVS use is a complex process. Of interest, we found that the patient’s knowledge of the potential severity of influenza is not sufficient to promote vaccine, suggesting that the information strategy must be adapted to each patient behavior.

Highlights

The seasonal epidemic influenza remains a major public health issue with 3–5 million severe cases, resulting in up to 650 000 deaths annually [1]
Vaccine uptake was 33.2%, 42% of patients knew about the possible severity of influenza, 23% thought that they were not at risk for severe influenza, 39% knew that they have an indication for the vaccine, and 4.3% to 11.5% expressed reservations concerning Influenza vaccination (IV) side effects and effectiveness
Our study shows that up to 24% of the patients admitted in the emergency department during the early- and epidemic seasonal influenza period were at high risk for severe influenza, and that influenza vaccine uptake was only 33% among them

Summary

Introduction

The seasonal epidemic influenza remains a major public health issue with 3–5 million severe cases, resulting in up to 650 000 deaths annually [1]. Every winter the seasonal flu affects 2 to 8 million people in France, causing several thousand deaths mainly elderly people or patients with chronic diseases, both of which are currently accepted indications for influenza vaccination [2]. Current recommendations insist on the importance of vaccination, which is currently considered as the most effective way to prevent the disease [1,2,3,4]. Worldwide influenza vaccination coverage ranges from 10% to 80% for the populations at risk of severe forms [5,6,7]. The reasons behind these variations are insufficiently identified [7,8]. It has been reported that missed opportunities to vaccinate are frequently associated with low vaccination rates [15,16]

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Results

Discussion

Conclusion