Missed Opportunities to Vaccinate Older Adults in Primary Care

Article Figures & Data

Table 1.

Demographic Characteristics, Visits and Vaccination Status

Characteristic	n = 217
Age (years) (mean ± SD)	74.9 ± 5.3
Sex (% male)	43.8
Number of months in study (mean ± SD)	37.1 ± 5.7
Number of influenza seasons available (mean ± SD)	3.8 ± 0.5
Total visits (mean ± SD)	12.1 ± 5.9
Primary care physician visits (mean ± SD)	8.6 ± 5.6
% Primary care physician visits (mean ± SD)	70.6 ± 28.5
Acute visits (mean ± SD)	1.1 ± 1.5
Chronic visits (mean ± SD)	8.9 ± 5.6
Preventive visits (mean ± SD)	2.1 ± 1.8
Ever received influenza vaccine (%)	81.1^*
Always received influenza vaccine (%)	23.5
Ever received pneumococcal vaccine (%)	75.1
Ever received tetanus toxoid (%)	29.5
Fully immunized^† (%)	10.1
Received no vaccines (%)	7.4

There were no significant differences by age group or sex.
* Percentage receiving influenza vaccine in 2000 to 2001 season was significantly lower than all three other seasons, by McNemar χ² test (P < .001).
† Received one influenza vaccine per season available and the pneumococcal vaccine and tetanus toxoid within the appropriate interval.

Table 2.

Visits, Discussions, Refusals, and Missed Opportunities to Vaccinate*

	Never Received an Influenza Vaccine (1998 to 2001) (n = 41)	Received 1 to 3 Influenza Vaccines (1998 to 2001) (n = 125)	Received 1 Influenza Vaccine/Season (1998 to 2001) (n = 51)	Received Pneumococcal Age ≥65 years (1991 to 2001)		Ever Received Tetanus (1991 to 2001)
	Never Received an Influenza Vaccine (1998 to 2001) (n = 41)	Received 1 to 3 Influenza Vaccines (1998 to 2001) (n = 125)	Received 1 Influenza Vaccine/Season (1998 to 2001) (n = 51)	Yes (n = 163)	No (n = 54)	Yes (n = 64)	No (n = 153)
Total visits	10.2 ± 6.0	11.7 ± 5.9^†	14.7 ± 5.3	12.2 ± 5.7	12.0 ± 6.7	13.3 ± 5.9	11.6 ± 5.9
PCP visits	8.1 ± 5.9	8.0 ± 5.2^‡	10.5 ± 5.7	8.6 ± 5.3	8.7 ± 6.3	9.4 ± 5.0	8.3 ± 5.8
% PCP visits	79.1 ± 25.8	68.6 ± 29.0	68.3 ± 28.7	70.5 ± 28.6	70.9 ± 28.4	72.6 ± 23.9	69.8 ± 30.3
MD discussed	0.15 ± 0.36	0.14 ± 0.39			0.91 ± 1.58		0.67 ± 1.38
Patient refused	0.32 ± 0.57	0.0.2 ± 0.15^§			0.31 ± 0.84		0.09 ± 0.44
Missed opportunities	3.4 ± 3.0	2.18 ± 2.13^¶			10.7 ± 7.3		10.8 ± 5.9

* PCP, primary care physician visits; % PCP, percentage of visits with primary care physician. All post hoc comparisons used Bonferroni corrections. Total visits for influenza vaccination are those during influenza season only; for pneumococcal and tetanus total visits are year round.
† P < .01 difference between never received and received 1 to 3 vaccines and between never received and received 1/season.
‡ P < .05 difference between received 1 to 3 vaccines and received 1/season.
§ P < .001 difference between never received and received 1 to 3 vaccines.
¶ P < .01 difference between never received and received 1 to 3 vaccines.

Table 3.

Comparison of Number of Visits (Mean ±SD) during 4 Influenza Vaccination Seasons

Visits	1998 to 1999		1999 to 2000		2000 to 2001		2001 to 2002
Visits	Vaccinated (n = 106)	Not Vaccinated (n = 99)	Vaccinated (n = 122)	Not Vaccinated (n = 91)	Vaccinated (n = 89)	Not Vaccinated (n = 128)	Vaccinated (n = 119)	Not Vaccinated (n = 98
Oct–Nov	1.13 ± 0.77^*	0.35 ± 0.69	0.99 ± 0.66^*	0.44 ± 0.69	0.78 ± 0.96	0.70 ± 0.77	1.20 ± 0.91^*	0.62 ± 0.75
Dec–Feb	0.89 ± 0.91	0.78 ± 0.91	0.93 ± 0.99	0.68 ± 0.92	1.06 ± 1.24^*	0.79 ± 0.88	—^†	—
Oct–Feb	2.02 ± 1.23^*	1.13 ± 1.27	1.92 ± 1.16^*	1.12 ± 1.16	2.37 ± 1.63^*	1.48 ± 1.17	—	—

* Difference between vaccinated and unvaccinated is significant at the P < .001 level.
† Visits in January and February 2002 were not collected.

Table 4.

Discussions, Refusals and Missed Opportunities to Vaccinate during 4 Influenza Seasons

Discussions, Refusals and Missed Opportunities to Vaccinate	1998 to 1999	1999 to 2000	2000 to 2001	2001 to 2002
Vaccinated patients, n (%)	106 (51.7)	122 (57.3)	89 (41.0)^*	119 (54.8)
Unvaccinated patients with ≥1 missed opportunity during influenza season, n (%)	59 (59.6)	52 (57.1)	90 (70.3)	48 (49.0)
Visits Oct–Feb^†	1.5 ± 1.3	1.6 ± 1.2	1.8 ± 1.4^§
MD discussed vaccination^†	0.01 ± 0.10	0.02 ± 0.13	0.06 ± 0.27^‡	0.02 ± 0.13
Patient refused vaccination^†	0.01 ± 0.07	0.02 ± 0.14	0.04 ± 0.22	0.01 ± 0.01
Missed opportunities to vaccinate Oct–Nov^†	0.16 ± 0.50	0.17 ± 0.46	0.37 ± 0.66^¶	0.20 ± 0.46
Missed opportunities to vaccinate Dec–Feb^†	0.37 ± 0.73	0.27 ± 0.68	0.41 ± 0.78^**
Missed opportunities to vaccinate Oct–Feb^†	0.53 ± 1.04	0.45 ± 0.91	0.78 ± 1.14^††

* 2000 to 2001 influenza season was significantly lower than the 1998 to 1999, 1999 to 2000, and 2001 to 2002 seasons (P < .001).
† Mean ± SD.
§ 2000 to 2001 influenza season was significantly higher than the 1999 to 2000 and 2001 to 2002 seasons (P < .005); data were not collected for visits in January and February 2002, precluding comparison analysis.
‡ 2000 to 2001 influenza season was significantly higher than the 1999 to 2000 and 2001 to 2002 seasons (P < .05).
¶ 2000 to 2001 influenza season was significantly higher than the 1999 to 2000 and 2001 to 2002 seasons (P < .002). To show the impact of the shortage year, visits were treated as potential missed opportunities if unvaccinated; although vaccine was not available in these practices, it was available elsewhere in 2000 to 2001 and in other years in these practices.
** 2000 to 2001 influenza season was significantly higher than the 1999 to 2000 season (P < .05); data were not collected for visits in January and February 2002, precluding comparison analysis.
†† 2000 to 2001 influenza season was significantly higher than the 1999 to 2000 season (P < .001); data were not collected for visits in January and February 2002, precluding comparison analysis.