Differences in attitudes, beliefs and knowledge of hospital health care workers and community doctors to vaccination of older people

• Published in: Vaccine Vol. 26; no. 44; pp. 5633 - 5640
• Main Authors: Ridda, I, Lindley, I.R, Gao, Z, McIntyre, P, MacIntyre, C.R
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 16.10.2008; Elsevier; Elsevier Limited
• Subjects: Access to information; Adult; Aged; Allergy and Immunology; Allied Health Personnel - psychology; Applied microbiology; Attitude of Health Personnel; Attitudes to pneumococcal vaccine; Bacteriology; Biological and medical sciences; Community Health Services; Elderly patients; Female; Fundamental and applied biological sciences. Psychology; General physicians; Health care; Health Care Surveys; Health Knowledge, Attitudes, Practice; Hospital health care workers; Hospitals; Humans; Immunization; Male; Medical personnel; Medical Staff, Hospital - psychology; Microbiology; Middle Aged; Miscellaneous; Nursing Staff, Hospital - psychology; Older people; Personnel, Hospital - psychology; Physicians; Physicians, Family - psychology; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - administration & dosage; Pneumonia; Streptococcus pneumoniae; Streptococcus pneumoniae - immunology; Studies; Surveys and Questionnaires; Vaccination - psychology; Vaccination - statistics & numerical data; Vaccine barriers; Vaccines; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Sydney New South Wales Australia; Australia; Australia, New South Wales, Sydney; Hospital health care workers; Attitudes to pneumococcal vaccine; Vaccine barriers; General physicians; Elderly patients; Human; Vaccination; Vaccine; Streptococcus pneumoniae; Streptococcaceae; Bacteria; Micrococcales; Health worker; Elderly
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2008.07.070

Abstract Pneumococcal disease and influenza are major causes of morbidity and mortality particularly among the elderly. Influenza and pneumococcal vaccination are recommended for people aged 65 years and older or persons with chronic illness. However, despite the burden of disease related to pneumococcus and influenza and the availability safe, efficacious and cost-effective vaccines, health care providers continue to have doubts about these vaccines. Little is known about barriers for pneumococcal vaccination in the health care providers particularly in the primary health care setting. Since 2005 a publicly funded program offering free pneumococcal vaccine for elderly people over 65 years has been implemented in Australia. Aim To investigate knowledge, attitudes and practices around vaccination of elderly patients among hospital health care workers and community general practitioners and to explore the difference between hospital doctors and GP. Methods A self-reported questionnaire survey distrubuted March and June 2007 to General physicians (GP's) whose practices are located in Western Sydney and health care staff consisting of Hospital Doctors (HD), hospital nurses (HN) and allied health care workers at a tertiary referral hospital in Western Sydney. Descriptive analyses were conducted; bivariate analyses were performed to investigate associations between variables. Results Completed surveys were obtained for 56.3% (335/595) GPs and 42.1% (346/822) for HHCWs. The HHCWs comprised 37.5% (130/346) HD, 57.8% (200/346) HN and 4.6% (16/346) allied health care workers. GP's are more likely to support elderly vaccination than hospital doctors (98.8% compared to 93%, P = 0.0007). GPs reported that the reason for not vaccinating patients in 88% (295/335) of the cases was due to patient refusal. GP's and HHCW both agreed that pneumococcal disease is a serious illness and that vaccination is an important preventive measure for the elderly. However, the majority 68.2% (88/129) of hospital doctors report that vaccinations are difficult to address due to multiple competing priorities compared to only 34.6% (116/335) of GPs, P < 0.0001. Hospital doctors are more likely than GPS (24% vs. 17%) to report that patients often complain of adverse effects from pneumococcal vaccine. Hospital doctors 20% (104/130) are significantly less likely than GPs < 1% (3/335) to have access to guidelines and other information regarding vaccination in the elderly. Conclusions GPs and hospital health care workers in our study were aware of, agreed with, immunization recommendation for the pneumococcal vaccine. Physician barriers to vaccination were patient's refusals and competing priorities, particularly for hospital health care workers, who were less likely to see vaccination as a priority. Hospitalisation is an opportunity for vaccination, but utilisation of this opportunity is reduced by lack of access to information about immunization for hospital health care workers and competing priorities. These could be areas to target for improved uptake of the elderly immunization.