Generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients - A nationwide survey

Background: Influenza and pneumococcal vaccination rates remain too low. Th is survey assessed generalist and subspecialist physicians' knowledge, atti tudes, and practices regarding influenza and pneumococcal vaccinations for high-risk patients. Methods: A self-administered questionnaire was mailed to 6000 physicians ra ndomly selected from a national database. Results: After 3 mailings, 1874 physicians (32%) of the 5858 eligible respo nded. Although most physicians thought that it was very important for their high-risk patients be current on influenza and pneumococcal vaccinations, only 86% and 75% of generalists and subspecialists, respectively, very stro ngly recommended influenza vaccinations to their elderly patients and only 81% and 64%, respectively, very strongly recommended pneumococcal vaccinati ons to their elderly patients (P < .001 for both). After multivariate logis tic regression, factors significantly associated with strongly recommending vaccinations to elderly patient,,, in the influenza and pneumococcal vacci nation models included female sex of provider, the provider having received an influenza vaccination, the provider's beliefs about vaccine effectivene ss and cost-effectiveness, a patient's risk for illness, and ease of target ing patients. In addition, generalists were more likely than subspecialists to strongly recommend pneumococcal vaccinations to their patients. Patient reminders, special clinics, and standing orders were each used by fewer th an 30% of respondents, although generalists were more likely than subspecia lists to use such strategies. Conclusions: Nontrivial proportions of generalist and subspecialist physici ans fail to strongly recommend influenza and pneumococcal vaccinations to t heir elderly and high-risk patients. Other effective strategies for promoti ng vaccine delivery are also used relatively infrequently. These findings s uggest areas for improvement if vaccination rates are to reach national goa ls.