Increasing Influenza and Pneumococcal Vaccination Uptake in Seniors Using Point-of-Care Informational Interventions in Primary Care in Singapore: A Pragmatic, Cluster-Randomized Crossover Trial

Am J Public Health. 2019 Dec;109(12):1776-1783. doi: 10.2105/AJPH.2019.305328. Epub 2019 Oct 17.

Abstract

Objectives. To evaluate the effectiveness of point-of-care informational interventions in general practitioner clinics to improve influenza and pneumococcal vaccination uptake among elderly patients.Methods. We conducted a pragmatic, cluster-randomized crossover trial in 22 private general practitioner clinics in Singapore, from November 2017 to July 2018. We included all patients aged 65 years or older. Clinics were assigned to a 3-month intervention (flyers and posters encouraging vaccination) plus 1-month washout period, and a 4-month control period (usual care). Primary outcomes were differences in vaccination uptake rates between periods. Secondary outcomes were identification of other factors associated with vaccination uptake.Results. A total of 4378 and 4459 patients were included in the intervention and control periods, respectively. Both influenza (5.9% vs 4.8%; P = .047) and pneumococcal (5.7% vs 3.7%; P = .001) vaccination uptake rates were higher during the intervention period compared with the control period. On multilevel logistic regression analysis, follow-up for hypertension, diabetes mellitus, hyperlipidemia, or any combination of the 3 was associated with uptake of both vaccines.Conclusions. Point-of-care informational interventions likely contributed to increased influenza and pneumococcal vaccination uptake. Patients on follow-up for hypertension, diabetes mellitus, hyperlipidemia, or any combination of the 3 were more likely to receive influenza and pneumococcal vaccination and should be actively engaged by physicians.Trial Registration. ClinicalTrials.gov Identifier: NCT03445117.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Over Studies
  • Diabetes Mellitus / epidemiology
  • Female
  • Health Promotion / organization & administration*
  • Humans
  • Hyperlipidemias / epidemiology
  • Hypertension / epidemiology
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / prevention & control
  • Logistic Models
  • Male
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines / administration & dosage*
  • Point-of-Care Systems / organization & administration*
  • Singapore
  • Socioeconomic Factors

Substances

  • Influenza Vaccines
  • Pneumococcal Vaccines

Associated data

  • ClinicalTrials.gov/NCT03445117