Prescribing rate of influenza vaccine among internal medicine residents for outpatient continuum care

Abstract

© 2014, Medical Association of Thailand. All rights reserved. Background: Annual epidemics of influenza viruses remain a substantial cause of morbidity and mortality worldwide particularly among vulnerable groups. Immunization is another way to reduce the infection and mortality rates, especially in high-risk groups; however, the data concerning prescription rates and possible influencing factors on decisions associated with influenza prescription of Thai internal medicine residents were limited. Objective: Siriraj internal medicine residency training has provided outpatient continuum care practice for all 1st year residents since 2008. A part of the curriculum was to prepare each trainee to be an effective vaccinator. This study aims to examine the competency of those residents who had completed the training, particularly about prescribing influenza vaccine. Material and Method: The authors retrospectively reviewed medical records of the patients that indicated need for influenza vaccine encountered by 2^nd and 3^rd year residents during June 2011 and May 2012. The 20-item questionnaire was also sent out in order to study possible factors associated on prescribing the vaccine. Results: Three hundred and seventy-three medical records were included and reviewed. The prescription rate of influenza vaccine was 8.0 percent. Comparing vaccine receiving and non-receiving groups, the authors found having respiratory problems (26.7% vs. 4.4%; odds ratio 8.0 [3.0-20.8]; p<0.001) and being self-paying (16.7% vs. 5.8%; odds ratio 3.2 [1.1-9.3]; p = 0.023) were the only two significant differences. Only 5.7 percent of total residents were an effective vaccinator. One hundred and five residents returned the questionnaire. Residents who had further plans for fellowship trainings had reported a higher influenza vaccine prescription rate than those who will be general internists (45.2% vs. 8.1%; adjusted odds ratio 14.04 [1.6-125.8]; p = 0.018). The authors also found that the rate of vaccine recognition, general knowledge of vaccination, and vaccine coverage remained 61.9%, 29.5%, and 21.0% among medicine residents. Conclusion: Prescribing rate of influenza vaccine remained low due to multifactor aspects, including doctor capability, attitude, patient recognition as well as reimbursement issues. In order to improve the rate of influenza vaccine prescriptions, a system-designed approach would be needed.