Combined influenza and pneumococcal vaccination of the elderly in general practice: The level of vaccination and the determinants of non-compliance

Objective. To gain insight into the vaccination behaviour of elderly people if they are offered a pneumococcal vaccine together with the annual vaccination against influenza. Design. Cross-sectional study. Method. In October 1999 in Amersfoort, a group of general practitioners offered a pneumococcal vaccine together with the yearly influenza vaccination to all 3,365 patients aged 65 years or over. A questionnaire was then mailed to a stratified sample (n = 972) of these patients. Vaccine acceptance and the determinants of non-compliance were then assessed by means of polytomous logistic regression analysis. Results. A total of 2,529 patients (75%) received the pneumococcal vaccine and 2,812 (84%) received the influenza vaccine. Predictors of non-acceptance of the pneumococcal vaccine were a perceived lack of recommendation by the general practitioner (odds ratio (OR): 4.6, 95% confidence interval (CI): 2.6-8.3) and fear of local side effects (OR: 2.8; 95% CI: 1.6-4.6). Predictors of refusal to accept either vaccination also included unwillingness to comply with the doctor's advice (OR: 6.1; 95% CI: 2.4-15.4), the belief that vaccinations weaken one's natural defences (OR: 2.7; 95% CI: 1.4-5.3 or that influenza is not dangerous (OR: 2.9; 95% CI: 1.5-5.4), and the fear of being made ill by pneumococcal vaccination (OR: 2.9; 95% CI: 1.1-7.9). People who felt healthy, found it difficult to come to the doctor's office, had private medical insurance, or were younger than 75 years of age remained unvaccinated more often. Conclusion. Addition of a pneumococcal vaccine to the existing influenza immunisation program resulted in high acceptance rates for both vaccinations. The role of the general practitioner was important in this connection