Influenza and pneumococcal vaccination in primary healthcare users with asthma, COPD and ACOS: a multi-center, mixed-methods study in Greece

Aim Vaccination against seasonal influenza and pneumonococcus is recommended for patients with chronic respiratory diseases, but their vaccination coverage is unsatisfactory internationally. Aim of this study was to explore the vaccination coverage on influenza and pneumococcal vaccines in adult primary healthcare users with diagnosed asthma, COPD or ACOS, the awareness of their necessity and patients' attitudes towards immunization in an effort to identify possible barriers. Method In this multi-centre, mixed-methods study- conducted at 23 Primary Care units- for 30 consecutive working days, a pre-tested questionnaire was administered to three randomly selected patients who visited the practice each day, after signing Informed consent. Results A total of 1571 patients were recruited (75.9% response rate). Among them, 91 (5,8%) patients were diagnosed with asthma (mean age 63.6 ±13.3, min 23- max 87, 25.3% male), 78 (5%) with COPD (mean age 69±13.3, min 47- max 85, 53.8%male) and 8 (0.5%) patients with ACOS (mean age 70.6±5.3, min 61- max 78, 25% male). Flu vaccine was performed for the current year by 59.3% of the patients with asthma (14.3% declared unaware of its necessity), 79.5% with COPD (11.5% unaware), 75% with ACOS (0% unaware). Within the last five years pneumococcal vaccines was done by 52.7% patients with asthma (18.7% unaware), 60.3% (30.7% unaware), 12.5% with ACOS (0% unaware). Among all 159 patients, concerns for direct adverse effects after immunization was declared by 30.8%, for long-term adverse events by 24.5% and fear of the needle by 14.5%. Preference for natural immunity was declared by 20.8% (327) and past experiences of misfortune events associated with vaccination by 17.1%. 37.5% believed that vaccination may be another way for pharmaceutical companies to gain financial profit. Vaccines' efficacy was questioned by 17%, while 9.4% believed that vaccines are only for children. Finally, 91.3% were interested in getting better informed about all the appropriate vaccines. Conclusion The coverage for influenza and pneumococcal vaccination in patients with respiratory diseases should be increased. Addressing vaccination hesitancy requires a tailored patient-centered approach to each patient in order to confront personal concerns and misinformation that may be barriers to increasing vaccination coverage. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Declaration of Interest No funding was received. The research protocol was approved by the Ethics committee of the Medical School of Aristotle University of Thessaloniki. Approval reference: 1.38/21.11.18On behalf of the Research Committee of Greek Association of General Practitioners, Greece. References and Clinical Trial Registry Information