Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study
Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study
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DOI：
10.1007/s11606-020-06187-1
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发表时间：
2020-09-16
影响因子：
5.7
通讯作者：
Haruta, Junji
中科院分区：
文献类型：
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作者：
Kaneko, Makoto;Aoki, Takuya;Haruta, Junji
背景：在世界范围内，老年人对流感和肺炎球菌疫苗的接种不足。虽然初级保健的患者经历与儿童的疫苗接种有关，但这种关系对于老年人仍不清楚。目的本研究探讨老年人初级保健经历与流感/肺炎球菌疫苗摄取之间的关系。设计与方法我们进行了一项多中心横断面调查，涉及日本城市和农村地区的25家初级保健机构。参与者是年龄在bb0 = 65岁的门诊患者，他们在为期一周的研究期间访问了其中一个参与机构。我们使用日本版初级保健评估工具（JPCAT）评估患者的初级保健体验，其中包括六个领域：首次接触（可及性）、纵向（护理的连续性）、协调性、综合性（可用服务）、综合性（提供的服务）和社区导向。我们使用广义线性混合效应模型来调整机构和个体协变量内的聚类。1000名参与者被纳入分析。在调整了机构内的聚类和其他可能的混杂因素后，流感和肺炎球菌疫苗接种与JPCAT总分呈正相关（每1个标准差增加的优势比分别为1.19,95%可信区间为1.01-1.40，优势比分别为1.26,95%可信区间为1.08-1.46）。在JPCAT结构域中，协调性和社区导向与流感疫苗的摄取有关，而纵向性、协调性和全面性与肺炎球菌疫苗的摄取有关。结论流感和肺炎球菌疫苗接种与老年人的初级保健经历呈正相关。考虑患者经验，特别是纵向、协调性、全面性和社区导向，可以提高疫苗接种率。
Background Older adults' uptake of influenza and pneumococcus vaccines is insufficient worldwide. Although patient experience of primary care is associated with vaccine uptake in children, this relationship remains unclear for older adults. Objective This study examined the association between patient experience of primary care and influenza/pneumococcal vaccine uptake in older adults. Design and Methods We conducted a multicentered cross-sectional survey involving 25 primary care institutions in urban and rural areas in Japan. Participants were outpatients aged >= 65 years who visited one of the participating institutions within the 1-week study period. We assessed patient experience of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which includes six domains: first contact (accessibility), longitudinality (continuity of care), coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a generalized linear mixed-effects model to adjust for clustering within institutions and individual covariates. Key Results One thousand participants were included in the analysis. After adjusting for clustering within institutions and other possible confounders, influenza and pneumococcal vaccine uptake was positively associated with JPCAT total scores (odds ratio per 1 standard deviation increase: 1.19, 95% confidence interval: 1.01-1.40 and odds ratio: 1.26, 95% confidence interval: 1.08-1.46, respectively). Of the JPCAT domains, coordination and community orientation were associated with influenza vaccine uptake and longitudinality, coordination, and comprehensiveness were associated with pneumococcal vaccine uptake. Conclusions Influenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake.