Advertisement

Canadian Journal of Public Health

, Volume 97, Issue 4, pp 335–339 | Cite as

Predictors of Influenza Immunization Among Home Care Clients in Ontario

  • John P. HirdesEmail author
  • Dawn M. Dalby
  • R. Knight Steel
  • G. Iain Carpenter
  • Roberto Bernabei
  • John N. Morris
  • Brant E. Fries
Article
  • 1 Downloads

Abstract

Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients.

Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients’ needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment.

Results: The overall rate of immunization reached about 80% by 2002. Factors such as age, respiratory problems, diabetes and congestive heart failure were associated with greater uptake, but overall rates of influenza immunization were lower than expected. Low education, smoking and poor medication adherence were negatively associated with influenza immunization. In addition, there was considerable variation in uptake among CCACs after adjusting for other significant individual-level independent variables.

Interpretation: Comprehensive assessments like the RAI-HC can be used to help identify and respond to health promotion and disease prevention issues in this population, and to compare rates across Canada.

MeSH terms

Influenza home care services risk factors 

Résumé

Contexte: Cette étude porte sur les facteurs associés à l’administration du vaccin antigrippal à la clientèle des soins à domicile en Ontario.

Méthode: Dans le cadre d’une visite programmée, nous avons évalué des personnes recevant des soins à domicile. Ces évaluations s’inscrivaient dans une étude pilote de la méthode d’évaluation RAI-HC (Resident Assessment Instrument - Home Care) dans 12 centres d’accès aux soins communautaires (CASC) de l’Ontario. La méthode RAI-HC est un outil d’évaluation multidimensionnel qui permet de définir les besoins des clients et leur niveau de capacité fonctionnelle. Par analyse de régression logistique multiple, nous avons cerné les facteurs associés à l’immunisation contre la grippe au cours des deux années antérieures à l’évaluation.

Résultats: Le taux global d’immunisation atteignait environ 80 % en 2002. L’âge, les troubles respiratoires, le diabète et l’insuffisance cardiaque congestive étaient associés à une demande accrue pour le vaccin antigrippal, mais dans l’ensemble, les taux d’immunisation contre la grippe étaient plus faibles que prévu. La sous-scolarisation, le tabagisme et le non-respect des directives concernant les médicaments étaient négativement associés à l’immunisation contre la grippe. De plus, nous avons noté d’importants écarts dans la demande pour le vaccin d’un CASC à l’autre, après rajustement des données pour tenir compte d’autres variables indépendantes significatives à l’échelle individuelle.

Interprétation: Des outils d’évaluation globaux comme la méthode RAI-HC peuvent être utiles pour cerner et résoudre les problèmes liés à la promotion de la santé et à la prévention des maladies dans la population recevant des soins à domicile, et pour comparer les taux à l’échelle du Canada.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ontario Ministry of Health and Long-Term Care. Ontario influenza bulletins. Available online at: http://www.gov.on.ca/health/english/program/pubhealth/flubulmn.html (Accessed October 31, 2005).Google Scholar
  2. 2.
    Lui KJ, Kendal AP. Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. Am J Public Health 1987;77:712–16.CrossRefGoogle Scholar
  3. 3.
    Sims RV. Immunization in the elderly. In: Lavizzo-Mourey R, Day SC, Diserens D, Grisso JA (Eds.), Practicing Prevention for the Elderly. Philadelphia, PA: Hanley and Belfus, Inc., 1989;37–46.Google Scholar
  4. 4.
    Fedson DS, Wajda A, Nicol JP, Hammond GW, Kaiser DL, Roos LL. Clinical effectiveness of influenza vaccination in Manitoba. JAMA 1993;270:1956–61.CrossRefGoogle Scholar
  5. 5.
    Govaert TME, Thijs CT, Masurel N, Sprenger MJW, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA 1994;272:1661–65.CrossRefGoogle Scholar
  6. 6.
    Mullooly JP, Bennett MD, Hornbrook MC, Barker WH, Williams WW, Patriarca PA, et al. Influenza vaccination programs for elderly persons: Cost-effectiveness in a health maintenance organization. Ann Intern Med 1994;121:947–52.CrossRefGoogle Scholar
  7. 7.
    Nichol KL, Margolis KL, Wuorenma J, von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994;331:778–84.CrossRefGoogle Scholar
  8. 8.
    Nichol KL, Wourenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998;158:1769–76.CrossRefGoogle Scholar
  9. 9.
    Nichol KL, Goodman M. Cost effectiveness of influenza vaccination for healthy persons between ages 65 and 74 years. Vaccine 2002;20:S21–S24.CrossRefGoogle Scholar
  10. 10.
    Ohmit SE, Arden NH, Monto AS. Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic. J Am Geriatr Soc 1999;47:165–71.CrossRefGoogle Scholar
  11. 11.
    Saah AJ, Neufeld R, Rodstein M, LaMontagne JR, Blackwelder WC, Gross P, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Arch Intern Med 1986;146:2353–57.CrossRefGoogle Scholar
  12. 12.
    Vu T, Farish S, Jenkins M, Kelly H. A metaanalysis of effectiveness of influenza vaccine in persons aged 65 years and over living in the community. Vaccine 2002;20:1831–36.CrossRefGoogle Scholar
  13. 13.
    National Advisory Committee on Immunization. Canadian immunization guide. Ottawa, ON: Health Canada, Health Protection Branch, 1998.Google Scholar
  14. 14.
    UK Department of Health. Flu and flu immunisation. Available online at: http://www.doh.gov.uk/flu.htm (Accessed October 31, 2005).Google Scholar
  15. 15.
    Centers for Disease Control and Prevention. Vaccine information. Available online at: http://www.cdc.gov/ncidod/diseases/flu/fluvac.htm (Accessed October 31, 2005).Google Scholar
  16. 16.
    Duclos P, Hatcher J. Epidemiology of influenza vaccination in Canada. Can J Public Health 1993;84:311–15.PubMedGoogle Scholar
  17. 17.
    Russell ML, Maxwell CJ. The prevalence and correlates of influenza vaccination among a home care population. Can J Public Health 2000;91(6):441–44.PubMedGoogle Scholar
  18. 18.
    Andrew MK, McNeil S, Merry H, Rockwood K. Rates of influenza vaccination in older adults and factors associated with vaccine use: A secondary analysis of the Canadian Study of Health and Aging. BMC Public Health 2004;4:36.CrossRefGoogle Scholar
  19. 19.
    Chapman GB, Coups EJ. Predictors of influenza vaccine acceptance among healthy adults. Prev Med 1999;29:249–62.CrossRefGoogle Scholar
  20. 20.
    Kamal KM, Amonkar MM. Determinants of adult influenza and pneumonia immunization rates. J Am Pharm Assoc (Wash DC) 2003;43:403–11.CrossRefGoogle Scholar
  21. 21.
    Tacken M, Braspenning J, Spreeuwenberg P, van den Hoogen H, van xEssen G, de Bakker D, et al. Patient characteristics determine differences in the influenza vaccination rate more so than practice features. Prev Med 2002;35:401–6.CrossRefGoogle Scholar
  22. 22.
    Nichol KL, Lofgren RP, Gapinski J. Influenza vaccination. Knowledge, attitudes and behavior among high-risk outpatients. Arch Intern Med 1992;152:106–10.CrossRefGoogle Scholar
  23. 23.
    van Essen GA, Kuyvenhoven MM, de Melker RA. Why do healthy elderly people fail to comply with influenza vaccination? Age Ageing 1997;26:275–79.CrossRefGoogle Scholar
  24. 24.
    Nicholson KG, Kent J, Hammersley V. Influenza A among community-dwelling elderly persons in Leicestershire during winter 1993-4; cigarette smoking as a risk factor and the efficacy of influenza vaccination. Epidemiol Infect 1999;123:103–8.CrossRefGoogle Scholar
  25. 25.
    Morris JN, Bernabei R, Ikegami N, Gilgen R, Frijters D, Hirdes JP, et al. RAI - Home Care (RAI-HC©) assessment manual for version 2.0. Washington, DC: interRAI Corporation, 1999.Google Scholar
  26. 26.
    Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter I, et al. Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. J Am Geriatr Soc 1997;45:1017–24.CrossRefGoogle Scholar
  27. 27.
    Kwan CW, Chi I, Lam TP, Lam KF, Chou KL. Validation of Minimum Data Set for Home Care ssessment instrument (MDS-HC) for Hong Kong Chinese elders. Clin Gerontol 2000:21.Google Scholar
  28. 28.
    Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. Minimum Data Set for Home Care: A valid instrument to assess frail older people living in the community. Med Care 2000;38:1184–90.CrossRefGoogle Scholar
  29. 29.
    Carpenter I, Gambassi G, Topinkova E, Schroll M, Finne-Soveri H, Henrard JC, et al. Community care in Europe. The Aged in Home Care project (AdHOC). Aging Clin Exp Res 2004;16:259–69.CrossRefGoogle Scholar
  30. 30.
    Foreman P, Thomas S, Gardner I. The Review and Identification of an Existing, Validated, Comprehensive Assessment Tool. Report for the Department of Human Services. Lincoln Centre for Ageing and Community Care Research, Australian Institute for Primary Care at La Trobe University, 2004.Google Scholar
  31. 31.
    Martin G, Martin I. Assessment of Community Dwelling Older People in New Zealand: A review of the tools. Report to the New Zealand Guidelines Group. Wellington: New Zealand Guidelines Group, 2003.Google Scholar
  32. 32.
    Black C, Mitchell L, Finlayson M, Peterson S. Enhancing Capacity to Study and Evaluate Home Care: An Evaluation of the Potential to Use Routinely Collected Data in Manitoba. Report to Health Transition Fund, Health Canada. Manitoba Centre for Health Policy and Evaluation, 2000.Google Scholar
  33. 33.
    Hirdes JP, Frijters DH, Teare GF. The MDSCHESS scale: A new measure to predict mortality in the institutionalized elderly. J Am Geriatr Soc 2003;51:96–100.CrossRefGoogle Scholar
  34. 34.
    Morris JN, Fries BE, Morris SA. Scaling ADLs Within the MDS. J Gerontol A Biol Sci Med Sci 1999;54A:M546–M553.CrossRefGoogle Scholar
  35. 35.
    Morris JN, Fries BE, Mehr DR, Hawes C, Mor V, Lipsitz L. MDS Cognitive Performance Scale. J Gerontol A Biol Sci Med Sci 1994;49:M174–M182.CrossRefGoogle Scholar
  36. 36.
    Folstein MF, Folstein SE, McHugh PR. “Minimental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.CrossRefGoogle Scholar
  37. 37.
    Canadian Institute for Health Information. Influenza immunization, by sex, household population aged 65 and over, Canada and provinces, 1996/97. Health Indicators 2001;3:1.Google Scholar

Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  • John P. Hirdes
    • 1
    • 2
    Email author
  • Dawn M. Dalby
    • 3
    • 4
  • R. Knight Steel
    • 5
  • G. Iain Carpenter
    • 6
  • Roberto Bernabei
    • 7
  • John N. Morris
    • 8
  • Brant E. Fries
    • 9
    • 10
  1. 1.Department of Health Studies and GerontologyUniversity of WaterlooWaterlooCanada
  2. 2.Homewood Research InstituteHomewood Health CentreGuelphCanada
  3. 3.Department of Kinesiology and Physical EducationWilfrid Laurier UniversityWaterlooCanada
  4. 4.St. Joseph’s Health System Research NetworkSt. Joseph’s Health CentreGuelphCanada
  5. 5.Hackensack Medical CenterHackensackUSA
  6. 6.Centre for Health Services StudiesThe University of KentCanterbury KentUK
  7. 7.Università Cattolica del Sacro CuoreRomeItaly
  8. 8.HSL Research and Training InstituteHebrew Senior LifeBostonUSA
  9. 9.Institute of GerontologyUniversity of MichiganAnn ArborUSA
  10. 10.Ann Arbor VA Medical CenterAnn ArborUSA

Personalised recommendations