For clinicians, raising awareness of the benefits of flu vaccination in adults with chronic health conditions such as heart disease, diabetes, and pulmonary disease, is imperative, according to the National Foundation of Infectious Diseases (NFID).
“About every year, we do a survey to determine various aspects of the acceptability, awareness, and receipt of influenza vaccines. Because the NFID is devoted to communicating about infectious diseases—their prevention, diagnosis, and treatment—to the general public as well as to all health care professionals, we think that this is information that is useful and may help provide changes in policy or activities in order to promote influenza vaccination in the context of the CDC’s recommendations,” William Schaffner, MD, Medical Director, The National Foundation for Infectious Diseases, told BreakingMED.
The NFID Healthcare Professionals Survey was conducted in 400 health care providers—including endocrinologists, primary care physicians, cardiologists, and pulmonologists, as well as nurse practitioners, nurses, and pharmacists—from October 28 through November 8, 2021, via an online survey. The second survey, the NFID Adult Patients Survey, was conducted in 300 patients treated for diabetes, chronic lung conditions, and cardiovascular conditions.
These three comorbid conditions were chosen because they are common and only increase with advancing age, explained Schaffner.
“It has been well established that all three of these background conditions predispose [patients] to more severe aspects of influenza and the complications of influenza, most notoriously pneumonia. While the recommendations to receive the vaccine extend to everyone older than 6 months of age, clearly, we have a special interest in people who have these chronic illnesses,” he said.
Upon analysis of survey results, NFID researchers found that only 45% of patients with chronic health conditions reported receiving their annual flu vaccine by early November. Another 40% reported planning to get a flu vaccine during the current flu season.
Other findings show that only 31% of health care providers recommended an annual flu vaccination to all patients with chronic health conditions, 44% reported doing so to most of their patients, 20% to about 50% of patients with chronic health conditions, and 5% to about 25%.
Cardiologists seemed to be the best at recommending flu vaccinations to their patients. Of the 86% of patients who reported that a health care provider recommended a flu vaccination in the past year, 72% received this recommendation from their cardiologist, 72% from their primary care physician, 32% from their pulmonologist, and 10% from an endocrinologist. “In the past and present, many internal medicine specialists who cared for patients very well left it to the primary care doctor—and maybe the pharmacists—to provide influenza vaccines. And they didn’t even discuss it. Increasingly, national organizations such as my own have been encouraging specialists to integrate influenza vaccine into the routine care of patients with these underlying illnesses,” said Schaffner.
Importantly, health care providers play a significant role in motivating patients to get an annual flu vaccine. Almost all patients (90%) who were told by a health care provider that an annual flu vaccination is critical to control their chronic condition received or plan to receive a flu vaccine, compared with 74% of those who were not told.
In addition, survey results showed that 51% of patients with these chronic conditions who received or planned to receive an annual flu vaccine were motivated by a recommendation from a health care provider. Even more compelling was the finding that a full 47% of patients who are not sure or not planning to be vaccinated reported that they would be more likely to do so if a health care provider recommended it. And, 51% of patients who were not sure about or not planning to get a flu vaccine would be more likely to do so if their health care provider provided it during a regular appointment.
Unfortunately, survey results also showed that there may also be a disconnect between patients and physicians regarding conversations about influenza risks and vaccination recommendations. Survey results showed that a full 48% of patients reported that they were never told by a health care provider that influenza would put them at increased risk for serious complications and make their chronic disease harder to manage. Yet, 77% of health care providers reported that they had done so.
“We need to train doctors to be less casual about what they consider a recommendation. When you ask doctors, they think they’ve recommended vaccination. When you ask the patients, they don’t remember hearing that recommendation. You have to be firm and direct and clear when you ’insist’ that your patient receive the vaccine,” said Schaffner. Be firm and sincere in your recommendation. Become a vaccine insister.”
These results highlight the importance of conversations between health care providers and patients about flu vaccinations, and the NFID concluded that health care providers must strongly and consistently recommend annual flu vaccination to all patients with chronic health conditions and that both flu and pneumococcal disease vaccination should be part of the routine management of these patients.
“Doctors [should] become not so much vaccine recommenders, but vaccine insisters,” Schaffner concluded.