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Strategies for Improving Influenza Vaccination Rates in Patients with Chronic Renal Disease
Kevin Schulte1, Helen Schierke, Miguel Tamayo
1Department of Nephrology and Hypertension. University Hospital Schleswig-Holstein; Department of Strategic Data Analysis and Health Policy North Rhine-Westphalia, North Rhine Association of Statutory Health Insurance Physicians, Düsseldorf; IKK Südwest, Saarbrücken; Medical Department, Division of Infectiology and Pneumology, Faculty of Medicine, Charite Berlin; Center for Renal, Hypertensive, and Metabolic Diseases, Hanover; Institute of Medical Informatics and Statistics, University of Kie; Division of Information Technology-Analysis and Development, Schleswig-Holstein Association of Statutory Health Insurance Physicians, Bad Segeberg; Thuringia Association of Statutory Health Insurance Physicians, Weimar.
Background:
The influenza vaccination rate among older and chronically ill patients in Germany has declined in the past decade in spite of vaccination campaigns.
Methods:
The influenza vaccination rate among persons with chronic renal disease was studied with the aid of billing data from various Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen, ASHIPs) in Germany. It was tested in a randomized controlled trial whether a written vaccination appeal, sent by physicians to patients, led to an increase in the vaccination rate. It was tested in a further such trial whether the vaccination rate among patients with renal disease could be improved by an appeal for vaccination that was sent by the ASHIPs to the treating nephrologists. Finally, it was also tested in a prospective interventional study whether the vaccination rate could be improved by an appeal for vaccination sent by a health- insurance carrier directly to the patients.
Results:
In 2012-2017, the vaccination rate among persons with chronically impaired renal function ranged from 41.1% to 46.9%; it ranged from 31.7% to 33.7% in kidney transplant recipients and from 42.7% to 44.7% in dialysis patients. An appeal for vaccination that was sent from physicians to patients raised the vaccination rate by 8.3% in the intervention group compared to the control group (p = 0.03; number needed to treat [NNT]: 13). On the other hand, an appeal for vaccination that was sent to the nephrologists lowered the vaccination rate by 0.8% in the intervention group compared to the control group. Finally, an appeal for vaccination that was sent by the health-insurance fund to the patients raised the vaccination rate by 3.2% (p<0.001; NNT: 32).
Conclusion:
Fewer than half of all patients with chronic renal failure in Germany are vaccinated against influenza. The vaccination rate was found to be increased only after an appeal for vaccination that was sent directly to the patients. A letter sent to the treating physicians had no positive effect at all.
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