Effectiveness of prescription-based influenza vaccination services among older adults in Binzhou, China: A...

Influenza poses a significant health risk to older adults in China, yet vaccination coverage remains low. This study evaluated the impact of prescription-based service models-with and without financial incentives-on influenza vaccine uptake among older adults.

We conducted a three-arm cluster-randomized controlled trial in Binzhou, China, involving 839 participants aged ≥60 years across five community health service centers (CHSCs). CHSCs were randomized to usual care (Group C), a prescription-based vaccination model (Group A), or the same model plus a small financial incentive (Group B). Participants in Group B received a waiver of the vaccination service fee (22 CNY), while vaccine costs remained self-paid. The primary outcome was influenza vaccination status during the 2025 season. A multivariable Generalized Estimating Equations (GEE) model was used to estimate odds ratios (ORs), accounting for cluster-level correlations and baseline covariates.

Vaccination coverage was 9.55% in Group C, 30.86% in Group A, and 83.23% in Group B. Compared with usual care, the prescription-only model significantly increased uptake (OR = 3.51; 95% CI: 2.58-4.78), while the addition of a financial incentive further amplified the effect (OR = 69.47; 95% CI: 37.34-129.26). The intervention was effective across subgroups, including participants with low education, low income, or cognitive limitations.

Embedding influenza vaccination into outpatient prescription services-particularly when coupled with modest financial incentives-substantially increases vaccine uptake among older adults. This low-cost, scalable model holds promise for addressing immunization gaps in primary care and improving health equity in aging populations.