[Evaluation of the vaccination prescription program in community-based patient populations]

Objective: To analyze the correlation of the vaccination prescription program with knowledge, vaccination willingness, and vaccination rates of influenza, pneumococcal, and herpes zoster vaccines among middle-aged and older adults from community-based patient populations. Methods: A before-and-after cross-sectional survey design was adopted, targeting community-based patient populations. From March to April 2024, a baseline survey was conducted among 10 500 outpatients and individuals undergoing health check-ups recruited from 175 survey sites (community health service centers/township health centers) across 35 counties (districts, cities) in Zhejiang Province using multistage sampling. Following a 16-month pilot implementation of the Vaccination Prescription Program, a terminal survey was conducted from September to October 2025 using the same methodology. Differences in indicators between the two surveys were compared using t-test or χ² test, and multivariate analysis was performed using generalized linear mixed models. Results: Compared with 2024, the knowledge scores of influenza, pneumococcal, and herpes zoster vaccines among participants significantly improved in 2025 (all P<0.001). Vaccination rates for influenza, pneumococcal, and herpes zoster vaccines increased from 45.16%, 16.42%, and 1.93% to 65.72%, 22.74%, and 5.74%, respectively (all P<0.001). Among participants who received a vaccination prescription, the vaccination rates for influenza, pneumococcal, and herpes zoster vaccines were 79.69%, 33.31%, and 11.13%, respectively, significantly higher than those in the non-prescription group (58.51%, 17.29%, and 2.96%). The composition of vaccination willingness changed, with an increase in the proportion of the "hesitant" group for all three vaccines (all P<0.001). Multivariate analysis showed that after adjusting for demographic characteristics and clustering effects of survey sites, the implementation of the vaccination prescription program intervention was positively associated with vaccination rates for all three vaccines (influenza vaccine aOR=3.16, 95%CI: 2.68-3.72; pneumococcal vaccine aOR=1.56, 95%CI: 1.30-1.87; herpes zoster vaccine aOR=3.05, 95%CI: 2.18-4.26). The proportion of "doctor's recommendation" as a reason for vaccination increased for all three vaccines. Among the reasons for non-vaccination, the proportion of "never heard of the vaccine" decreased, while the proportions of "too expensive", and "concerned about vaccine side effects" increased. Conclusion: Following the implementation of the Vaccination Prescription Program, knowledge and vaccination rates for influenza, pneumococcal, and herpes zoster vaccines significantly improved among middle-aged and older adults from community-based patient populations, with doctors' recommendation as a key facilitator.