According to the Robert Koch Institute there have been approximately 120,000 laboratory-confirmed cases of influenza in Germany in the 2019/20 season so far, with 202 deaths. Persons with chronic pre-existing conditions are particularly susceptible to infection. In this context, Prof. Dr. Stefanie Klug, head of the Chair of Epidemiology, together with colleagues from the Institute of General Medicine at the LMU, has published a systematic review of general medical measures aimed at increasing influenza vaccination rates in chronically ill patients in the 'Deutsches Ärzteblatt' (The German Medical Association's official science journal). The medical journal is the official journal of the German Medical Association and the German Association of Statutory Health Insurance Physicians and has an impact factor of 4.469.
“The Standing Vaccination Committee (STIKO) at the Robert Koch Institute issues vaccination recommendations for older people aged 60 and over as well as patients with chronic pre-existing conditions. Unfortunately, the vaccination rates are not as high as they should be, especially in the high-risk groups,” said Prof. Klug explaining the current situation. “For this reason, the aim of this publication was to identify measures in general medical practice that could be used to increase influenza vaccination rates among the chronically ill.”
The PRISMA statement (“Preferred Reporting Items for Systematic Reviews and Meta-Analyses”) was used for the analysis. This is an evidence-based minimum set of elements to help authors report a wide range of systematic reviews and meta-analyses that assess the benefits and harms of a specific healthcare intervention.
A total of 15 randomised controlled trials were included in the review. These examined a wide range of different patient populations. Eleven publications dealt with patients with cardiovascular diseases and four studies dealt with chronic obstructive pulmonary disease (COPD) or asthma.
Categorisation of the interventions was divided into two areas. Seven papers focused on medical personnel. Further training for practice teams was examined in three studies. Automatic reminder systems for doctors featuring printed vaccination recommendations on documentation forms were presented in two publications. The expansion of competencies for healthcare professionals was also examined twice.
The second area focused on patients. For this purpose, the eight included publications were sub-divided according to the delivery format. Methods included reminder SMS messages, postcards and letters, an educational brochure as well as financial incentives.
Overall, patient-centred studies tended to have larger samples. On the other hand, studies focusing on medical personnel demonstrated a higher degree of quality.
The research team concluded that training for practice teams focusing on a specific disease increased vaccination rates by up to 22 percent. However, the most significant effect against increasing vaccination rates was a financial incentive. Furthermore, reminder SMS messages achieved a maximum absolute improvement of 3.8 percent. Compared to complex interventions, the simple interventions under review demonstrated improved quality and greater effects.
Consequently, the following key statements emerged as a conclusion:
- Less than half of all chronically ill people in Germany have received an influenza vaccination.
- General medical practice is suitable for the implementation of interventions to improve this situation.
- Training for practice teams focusing on specific chronic diseases could be more effective than vaccination-centred approaches.
- Automatic patient reminder systems are recommended but have only been used rarely in Germany to date.
- A recommendation to implement reminder systems for doctors can be made with a high degree of reliability.
Prof. Dr. Stefanie Klug
Chair of Epidemiology
phone: 089 289 24950
Text: Romy Schwaiger
Photos: Deutsches Ärzteblatt/Chair of Epidemiology