Prescribing Rate of Influenza Vaccine among Internal
Medicine Residents for Outpatient Continuum Care
Weerachai Srivanichakorn MD*,
Karnchana Asavathitanonta MD*, Chaiwat Washirasaksiri MD*, Thanet Chaisathaphon MD*,
Charoen Chouriyagune MD*, Pochamana Phisalprapa MD*, Denla Pandejpong MD*
Affiliation :
* Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Background : Annual epidemics of influenza viruses remain a substantial cause of morbidity and mortality worldwide
particularly among vulnerable groups. Immunization is another way to reduce the infection and mortality rates, especially
in high-risk groups; however, the data concerning prescription rates and possible influencing factors on decisions associated
with influenza prescription of Thai internal medicine residents were limited.
Objective : Siriraj internal medicine residency training has provided outpatient continuum care practice for all 1st year
residents since 2008. A part of the curriculum was to prepare each trainee to be an effective vaccinator. This study aims to
examine the competency of those residents who had completed the training, particularly about prescribing influenza vaccine.
Material and Method: The authors retrospectively reviewed medical records of the patients that indicated need for influenza
vaccine encountered by 2nd and 3rd year residents during June 2011 and May 2012. The 20-item questionnaire was also sent
out in order to study possible factors associated on prescribing the vaccine.
Results : Three hundred and seventy-three medical records were included and reviewed. The prescription rate of influenza
vaccine was 8.0 percent. Comparing vaccine receiving and non-receiving groups, the authors found having respiratory
problems (26.7% vs. 4.4%; odds ratio 8.0 [3.0-20.8]; p<0.001) and being self-paying (16.7% vs. 5.8%; odds ratio 3.2
[1.1-9.3]; p = 0.023) were the only two significant differences. Only 5.7 percent of total residents were an effective vaccinator.
One hundred and five residents returned the questionnaire. Residents who had further plans for fellowship trainings had
reported a higher influenza vaccine prescription rate than those who will be general internists (45.2% vs. 8.1%; adjusted
odds ratio 14.04 [1.6-125.8]; p = 0.018). The authors also found that the rate of vaccine recognition, general knowledge
of vaccination, and vaccine coverage remained 61.9%, 29.5%, and 21.0% among medicine residents.
Conclusion : Prescribing rate of influenza vaccine remained low due to multifactor aspects, including doctor capability,
attitude, patient recognition as well as reimbursement issues. In order to improve the rate of influenza vaccine prescriptions,
a system-designed approach would be needed.
Keywords : Influenza vaccine, Prescription, Internal medicine resident, Outpatient, Continuum care
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