Identifying obstacles to vaccination – a central step towards higher immunization rates?
Poster: 26th European Congress of Clinical Microbiology and Infectious Diseases 9.-12. April 2016; Amsterdam- Niederlande
Introduction: In 2015, measles should have been eliminated in Germany, but there have been 2453 cases of infection with measles reported till 10/2015. The purpose of this study was to define the obstacles to vaccination (OV), which prevent physicians from increasing vaccination rates and to investigate their influence on the doctors' practice management. Methods: In a literature review we identified 15 OV. A questionnaire was sent to the Associations of Statutory Health Insurance Physicians (ASHIP), professional associations of resident physicians, pharmaceutical companies and associations of health insurance companies to analyze the relevance of these OV in daily practice. Afterwards, we started an online-survey among resident physicians (general practitioners, gynecologists and pediatricians) to assess the importance of 17 OV. Results: The questionnaire showed two more OV, which seemed to be relevant for residential physicians and were therefore included in the online-survey. From 527 returned datasets, we analyzed 463 complete datasets (51% general practitioners, 34% gynecologists and 13% pediatricians). The OV were divided in two groups: intrinsic OV, which act inside the vaccination system and extrinsic OV, which influence the vaccination system from outside. Inadequate payments of vaccination advice (66% relevant vs. 25% not relevant), discrepancy between recommendation of vaccinations and assumption of costs (57% relevant vs. 30% not relevant), vaccination agreements between ASHIP and health insurance companies (53% relevant vs. 33% not relevant), inadequate payment of vaccinations (47% relevant vs. 41% not relevant) and bureaucracy, which delays the takeover of current vaccination recommendations (46% relevant vs. 38% not relevant) were classified as relevant intrinsic OV. The complexity of immunization schedules and bill of costs, recourse threats and conflicting vaccination recommendations were assumed to be present but not relevant intrinsic OV (relevant < not relevant). Furthermore, relevant extrinsic OV were opponents of vaccination among patients (78% relevant vs. 21% not relevant), procurement problems of vaccines (54% relevant vs. 36% not relevant), and opponents of vaccination among doctors (50% relevant vs. 41% not relevant). However, present but not relevant extrinsic OV (relevant < not relevant)were too many different vaccines, fantasy names of vaccines complicate the recognition and assignment, lack of monovalent vaccines, poor information by the pharmaceutical industry and deficiencies in education and training. Discussion: The results suggest that main intrinsic OV can only be eliminated by political corrections. Mainly the inadequate payment of vaccination advice must be changed to solve the most important extrinsic obstacle to vaccination. A trustful and intensive vaccination advice is necessary to overcome the patients' refusal and to improve the immunization rates all around the world.