Evaluating the difference in preventive vaccination uptake in patients with diabetes mellitus.

Abstract

TO THE EDITOR: According to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices, yearly vaccination for seasonal influenza, as well as vaccination with the pneumococcal vaccine, has the potential to significantly reduce morbidity and mortality in patients with diabetes.1 People with diabetes may have abnormal immune function, which puts them at an increased risk for complications, hospitalizations, and death from pneumococcal disease or influenza. Healthy People 2020 set goals specifically for vaccination in high-risk adults (including diabetic patients) of 90% for seasonal influenza and 60% for pneumococcal disease.2 At baseline, vaccination rates are at 39% and 17%, respectively. If goals are unmet, health care professionals will need to gain an understanding of why these patients are not vaccinated and then develop ways to increase vaccination in the future. The objective of our survey was to evaluate preventive vaccination uptake in diabetic patients and identify reasons related to their vaccination decisions. Methods. A survey was designed to evaluate preventive vaccination rates in diabetic patients patronizing a mass merchandiser community pharmacy. The survey assessed the reasons for patient vaccination decisions and was adapted from a CDC survey evaluating similar information for Medicare beneficiaries.3 All diabetic patients over the age of 18 receiving prescriptions were identified as possible participants in this institutional review board–approved survey. The χ2 test was used to analyze data. Results. Seventy-six of 240 patients completed the survey, for a response rate of 31.7%. Approximately 29% of patients were not getting a yearly influenza vaccine and 39% of patients had not received the pneumococcal vaccine. Fewer patients who were younger than 65 years old had received the pneumococcal vaccine compared to patients 65 years or older (p = 0.02). A summary of reasons identified for vaccination decisions is included in Table 1. Discussion. From our results, we have concluded that patients who are younger than 65 years tend to be more likely to recognize that they are at high risk of complications from influenza and pneumococcal disease; however, their vaccination rates tend to be lower than those of patients who are over 65. Patients aged 65 and over have a higher rate of vaccination, but are vaccinated because of their age, not recognizing that having diabetes and being older puts them into a high-risk category. The results of our survey are similar to findings of the CDC survey of Medicare beneficiaries concerning reasons for not receiving the influenza and pneumococcal vaccinations.3 Limitations to our study include the fact that we were not able to evaluate a difference between patients with type 1 and those with type 2 diabetes, as there could be a perceived difference in risk based on type of diabetes. As pharmacists who work in a variety of practice areas, we should consider educating our diabetic patients about the risk of complications from these diseases and the importance of vaccination to increase preventive vaccine uptake. Many patients are not receiving the influenza vaccine because they fear becoming ill or experiencing adverse effects. Providing directed education to patients about the influenza vaccine and discussing its usual adverse effects may in-