Reanalysis of a Randomized Controlled Trial on Promoting Influenza Vaccination in General Practice Waiting Rooms: A Zelen Design

In 2014–2015, we conducted a randomized controlled trial (RCT) assessing the effect of an advertising campaign for influenza vaccination using posters and pamphlets in general practitioner (GP) waiting rooms. No effect of the intervention could be demonstrated, but the immunization uptake increased in both arms of the study. In 2019, we deepened the investigations explaining the increased uptake conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients eligible to be vaccinated who were registered with 175 GPs. The main outcome remained the number of vaccination units delivered per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (northern France). No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake, especially among people older than 65, can be explained by a cohort effect. Health promotion and the promotion of primary health care may play an important role in this increase.

Social representations of mandatory vaccination in patients and general practitioners in Moselle, France

Vaccine controversies affect the image of vaccination. At the end of 2014, there was a shortage of tetra- and pentavalent vaccines, although immunization obligation was being discussed. Our objective in this context was to study the social representations of mandatory vaccination in general practitioners and patients. Thirty general practitioners and 30 patients were recruited for this study based on hierarchal evocation. Each provided seven associations, which were revealed spontaneously in response to the evocation of the inductive concept: "mandatory vaccination". An order of importance and a connotation were attributed to them. These associations were classified into subthemes and themes. For each, the frequency of occurrence, the median rank of importance, and the polarity index were calculated and then compared. The image of vaccination was positive (polarity index from doctors and patients: +0.22 and +0.24, respectively). The doctors mentioned first the organization of the vaccine follow-up (21.9%). For patients, the benefits of vaccination predominated (22.38%), although these benefits were considered more important by the doctors. Doctors raised vaccine controversies more frequently than patients and were more concerned with the practical aspects of vaccination (injection, pain). The current controversies have not eroded the representations of mandatory vaccination. However, doctors are critical towards the media and vaccination policy. Patients, on the other hand, are afraid of side effects and do not have complete confidence in vaccination. Immunization obligation does not appear to be challenged by either of the two populations. To sustain immunization, our main asset remains communication and information to patients.

Vaccination of cancer patients treated with chemotherapy: A survey among general practitioners

OBJECTIVES

Despite specific recommendations issued by the French Public Health Council (Haut Conseil de Santé Publique), the vaccination coverage of patients with cancer or malignant blood disease remains insufficient. The aim of this study was to assess the vaccination of chemotherapy patients by their general practitioner (GP).

METHODS

A survey was conducted between March and July 2017 in 4 French departments to describe the immunization practices of GPs for their chemotherapy patients and provide solutions to help to increase the vaccination rate.

RESULTS

Of the 1610 GPs who received the questionnaire, 287 (17.8%) returned a usable form; 92.6% were globally pro-vaccine. One third of GPs (37.3%) declared that they vaccinated all their chemotherapy patients. The GPs (n=180) who never or only sometimes vaccinated their chemotherapy patients mainly voiced concerns about not being properly trained (45.6%) and the lack of easily available information on vaccination (35.0%). Three-quarters (n=212; 74%) of the GPs wanted to improve their level of medical knowledge via continuing education (52.4%) or by reading guidelines available on-line (39.6%). GPs suggested that a specific vaccination schedule be included in the letter they receive from the cancer specialist (72.8%) and that patient awareness be increased (50.5%).

CONCLUSIONS

GPs are in favor of the vaccination of cancer patients. The main obstacles stated are the lack of education and the lack of easily available information. Vaccination coverage could be increased by improving the doctor-to-doctor relation between GPs and cancer specialists.

Design of a national and regional survey among French general practitioners and method of the first wave of survey dedicated to vaccination

OBJECTIVES

France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs' vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey.

PATIENTS AND METHODS

Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet.

RESULTS

GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712).

CONCLUSION

The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.