A new survey by the National Foundation for Infectious Diseases (NFID) shows that despite recommending that patients with chronic illness get an annual flu shot, only 45% of those patients get it. People with chronic illness are at increased risk of serious flu-related complications, including hospitalization and death.
The survey looked at doctors’ flu vaccination practices and communication between health care providers (HCP) and their adult patients with chronic illnesses.
Overall, less than a third of HCPs (31%) said they recommend an annual flu shot for all of their patients with chronic health problems. There were some surprising differences between the sub-specialists. For example, 72% of patients with heart problems who visited a cardiologist said their doctor recommended the flu shot. The recommendation rate dropped to 32% of lung patients who saw a pulmonologist and only 10% of people with diabetes who saw an endocrinologist.
There’s a pretty big gap between what doctors and patients say about their interactions. A whopping 77% of health professionals who recommend annual flu vaccination say they tell their patients when they are at greater risk of complications from the flu. However, only 48% of patients state that they have received such information.
While knowledge is crucial for patients to learn, their risk of influenza is often left out of discussion. For example, patients with heart disease are six times more likely to have a heart attack within 7 days of being infected with the flu. People with diabetes are six times more likely to be hospitalized with flu and three times more likely to die. Likewise, people with asthma or COPD are at a much higher risk of complications.
One problem is that more than half of the specialists who do not offer the flu vaccine say that vaccinations are the responsibility of the family doctor. However, only 65% of patients with one of these chronic diseases state that they see their family doctor at least once a year.
Much of the discrepancy between how the patient perceives what they are told and the doctor’s is “how the ‘recommendation’ is actually made,” said William Schaffner, MD, NFID medical director and professor of medicine from Vanderbilt University in Nashville, Tennessee, told Medscape Medical News. Schaffner gave the following example: At the end of the visit, the doctor could say: “It’s that time again – you want to think about a flu shot.”
“The doctor thinks he recommended this, but the doctor really opened the door for you to think about it and leave [yourself] not vaccinated. “
Schaffner’s alternative? Tell the patient, ‘You will get your flu vaccine on the way out. Tom or Sally will give it to you. ‘ That’s a whole different kind of recommendation. And there is a much greater certainty of getting the vaccine. “
Another big problem, says Schaffner, is that many medical specialists “don’t see vaccinations as part of their routine care,” even though they manage a large part of patient care themselves. He says doctors should be more “directive” in their treatment and vaccinations should be better integrated into routine practice.
Jody Lanard, MD, a retired risk communications consultant who worked for many years with the World Health Organization communicating disease outbreaks, told Medscape Medical News that the gap between doctor and patient reports was “truly staggering. And it is actionable!” “
She made several practical suggestions. On the one hand, she said: “The messages to the specialists have to be very, very empathetic. We know that you are already overwhelmed. And here we are asking you to do something that you consider to be the work of others.” But when your patient catches the flu, your job as a cardiologist or endocrinologist becomes more complicated and time-consuming. So vaccinating your patients is a good investment and makes your job easier.
Due to the different reports from patients and doctors, Lanard suggested implementing a “feedback mechanism” in which they [the healthcare providers] Issue a prescription, then call the office [the patient]to see if they got the shot or not. Because in this way it will help correct the discrepancy between them who think they have told the patient and the patient who does not hear. “
When asked why there might be a large gap between what doctors report and what patients heard, Lanard said, “Doctors often communicate in [a manner] a kind of checklist. And patients focus on a thing or two that they value. And the doctor mentioned some things that are on a separate topic that are not on the patient list and it goes right by them. “
Lanard recommended short storytelling instead of checklists. For example: “I’ve been treating your diabetes for 10 years. During this last flu season some of my diabetics had a really rough time catching the flu. Get your flu shot. “
She urged the HCPs, “Make it more personal … but it can still be written in advance as part of something that does [you’re] keep this in mind during the review. “She added that their professional associations may be able to send them suggested language that they can customize.
Finally, Lanard warned of vaccine myths. “The word myth is so offensive. It’s basically a word that signals that you are an idiot.”
She advised professionals to avoid the word “myth”, which would make the person defensive. Instead, say something like, “‘A lot of people, even some of my own family members, think the flu vaccine will give you the flu … but it doesn’t.” And then you go into reality. “
Suggested that specialists do the follow-up calls and close the feedback loop, Lanard said, “If they did the survey a few years later, I’d bet the gap would narrow.”
Schaffner and Lanard have not disclosed any relevant financial relationships.
National Infectious Diseases Foundation. Chronic Disease Survey 2021: Gaps Between Healthcare Professionals and Adult Patients
Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family’s Story of Hope and Triumph Over Evil and of Conducting Clinical Research, the essential guide on the subject. You can find her on drjudystone.com or on Twitter @drjudystone.