Title:
Rates and predictors for influenza vaccine prescriptions among HIV-infected clinic patients in Singapore.

Abstract:
Although Singapore national guidelines recommend influenza vaccination for individuals with comorbidities, the vaccine uptake remains relatively low. This study examines the rates of influenza vaccine prescriptions in a clinic population, and patient, doctor and clinic factors that could affect the vaccine prescribing rates.
This retrospective review utilised electronic medical records from HIV-infected patients seen in an infectious disease (ID) specialist clinic. Data from 40 randomly selected patients per physician were analysed for the outcome of influenza vaccine prescriptions from 1 January to 31 December 2007. All 7 consultants and the 6 ID registrars who had spent at least 4 months in the Department during 2007 were included. Data analysed included patient, physician, and clinic characteristics, and clinically relevant outcomes of admission within a year, and the length of hospital stay.
Of the 461 HIV-infected patients analysed for this study, only 107 (23%) were prescribed influenza vaccine in 2007. Vaccine prescribing rates by individual physicians ranged from 0% to 77%. The outcome of vaccine prescribing was analysed by patient demographics (age >40 years, gender, race), physician characteristics (doctor grade, gender and training), and clinic volumes (number of patients per clinic session). Multivariate analysis demonstrated that patients with female doctors (OR 1.8, 95% CI, 1.1 to 3.0, P = 0.017), and doctors with overseas medical training (OR 11.6, 95% CI, 6.0 to 22.2, P <0.001) were significantly more likely to have influenza vaccine prescribed. On univariate analysis, patients were more likely to be admitted if they were male (OR 2.1, 95% CI, 1.0 to 5.1, P = 0.041), and over 40 years old (OR 2.1, 95% CI, 1.1 to 4.5, P = 0.024). Patients prescribed influenza vaccine showed a non-significant trend for protection against admission (OR 0.7, P = 0.288), and shorter length of stay (median 5 vs 9 days, P = 0.344).
Influenza vaccine prescribing for HIV-infected outpatients in 2007 was only 23%, even in an ID specialist clinic. There was substantial variability in prescribing rates by individual physicians. Neither patient demographics nor patient volumes per clinic session had an impact on the prescribing rates, but significant predictors included physician gender and medical school training. Patients prescribed influenza vaccine had fewer admissions and shorter hospital lengths of stay, although these trends were non-significant.