Physician Recommendation Influences Rate of Pneumococcal Vaccination in High-Risk Patients


The study shed light on the importance of the source of vaccine information and other factors that prevent lifesaving vaccination.

The factors that influence vaccination among patients with cardiovascular disease (CVD) is valuable for physicians to understand, according to the results of a recent study published in Vaccine. Although patients at higher risk were more likely to show interest in vaccination(influenza or pneumococcal), patient interest alone did not directly result in taking action.

Credit: Trsakaoe -

Credit: Trsakaoe -

“There was not always a positive relationship between the presence of risk factors and the decision to be vaccinated,” wrote study authors in the recent article. “Vaccination rate of those with a comorbidity is lower than those without a comorbidity.”

However, the results suggest that patients who learned of the pneumonia vaccine from a physician were 2-times more likely to get it. The rate of vaccination was greatest (83%) among patients who learned about the vaccine from their physician.

Influenza and pneumococcal infections cause morbidity and death in high-risk and/or older adults, but these diseases are vaccine-preventable. While immunization is regarded as one of the most effective tools against many infection diseases, people at higher-risk tend to have lowerimmunization rates.

Investigators in Turkey conducted a study to understand factors that influence vaccinations in older adults or people at higher risk. They evaluated coverage rates, patient attitude/opinion of immunization, reason for vaccination, importance of physician recommendation for vaccination, and demographic factors.

In a multicenter, observational, prospective cohort study, investigators enrolled 1808 patientswith CVD who were admitted to a cardiology outpatient clinic and were older than age 18.Patients completed a questionnaire and then were informed by the physician about a pneumonia vaccine. Investigators checked patient medical records later to see if the patient got vaccinated.

Health behavioral factors, sociodemographic factors, psychological factors, and health access were found to be barriers to vaccination. Among the sociodemographic factors, older age (above age 65 years) was associated with greater rates of vaccination. In addition, higher education level was associated with higher vaccination rate. Further, gender may also be a contributing factor, as women were shown to be 1.4 times more likely to be vaccinated, according to study data.

Some participants had a more negative perception of the vaccine. Although 17.5% of participants thought the vaccine was beneficial, 3.6% thought that it was harmful. While many believed it was harmful, vaccination frequency did not reflect this wariness.

Approximately 67% of patients did not even know about a pneumonia vaccine, and more than 60% of patients assumed the pneumonia and influenza vaccines were the same. Upon learning about the vaccine, 1122 patients preferred to be vaccinated: 827 preferred vaccinations at the family physician office and 289 preferred it at a clinic. Patients who also needed the influenza vaccine were also more likely to receive the pneumococcal one as well.

Investigators believe that free access to the vaccine would promote influenza vaccination, since those without health insurance were less likely to be vaccinated. However, since the study is cross-sectional and only assumes correlation, it does not describe causation.

The investigative team concluded that physicians need platforms to provide vaccination information to higher-risk groups in Turkey; further, increased physician recommendations could be a strategy to promote both pneumococcal and influenza vaccination.


Ekin T, Kış M, Güngören F, et al. Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians’ Recommendations on Vaccination Rates. Vaccines. 2023.

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