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


Study sheds light on the importance of the source of vaccine information and other factors that prevent lifesaving influenza or pneumococcal vaccination.

Health care providers should understand the factors that influence vaccination among patients with cardiovascular disease (CVD), according to the results of a recent study published in Vaccine. Although patients at higher risk were more likely to show interest in vaccination for influenza or pneumococcal, it did not directly entail action.

Credit: Trsakaoe -

Credit: Trsakaoe -

“There was not always a positive relationship between the presence of risk factors and the decision to be vaccinated,” the study authors wrote 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 twice as likely to get it. The rate of vaccination was greatest (83%) among patients who learned about it from their physician, according to the study.

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

Investigators in Turkey sought to understand the factors that influence vaccinations in older adults or people with high-risk conditions. 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 patients with CVD who were admitted to a cardiology outpatient clinic and are older than 18 years of age. Patients completed a questionnaire and then were informed by the physician about a pneumococcal vaccine. Investigators checked patient medical records later to see whether 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, being above 65 years of age was associated with greater rates of vaccination. In addition, higher education level was associated with higher vaccination rate. In this study, women were also 1.4 times more likely to be vaccinated.

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

Approximately 67% of patients did not even know about a pneumococcal 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 immunization.

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

The investigative team concluded that physicians need platforms to provide vaccination information to high-risk groups in Turkey. Increased physician recommendations could be a strategy that promotes both pneumococcal and influenza vaccination, according to the study.


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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