BACKGROUND:
Studies show consistently that physician recommendations and patient attitudes are important predictors of influenza immunization. Significant racial/ethnic disparities in influenza immunization necessitate further study of these factors among minority elderly.

OBJECTIVE:
To examine the effects of provider recommendations and patient attitudes on influenza vaccination among African-American and white elderly.

METHOD:
We investigated physician recommendations and patient attitudes toward influenza vaccination in a survey of seniors sampled from the Medicare enrollment database in the five sites which were part of the Racial and Ethnic Adult Disparities in Immunization Initiative (READII). Respondents were scored on five questions related to influenza vaccination; those with scores of 3 or less were considered to have negative attitudes, and those with scores of 4 or 5, positive attitudes.

RESULT:
African-Americans were significantly more likely than whites to have negative attitudes toward influenza vaccination (54% vs. 25%). African-Americans were also more likely to report receiving a provider recommendation this year than whites, both among vaccinated (78% vs. 68%) and unvaccinated (45% vs. 37%) respondents. Among African-Americans who received recommendations, 83% of those with a positive attitude compared to 41% of those with a negative attitude were vaccinated. Among whites these proportions were 93% and 66%, respectively. Among those with no recommendation, 55% of African-Americans with a positive attitude and 13% of those with a negative attitude were vaccinated, compared to 83% and 30% of whites.

CONCLUSION:
As previous studies have reported, provider recommendations result in higher vaccination rates regardless of patient attitude, reiterating the importance of increasing provider recommendations for all eligible patients. The independent effect of patient attitude suggests that patient education materials that specifically address concerns about influenza vaccine could help raise immunization rates, especially among minorities.

LEARNING OBJECTIVES:
Participants will be able to describe the effects of provider recommendations and patient attitudes on receipt of influenza immunization.