Determinants of Vaccination Choices in Inflammatory Rheumatic and Musculoskeletal Disorders

Overview

This qualitative study explores barriers and facilitators influencing vaccination decisions among patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) and their healthcare providers in Germany. Despite recommendations and reimbursement policies, vaccination coverage remains low, with only about 25% adherence to guidelines. The study identifies key factors affecting vaccination uptake and suggests strategies to improve coverage in this vulnerable population.

Background

Patients with iRMD are at increased risk for infections due to their disease and immunosuppressive treatments, making vaccinations critical for preventing influenza, pneumococcal disease, and other infections. In Germany, vaccines recommended by the Standing Committee on Vaccination (STIKO) are reimbursed and primarily administered in outpatient settings, mainly by general practitioners. However, coordination between primary and specialist care varies, impacting vaccination counseling and implementation. Despite these provisions, vaccination rates among iRMD patients remain inadequate, highlighting the need to understand underlying reasons for suboptimal uptake.

Data Highlights

The study conducted semi-structured interviews with 15 iRMD patients, 10 general practitioners, and 5 rheumatologists to explore vaccination behaviors. Recruitment employed purposive and snowball sampling to ensure participants had relevant experience. Interviews covered vaccination recommendations, decision-making processes, and expectations, guided by behavioral and implementation science frameworks. Data were analyzed using qualitative content analysis to identify themes related to capability, opportunity, and motivation influencing vaccination choices.

Key Findings

• Vaccination coverage among iRMD patients in Germany is low, with only about 25% adhering to current guidelines.
• Barriers include inconsistent coordination between GPs and specialists, leading to unclear responsibilities for vaccination counseling and documentation.
• Patients’ knowledge gaps and concerns about vaccine safety and efficacy affect their willingness to be vaccinated.
• Physicians report variability in practice routines and communication networks that influence vaccination implementation.
• Facilitators include regular vaccination status checks, clear communication, and coordinated care between healthcare providers.
• Reimbursement policies remove financial barriers, but organizational and motivational factors remain critical determinants of vaccination uptake.

Clinical Implications

Clinicians should prioritize regular assessment of vaccination status in iRMD patients and foster clear communication between primary care and specialists to ensure consistent vaccination counseling. Addressing patient concerns through education and coordinated care pathways may enhance vaccine acceptance. Implementing systematic workflows and clarifying roles can help close the vaccination gap in this high-risk group.

Conclusion

This study highlights multifaceted barriers and facilitators influencing vaccination decisions among iRMD patients and their physicians. Improving coordination, communication, and patient education are essential to increase vaccination coverage and protect this vulnerable population from preventable infections.

References

1. VAC-MAC Project/Joint Federal Committee Germany/2024 -- Determinants of Vaccination Choices Among Individuals with Inflammatory Rheumatic and Musculoskeletal Disorders: A Qualitative Study