Influenza vaccination of hospital staff in Germany: a five-year survey on vaccination coverage and policies: identified deficits in influenza immunisation campaigns for hospital employees.

OBJECTIVES: Influenza vaccination of hospital staff is recommended by STIKO, the German committee for vaccination. A survey was conducted to assess compliance with this recommendation. The occupational health services of 25 hospitals participated in a survey and provided data by questionnaire on influenza vaccination and on hospital policies to promote coverage of employees. METHODS: Vaccination activities were monitored by occupational health services (OHS) for five consecutive years from 1997 to 2002. The hospital sample covered a total of 17,089 beds (3.23% of the hospital capacity in Germany) and a total number of 41,969 employees (4.39% of hospital staff). RESULTS: The proportion of hospitals actively offering influenza vaccination increased from 48 % in 1997/98 to 92% in 2001/02. Vaccination coverage of all staff in 1997 was only 3.3% and reached 8.4% in 2001/02. Coverage of vaccinating hospitals increased from 5.0% to 10.4%. Poster campaigns and managing board commitment had significant impact. CONCLUSIONS: Considerable progress has been made to involve more hospitals and to increase coverage for vaccination of hospital employees. Nevertheless, coverage levels remain unacceptably low. Recommendations are ignored extensively.

Optimizing polypharmacy among elderly hospital patients with chronic diseases--study protocol of the cluster randomized controlled POLITE-RCT trial.

BACKGROUND: Treatment of patients with multimorbidity is challenging. A rational reduction of long-term drugs can lead to decreased mortality, less acute hospital treatment, and a reduction of costs. Simplification of drug treatment schemes is also related to higher levels of patient satisfaction and adherence. The POLITE-RCT trial will test the effectiveness of an intervention aiming at reducing the number of prescribed long-term drugs among multimorbid and chronically ill patients. The intervention focuses on the interface between primary and secondary health care and includes a pharmacist-based, patient-centered medication review prior to the patient's discharge from hospital. METHODS: The POLITE-RCT trial is a cluster randomized controlled trial. Two major secondary health care providers of Mecklenburg-Western Pomerania, Germany, take part in the study. Clusters are wards of both medical centers. All wards where patients with chronic diseases and multimorbidity are regularly treated will be included. Patients aged 65+ years who take five or more prescribed long-term drugs and who are likely to spend at least 5 days in the participating hospitals will be recruited and included consecutively. Cluster-randomization takes place after a six-month baseline data collection period. Patients of the control group receive care as usual. The independent two main primary outcomes are (1) health-related quality of life (EQ-5D) and (2) the difference in the number of prescribed long-term pharmaceutical agents between intervention and control group. The secondary outcomes are appropriateness of prescribed medication (PRISCUS list, Beers Criteria, MAI), patient satisfaction (TSQM), patient empowerment (PEF-FB-9), patient autonomy (IADL), falls, re-hospitalization, and death. The points of measurement are at admission to (T0) and discharge from hospital (T1) as well as 6 and 12 months after discharge from the hospital (T2 and T3). In 42 wards, 1,626 patients will be recruited. DISCUSSION: In case of positive evaluation, the proposed study will provide evidence for a sustainable reduction of polypharmacy by enhancing patient-centeredness and patient autonomy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42003273.