title: Effectiveness of a co-ordinated nation-wide programme to improve influenza immunisation rates in The Netherlands.
abstract: OBJECTIVE
  To assess t he effectiveness of a nation-widemultifaceted intervention programme involving general practitioners (GPs) on influenza immunisation practice.
  
  
  METHODS
  Pragmatic before-after trial using pre- and post-measurement questionnaires.
  
  
  METHODS
  Random sample of Dutch general practices.
  
  
  METHODS
  During a 2.5-year period (1995-1997) a variety of methods was implemented to enhance physician adoption of the immunisation guideline, including employment of facilitators, information-based methods, small-group consensus meetings, individual instructions and introduction of supportive computer software.
  
  
  METHODS
  Influenza immunisation practice and influenza vaccine uptake.
  
  
  RESULTS
  In 988 practices all influenza vaccination characteristics markedly improved from 1995 to 1997. The most significant changes were found in computerised marking of high-risk patients (from 54% to 82% of practices), computerised selection (41% to 77%) and sending personal reminders (40% to 77%). Vaccine uptake increased from 9% to 16% of the practice population (78% increase, p < 0.001). Uptake was most prominent in urban and single-handed practices and in those with more patients insured through the National Health Service, low GP workload and low baseline uptake.
  
  
  CONCLUSIONS
  Our data suggest that a co-ordinated approach involving primary care physicians can succeed in enlarging the public health impact of a population-based preventive measure.
authors.affiliation: Julius Center for General Practice and Patient Oriented Research, University Medical Center, Utrecht, The Netherlands. E.Hak@med.uu.nl
authors.forename: E
authors.initials: E
authors.lastname: Hak
authors.forename: R P
authors.initials: RP
authors.lastname: Hermens
authors.forename: A W
authors.initials: AW
authors.lastname: Hoes
authors.forename: T J
authors.initials: TJ
authors.lastname: Verheij
authors.forename: M M
authors.initials: MM
authors.lastname: Kuyvenhoven
authors.forename: G A
authors.initials: GA
authors.lastname: van Essen
mesh_terms: D000704:Analysis of Variance; D005194:Family Practice; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007251:Influenza, Human / Q000517:prevention & control*; D009313:National Health Programs / Q000458:organization & administration*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D011446:Prospective Studies; D018709:Statistics, Nonparametric