title: Obstacles to influenza immunization in primary care.
abstract: BACKGROUND
  General practices undertake annual immunization campaigns to protect susceptible patients against influenza. Many practices, however, do not adopt effective approaches and there is great variation in the immunization rates achieved. This study aimed to assess the attitudes of primary care staff to the annual immunization programme, the obstacles they face, and possible reasons for the wide variation in immunization rates.
  
  
  METHODS
  A semi-structured questionnaire survey of general practice groups in Salford &Trafford during winter 1997-1998 was carried out, a total of 104 practices.
  
  
  RESULTS
  Respondents perceived influenza vaccine to be effective (93.2 per cent), well received by patients (91.7 per cent) and without significant side-effects (83.6 per cent). The annual immunization programme was seen as being necessary (91.8 per cent), cost-effective (76.7 per cent), reducing hospital admissions (82.2 per cent), but very time consuming (64.4 per cent). Practices were more likely to target patients specified in the Chief Medical Officer's guidelines; however, most (98.6 per cent) targeted the over-75s before their inclusion in the guidelines, and many (61.6 per cent) targeted the over-65s. Practices did not always use the most effective methods of contacting patients, primarily relying on posters (97.3 per cent), opportunistic contacts (95.9 per cent) and reminders on prescriptions (83.6 per cent), rather than letters (39.7 per cent) and telephone calls (11.0 per cent). Practices identified several common obstacles to immunization, relating to the cost and administrative burden of the annual immunization programme, difficulty identifying high-risk patients, and public beliefs about influenza and influenza vaccine.
  
  
  CONCLUSIONS
  Although generally positive towards influenza immunization, practice staff differ in their ability to cope with, and the appropriateness of their response to, the pressures of the annual immunization programme. Additional support and co-operation from the Department of Health, Health Authorities and pharmaceutical companies could remove some of the obstacles to immunization of high-risk patients.
authors.affiliation: Department of Public Health, University of Liverpool. timdoran@liverpool.ac.uk
authors.forename: T
authors.initials: T
authors.lastname: Doran
authors.forename: R
authors.initials: R
authors.lastname: McCann
mesh_terms: D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000191:economics / Q000600:supply & distribution; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D017010:Reminder Systems; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D007252:Influenza Vaccines