Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice.
BACKGROUND
Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60% and 70%. Almost all influenza immunisation in the UK is done within general practice. Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies.


OBJECTIVE
To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practices.


METHODS
Randomised controlled trial.


METHODS
Three research general practices within the East London and Essex network of researchers (ELENoR).


METHODS
Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice. The intervention, during October 2000, was a telephone call from the practice receptionist to intervention group households, offering an appointment for influenza immunisation at a nurse-run. clinic Main outcome measures were the numbers of individuals in each group receiving immunisation, and practice costs of a telephone-appointing programme.


RESULTS
intention to treat analysis showed an immunisation rate in the control group of 44%, compared with 50% in the intervention group (odds ratio = 1.29, 95% confidence interval = 1.03 to 1.63). Of the patients making a telephone appointment, 88% recieved immunisation, while 22% of those not wanting an appointment went on to be immunised. In the controlgroup, income generated was 11.35 pounds per immunisation, for each additional immunisation in the intervention group the income was 5.20 pounds. The 'number needed to telephone' was 17.


CONCLUSIONS
Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6% using a simple intervention by receptionists. Immunisation rates in this low-risk group fell well short of the 60% government target. Improving immunisation rates will require a sustained public health campaign. Retaining the item-of-service payments to practices should support costs of practice-based interventions.
Hull
Sally
S
Department of General Practice and Primary Care, Queen Mary College, London. s.a.hull@qmw.ac.uk
Hagdrup
Nicola
N
Hart
Ben
B
Griffiths
Chris
C
Hennessy
Enid
E
D000368:Aged; D001071:Appointments and Schedules; D003365:Costs and Cost Analysis; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000191:economics / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017010:Reminder Systems; D013689:Telephone
D007252:Influenza Vaccines